Background

Globally, suicide is a significant public health concern with over 700,000 people worldwide dying by suicide each year.1 A range of factors, especially mental disorders, which include substance use disorders and adverse life events, can increase the risk of suicide.2 A study examining psychosocial and psychiatric factors and service engagement among people who died by suicide compared with a living control group in the Cork region (Cork City and County ) was published in 2022.3

Methods

A case–control study using multiple sources, including review of coronial files and structured interviews with family members and general practitioners (GPs), was conducted. Data on 132 consecutive cases of suicide or probable suicide were extracted from coronial files for deaths which occurred between June 2014 and September 2017. The control group included 53 living people who attended the same GP practices as the deceased. Interviews were conducted with 35 family informants and 53 living control participants. GPs completed questionnaires for 60 suicide deaths and 27 control participants.

Results

The 132 people who died by suicide and the 53 living control participants were predominantly male. A similar proportion of the people who died by suicide and the control participants had a history of physical, emotional, or sexual abuse reported. People who died by suicide were more likely than control participants to be single, living alone, and unemployed. People who died by suicide were significantly more likely than control participants to:

• Have a psychiatric diagnosis (60% vs 18.5%)
• Have a depressive illness (36.7% vs 14.8%)
• Have a history of violent behaviour (45.7% vs 22.6%)
• Experienced legal troubles (31.4% vs 11.3%).

The majority of people who died by suicide and the majority of control participants had contacted a GP in the year prior to death; however, a higher proportion (23.3%) of people who died by suicide had 10 or more consultations during the year prior to death compared with control participants (3.7%). A higher proportion of people who died by suicide had a history of alcohol misuse (31.4%) compared with control participants (17%). Also, a higher proportion of people who died by suicide had a history of drug misuse (22.9%) compared with the control participants (9.4%).

While none of the control group had a history of previous self-harm, one-half (50%) of people who died by suicide had previously self-harmed. Over one-quarter (26.7%) of people who died by suicide had previously received treatment as a psychiatric inpatient compared with 3.7% of control participants. No psychiatric diagnosis was reported for 40% of people who died by suicide.

Conclusion

Referencing existing international research, the study reports that training primary care doctors in depression recognition and appropriate treatment, which may include pharmacotherapy in combination with psychosocial interventions, can help prevent suicide.

Primary care providers should be adequately resourced to deliver multidisciplinary interventions to engage, assess, and treat patients at risk of suicide, targeting those who present very frequently, those with a history of self-harm or substance misuse, and those with psychological presentations. 

1  World Health Organization (2021) Suicide worldwide in 2019: global health estimates. Geneva: World Health Organization. Available online at: https://www.who.int/publications/i/item/9789240026643

2  Hawton K and Pirkis J (2017) Suicide is a complex problem that requires a range of prevention initiatives and methods of evaluation. Br J Psychiatry, 210(6): 381–383.

3 McMahon EM, Greiner BA, Corcoran P, Larkin C, Leitao S, McCarthy J, et al. (2022) Psychosocial and psychiatric factors preceding death by suicide: a case–control psychological autopsy study involving multiple data sources. Suicide Life Threat Behav, 52(5): 1037–1047. https://www.drugsandalcohol.ie/36618/