A retrospective cohort study of clinical characteristics and healthcare contacts in Sweden prior to suicide in individuals with heart disease

Heart diseases are among the leading causes of disease burden worldwide with often a large impact on the lives of the affected individuals. The association between heart disease and depression is well-known and elevated suicide risk has been demonstrated in several types of heart disease. The aim of this study was to investigate what health care contacts individuals with heart disease who died by suicide had in the two years prior to death, compared to those without, and whether signs of mental health problems were recognised and addressed. As a part of a larger project, medical records from all care settings (primary care, hospital records etc.) for the last two years for all individuals who died by suicide in Sweden in 2015 were evaluated, n = 1,179. In this sub-study, we investigated healthcare contacts for the individuals with heart disease, n = 124, and compared these to those without, n = 1,055. We analysed the clinical characteristics of their last visit in all health care settings, and demographic and clinical factors contributing to recognition of depression when outside of psychiatric specialist care. The individuals with heart disease had more healthcare contacts than those without during the last two years before death. During their final week of life, 58% were in contact with health care, compared to 32% for those without (p < .001). The contacts took place primarily in primary care and somatic specialist care. At the last doctor’s visit, 51% had symptoms of depression and/ or anxiety recorded, but less than 25% had an action taken due to this if the visit was in primary care or somatic specialist care. Suicide risk was assessed as elevated in 15%, but only a small proportion of these in primary care (3%) and somatic specialist care (4%). The individuals with heart disease had many healthcare contacts before dying by suicide, especially in primary care and somatic specialist care, yet their mental health problems were not sufficiently identified or treated. This points to a need to improve the recognition and treatment of depression in these settings to support suicide prevention in individuals with heart disease.