Management in primary care at the time of a suicide attempt and its impact on care post-suicide attempt: an observational study in the French GP sentinel surveillance system

Abstract

Background: We aimed to describe primary care management at the time of a suicide attempt (SA) and after the SA. Methods: An observational (cross-sectional) study was conducted among 166 sentinel GPs within France (a nongatekeeping country) between 2013 and 2017 for all GP's patients who attempted suicide. Measurements: frequency of patients 1) managed by the GP at the time of the SA, 2) addressed to an emergency department (ED), 3) without care at the time of the SA, and 4) managed by the GP after the SA and factors associated with GP management at the time of and after the SA. Results: Three hundred twenty-one SAs were reported, of which N = 95 (29.6%) were managed by the GP at the time of the SA, N = (70.5%) were referred to an ED, and N = (27.4%) remained at home. Forty-eight (14.9%) patients did not receive any care at the time of the SA and 178 (55.4%) were managed directly by an ED. GPs were more likely to be involved in management of the patient at the time of the SA if they were younger (39.2% for patients < 34 years old; 22.9% for those 35 to 54 years old, and 30.3% for those more than 55 years old p = 0.02) or the SA involved a firearm or self-cutting (51.9%) versus those involving drugs (23.7%); p = 0.006). After the SA, GPs managed 174 patients (54.2%), more often (60%) when they provided care at home at the time of the SA, p = 0.04; 1.87 [1.07; 3.35]. No other factor was associated with management by GPs after the SA.

Nurses’ experiences of suicide attempts in palliative care

“…Michaud et al (2021) illustrate how individuals who have attempted suicide appreciate the nurse's professional involvement in their aftercare, and they also appreciate more meetings and more follow-up calls. Younes et al (2020) mention how GPs become more involved in the individual's care after a suicide attempt. Individuals who attempt suicide place value on staff who are committed, both humanly and professionally (Michaud et al 2021).…”

Trends and characteristics of attempted and completed suicides reported to general practitioners before vs during the COVID-19 pandemic in France: Data from a nationwide monitoring system, 2010–2022

“…For each reported case, GP provide descriptive data. Collected data evolve according to research interests and context [ 27 , 31 , 33 , 34 ]. The data included sociodemographic characteristics, history of previous attempts, the method used for the suicidal act, the vital outcome (whether the patient survived or died), and the characteristics of the last consultation in primary care (date, reasons, exploration, and expression of suicidal ideation).…”

“…Among them, 37.7% reported visiting a doctor or a psychiatrist/psychologist. Another study showed that French GPs were more likely to be involved in the management of the patient at the time of the SA if the patients were younger [ 27 ]. This may have been exacerbated during the pandemic due to hospitals being overwhelmed or the fear of going to the hospital.…”

Secondary mental health service utilisation following emergency department contact for suicidal behaviour: A systematic review

“…In some countries, ED referrals are made primarily to GPs ( Fleischmann et al, 2005 ), and evidence shows that GPs are highly involved in the care of their suicidal patients ( Boffin and Van Casteren, 2018 ). GPs are often the first health professional seen after a suicide attempt ( Younes et al, 2020 ), and they frequently see people within 1 week of hospital discharge following a suicide-related admission ( Gunnell et al, 2002 ). As most studies only documented if an individual had a health service contact, and not the number or types of health service contacts received, the overall level of support and aftercare people received could also not be determined.…”