The role of primary care in the prevention of suicide and accidental deaths among young men: an epidemiological study.

Abstract

BACKGROUND: Despite generally falling mortality and suicide rates, among young men the rates of violent death from accidents and suicide continue to rise. Most research has focused upon suicide, and the potential for effective interventions, particularly in primary care, remains controversial. AIMS: To compare health service contacts prior to suicidal and accidental deaths among young men. DESIGN OF STUDY: Examination of inquest data, postmortem and toxicology reports, and general practitioner (GP) and hospital records. SETTING: All sudden, unexpected, violent or unnatural deaths involving young men aged between 15 and 39 years and reported to the four coroner's offices of Merseyside and Cheshire during 1995. METHOD: We compared data on the timing and nature of final GP contacts before death among young men with a verdict of accident or misadventure and suicide or undetermined death. RESULTS: Out of a total of 268 violent deaths, 130 received verdicts of accident/misadventure and 97 received verdicts of suicide/undetermined death. Information on the final contact with a GP was available for 172 deaths. Although there was a significant difference between the proportion of suicide cases (56%) and that of cases of accidental death (41%) who had seen their GP during the 3 months before death, this was not significant at 1 month (38% versus 30%, respectively). Suicide cases were more likely to have seen a mental health professional at some time (27% for suicides versus 13% for accidental deaths). CONCLUSION: These findings confirm that relatively few young men consult their GP during the period before death from suicide or accidents. Prevention strategies must extend beyond suicide risk assessment, and consider ways to encourage young men to consult GPs when they are experiencing emotional distress or problems related to mental health or substance misuse.