New report highlights healthcare contacts prior to suicide in Stockholm county
A new report from the National centre for suicide research and prevention (NASP) at Region Stockholm and Karolinska Institutet shows that 33 of the 230 people who died by suicide in Stockholm County in 2015 had been in contact with healthcare services during the last 24 hours of their lives. The report provides insights into the types of healthcare contacts these individuals had, the problems documented in their medical records, and the support interventions that were ongoing.
Of the 230 people who died by suicide in Stockholm County in 2015, 33 had contact with healthcare services during their final 24 hours, and for 20 of them, the contact occurred on the same day as their death. In this sub-study, medical records were reviewed retrospectively over a two-year period to examine where these 33 individuals sought care, what concerns were documented, and what interventions were underway.
Most individuals, 21 out of 33, had their final healthcare contact within psychiatric services. At the same time, just over one-third had contact exclusively with primary care or specialist somatic healthcare services.
“By studying the healthcare contacts people had during their final day of life, we can learn more about how individuals at risk of suicide seek care, what needs they express, and which warning signs are documented. This knowledge is important for psychiatry, primary care, and specialist somatic healthcare in the continued work of suicide prevention,” says Inga-Lill Ramberg, PhD, affiliated with NASP and the Department of Learning, Informatics, Management and Ethics at Karolinska Institutet, and an administrator at Region Stockholm.
Frequent and recurrent healthcare contacts
The review of medical records showed that healthcare contacts were often extensive. Individuals who had contact with psychiatric services typically had a large number of previous healthcare visits, and several had been admitted to psychiatric inpatient care. Their final contacts most often concerned already known problems rather than newly emerging issues.
Depression and anxiety were the most commonly documented mental health problems within psychiatric care. In somatic healthcare, pain and fatigue were the most frequently described concerns. Medical records also often contained information about psychosocial difficulties, particularly relationship problems, threats, and violence.
Different healthcare patterns among younger and older individuals
A comparison between the two youngest and the two oldest individuals revealed notable differences. The younger individuals had extensive contact with psychiatric services and more documentation regarding previous suicide attempts, suicide risk assessments, and ongoing support interventions. By contrast, the two older individuals had only been in contact with somatic healthcare services during the two years preceding their deaths. Documentation was also more limited and more frequently focused on physical symptoms such as fatigue.
Notes on suicide risk less common outside psychiatry
For most individuals whose final contact was within psychiatric services, medical records contained notes about previous suicide attempts, self-harm, or assessed suicide risk. Such documentation was considerably less common among individuals whose last contact was within primary care or specialist somatic healthcare.
“Primary care is the frontline of the healthcare system and serves a large proportion of the population. For older individuals at risk of suicide, it may be their only point of contact with healthcare services. Healthcare professionals therefore need the conditions and competence to recognise mental ill-health and ask about suicidal thoughts, even among people who primarily seek care for physical complaints, particularly when those complaints involve fatigue and pain,” says Inga-Lill Ramberg.
The report also raises issues related to coordination of care. One observation was that coordinated individual care plans (SIP) were used relatively infrequently, despite the fact that many individuals had complex needs involving multiple service providers.
The study cannot determine which factors triggered the individual suicides. However, the review of medical records contributes valuable knowledge about healthcare contacts, documented concerns, and life circumstances during the final period of life, which can support ongoing suicide prevention efforts.
Publication
Ramberg, I-L, Karlsson, L, Stefenson, A, Wasserman, E, Journalgranskningsstudie – Självmord i Stockholms län 2015. Ett sista rop på hjälp? Nationellt centrum för suicidforskning och prevention, Karolinska Institutet och Region Stockholm; 2026. Rapport 2026:03
Key findings
- 230 people died by suicide in Stockholm County in 2015.
- 33 of these individuals had contact with healthcare services during their final 24 hours of life.
- For 20 of the 33 individuals, the healthcare contact occurred on the same day as the death.
- Medical records for these 33 individuals were reviewed retrospectively over a two-year period.