Medical records review study

The review was conducted using comprehensive templates developed by researchers in Lund in collaboration with the Swedish Psychiatric Association. The templates are based on the Swedish Psychiatric Association’s guidelines for the care of individuals at risk of suicide. The templates include questions about care within psychiatry, somatic specialist care, and primary care, and contacts with other authorities. The medical records review study is a nationally coordinated project where NASP has been responsible for data collection in Stockholm County. 

Documented healthcare consumption, complaints, and psychosocial stressors 

Most of those who died by suicide in 2015 in Stockholm County had contacted healthcare within two years before their death, and just over half within the last month. Depressive complaints (58.1%) were the most common issue noted in medical records at the last psychiatric visit, while pain was the most common issue in both primary care (35.8%) and somatic specialist care (50%). For more than half, there were notes about relationship difficulties (57.6%). Common notes also included loneliness (36.4%), bullying, discrimination, and homelessness (33.3%), and problems with work/school (31.8%). 

Psychosocial factors documented among young people aged 0–24 in Stockholm 

The study shows that among the 27 young people (0–24 years) who committed suicide in Stockholm in 2015, almost all had sought care within two years before their death, and over half had been in contact with healthcare in the last four weeks. 

Almost half of the group had been noted with relationship problems or problems at school/work, and more than one-third had substance abuse issues. Also, almost half of these young people had been subjected to violence, threats, or abuse. In other parts of the country, however, barely one in four young people had the same documented experience. Despite similar patterns in the documented psychosocial stressors among young people nationally, a larger proportion of young people in Stockholm had these stressors noted in their records, which may be due to differences in psychosocial burden or in how records are kept. It should be noted that psychosocial difficulties are likely underreported in records, especially outside of psychiatry. 

Psychosis and suicide 

Individuals with a psychosis diagnosis constitute a high-risk group for suicide, with 10–15% dying by suicide. In the journal review study, 17 out of 230 individuals in Stockholm County had psychosis issues, and all had healthcare contacts, primarily within psychiatry, in the year before the suicide. Five individuals had been discharged from inpatient care within six weeks before the suicide, and six had parallel contacts with primary care or somatic specialist care within three months before the suicide. Despite many having documented psychosocial difficulties, these were rarely addressed in care or treatment plans. Only three out of seventeen had contact with specialized psychosis care, and none had a documented coordinated care plan with social services or other healthcare providers.