Use of primary health care services prior to suicide in the Norwegian population 2006–2015

Hauge, Lars Johan; Stene‐Larsen, Kim; Grimholt, Tine K.; Øien-Ødegaard, Carine; Reneflot, Anne

doi:10.1186/s12913-018-3419-9

Cited by 33 publications

(34 citation statements)

References 24 publications

(30 reference statements)

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“…They probably do not reach those most at risk of financial problems. Lower representation of men in the GP population is in line with previous research [19][20][21] and with research on younger people's healthseeking behaviour [22,23].…”

Section: Discussionsupporting

confidence: 88%

Should GPs ask patients about their financial concerns? Exploration through collaborative research

Ose

Kaspersen

et al. 2020

Scandinavian Journal of Primary Health Care

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Objective: Health services should arguably be concerned about the financial situation of patients since health problems can cause financial concerns, which in turn can cause health problems. In this study, we explored the role of the general practitioner (GP) as a potential early discoverer of financial problems who can refer at-risk patients to financial counselling services. Design: A collaborative health service research experiment. For four weeks, GPs asked their patients predefined questions about financial concerns and health, by anonymous data mapping. GPs shared their experiences with the researchers after the experiment. Setting: One GP office in Norway. Subjects: A total of 565 patients were included in data mapping by 8 GPs. Main outcome measures: Patient prevalence data and GPs experimental data of patients' health problems that caused financial concerns and financial concerns that affected patients' health. Results: Of 565 GP patients, 11% (n ¼ 63) indicated that they had health problems causing them financial concerns, or vice versa; 9% of patients reported health problems causing financial concerns and 8% of patients reported financial concerns that affected their health. Through the data mapping experiment GPs became aware of financial concerns of their patients and by this expanded and improved their therapeutic toolbox. Several months after the experiment the GPs reported that more patients received financial counselling since the GPs asked their patients about financial problems more often than before and because the patients had heard that GPs cared about such problems. Conclusion: Our results suggest that GPs can be early discoverers of financial problems interacting with their patients' health. When there are no clear medical explanations for the health problems that prompted the consultation, the best therapy may thus be financial counselling. KEY POINTS Many people live on the edge of financial ruin and struggle to keep track of their finances, but limited research exists that investigates associations between finance and health. In a collaborative health services research experiment 11% of the patients at a Norwegian GP office had health problems that caused them financial concerns, or vice versa. GPs found it helpful to ask patients about their financial concerns when no clear medical explanations for their health problems was found. Then free financial counselling services could be offered.

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Section: Discussionsupporting

confidence: 88%

Should GPs ask patients about their financial concerns? Exploration through collaborative research

Ose

Kaspersen

et al. 2020

Scandinavian Journal of Primary Health Care

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“…Several studies report that healthcare use in the year and months prior to suicide is common [6–9]. While approximately two out of 10 have been in contact with mental healthcare within a month of suicide, more than four out of 10 have consulted the primary healthcare services [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Use of prescription medication prior to suicide in Norway

Reneflot

Kaspersen

Hauge

et al. 2019

BMC Health Serv Res

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Background The use of psychotropic medications in relation to mental disorders is considered central to preventing suicide. However, few studies have addressed prescription patterns at different time points within the last year prior to suicide and compared these with those of the general population. Methods We use data covering the period from 2010 to 2011 from the Norwegian Cause of Death Registry and the Norwegian Prescription Database to examine dispensing patterns of prescription medication within 12 months and within 30 days of suicide. Our data includes all registered suicides in Norway among individuals aged 15 years and older in 2011 ( n = 594), 434 men and 160 women. Dispensing of prescription medication in the general population (n ≈ 4 million) are used for comparison. Results Dispensing of any prescription medication were high and varied from 95.6% for females and 83.2% for males within 12 months of suicide, to 64.4% for females and 47.2% for males within 30 days of suicide, respectively. The percentages with dispensed prescription medication increased with age. A similar sex and age pattern was observed for the dispensing of psychotropic medications. Within the last 30 days, close to one in two were dispensed psychotropic medications. The dispensing of antidepressants, hypnotics and sedatives was more common than the dispensing of other categories of psychotropics. The percentages with dispensed prescription medication among the population controls were considerably lower, in particular the dispensing of psychotropics. Conclusion Dispensing of prescription medications, including psychotropic medications, is common prior to suicide. The percentage with dispensed prescription medication increases with age and are higher for females than for males.

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“…The literature shows, that up to 80% of suicide victims visited their GP in the year prior to their suicide and almost half even a month before (19,20). However, GPs often did not recognize the symptoms of a potential suicide risk in their patients' behaviour (21,22). Suicide prevention strategies in primary care aim at training and increasing the awareness of GPs.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of brief screeners for suicidal behaviour in primary care

Lukaschek¹,

Frank²,

Halfter

et al. 2019

Preprint

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Background As primary contacts, general practitioners can play a pivotal role in identifying suicidal behaviour in their patients. Therefore, actively screening patients at risk should be an integral part of primary care services. We summarized the available studies reporting diagnostic accuracy of short screening instruments for suicidal behaviour in primary care or the general population in a narrative synthesis. A brief instrument could improve the identification of vulnerable patients and their subsequent referral to mental health specialist. Methods: The following databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched in January 2019 without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. The authors followed the PRISMA extensions for Diagnostic Test Accuracy Studies. Results Six relevant studies fulfilled all criteria and were included. Each index test was only assessed in a single study. The studies each used different reference standards. Target conditions defined across the different studies were suicidal ideation, suicide plan, suicide attempt, and suicidal behaviour in general. The diagnostic accuracy measurements sensitivity and specificity had a wide range (sensitivity: 26% - 100%, specificity: 64% - 99%). Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 80% and specificity of 50% with a moderate to high GRADE rating was achieved by six of nine index tests. Conclusions Overall, only a few studies assessed screening instruments for suicidal behaviour in primary care or the general population. The identified studies were heterogeneous regarding sample size, index test, and reference standard. Since each index test was only evaluated in one study, their interpretability is limited. No uniform gold standard was found, as the studies identified used different reference standards. Although there are other promising short questionnaires, the majority has not yet been evaluated in primary care setting or the general population with regard to their diagnostic accuracy. A final assessment should always be based on the clinical judgement of the attending physician. Registration The study protocol was registered at PROSPERO (ID: CRD42019122173).

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Use of primary health care services prior to suicide in the Norwegian population 2006–2015

Cited by 33 publications

References 24 publications

Should GPs ask patients about their financial concerns? Exploration through collaborative research

Should GPs ask patients about their financial concerns? Exploration through collaborative research

Use of prescription medication prior to suicide in Norway

A systematic review of brief screeners for suicidal behaviour in primary care

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