Treatment pathways for suicide victims and suicide bereaved

Suicide is a public health problem. Despite continued efforts, including two action plans for suicide prevention during the last two decades, suicide rates have not declined. Each year, about 650 Norwegians die by suicide. For each suicide there are numerous suicide bereaved. Prevention strategies have so far focused on the role of the specialist mental health care services and the treatment of mental disorders, whereas the role of the primary health care service has received less attention. More than 80 percent of suicide victims have been in contact with GPs in primary care within a year of the suicide, suggesting a high potential for suicide prevention. Little is known about the treatment and follow-up in the health care and welfare services prior to suicide. Studies indicate that the quality of the treatment varies, and only a minority of municipalities in Norway have structural systems for the treatment and follow-up of persons at risk of suicide. Studies on health care service use and follow-up among the suicide bereaved are lacking, despite that over 80 percent of the suicide bereaved are in need of follow up after the loss. The primary goal of this project is to examine the role of the health care and welfare services in preventing suicide and in the follow-up of the suicide bereaved. We will also study geographical differences in treatment prior to suicide and in the follow-up of the suicide bereaved. Both register data and qualitative interviews with the suicide bereaved and with professional in the health care services will be used. A special focus will be on the GPs coordinating role. We will also study individual treatment pathways and explore how different pathways are related to individual factors and to factors relating to the health care service. So far, we have found that contact with GPs in the primary health care prior to suicide is frequent in both sexes and across most age groups. Younger males show the overall lowest rates of contact. Moreover, immigrants have less contact with primary health care services prior to suicide than the majority population. With regards to the suicide bereaved, we have observed an increase in contact with primary health care both prior to and following the loss of a parent. The contact rate prior to the loss were less for boys than for girls. Among adult suicide bereaved we have also found an increased risk of non-employment after the loss and this effect was strongest for women.

Despite continued efforts, including two action plans for suicide prevention, suicide remain a significant public health problem with consequences well beyond the lives lost. Prevention strategies have so far mainly focused on the role of the specialist mental health services, whereas the role of primary health care has received less attention. Studies indicate that the quality of the treatment received varies and only a minority of the municipalities in Norway have structural systems for treatment and follow up of suicidal patients and the suicide bereaved. A large proportion of suicide victims have been in contact with primary health care close to the time of suicide, which suggests a high potential for suicide prevention, but little is known about the treatment and follow up they have received. Studies on contact rates and treatment pathways for suicide bereaved are completely lacking, in spite of over 80% of suicide bereaved needing help after the loss. In this project we aim to explore the treatment and user pathways within the health care and welfare sectors among suicide victims and the suicide bereaved. By identifying factors that either optimise or hinder healthy outcomes the project is likely to improve treatment and prevent suicides. To address the project’s research questions, we will make use of large registry linkages, and complement this information with qualitative data from focus-group interviews. To ensure a high value return to parties involved in suicide prevention, the project is developed and will be executed in close collaboration with the user organisations.