Quantification of healthcare utilization and psychopharmacological treatment in relation to the timing of suicide attempts in patients with common mental disorders: An analysis of big claims data of Austria
Common mental disorders (CMDs) are prevalent and risk factors of suicidal behavior. Knowledge on the timing of healthcare contacts and of psychotropic treatment of patients with and without suicide attempt, and how psychotropic treatment relates to subsequent risk of re-hospitalization is needed to inform personalized medicine and healthcare planning.
Administrative claims data of 22,276 CMD patients with inpatient care between January 1st, 2006 and December 31st, 2011 was used. Suicide attempters (cases, n=616) and non-attempters (controls, n=21,661) were compared regarding their timing of specific healthcare contacts and dispensed dosages of medication. A cluster analysis identified patterns in psychotropic treatments in suicide attempters. Associations with subsequent re-hospitalization for mental disorders were analyzed with regression analysis.
Contacts with general practitioners (GPs) peaked around diagnosis but were lower for attempters than non-attempters +/-0.5 years around the diagnosis (MD of contact probabilities=-0.054, 95% Confidence Interval [CI]: males: -0.073 – -0.035 p<0.0001; females: MD=-0.045, CI -0.060 – -0.030, p<0.0001). Regarding psychiatrists, female but not male attempters had markedly increased contact probabilities after the attempt compared to non-attempters (MD=0.015, CI 0.0087-0.021, p<0.0001). Treatment by psychotherapists and psychologists typically occurred after the suicide attempt. A cluster of attempters with long-term benzodiazepine exposure had an increased risk of re-hospitalization (odds ratio 2.4, CI 1.1-5.5).
Gatekeeper training of GPs to improve referral to specialist care, and earlier access to psychotherapeutic/ psychological treatment is needed. Suicide attempting CMD patients with sustained benzodiazepine use are at risk of poor prognosis, raising questions about over-treatment with this substance.
T. Niederkrotenthaler, E. Mittendorfer-Rutz, S. Thurner, P. Klimek, Quantification of healthcare utilization and psychopharmacological treatment in relation to the timing of suicide attempts in patients with common mental disorders: An analysis of big claims data of Austria (in review)