Suicide risk after discharge from in-patient psychiatric care: A 15-year retrospective cohort study of individual patient data.

Journal: Journal of affective disorders

Volume: 354

Issue: 

Year of Publication: 

Affiliated Institutions:  Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. Institute of Clinical Biometrics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria. Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical University of Hannover, Hannover, Germany. Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. Electronic address: andreas.wippel@meduniwien.ac.at.

Abstract summary 

Suicide rates are known to be increased in patients after discharge from in-patient psychiatric treatment. However, evidence on risk factors for suicide within this patient group are contradictory. Thus, this study aims to investigate suicide after discharge from a sizeable psychiatric care facility to determine associated risk factors.Data on individual patient level from a 15-year single-centre cohort were linked to data from the national death registry and cumulative incidence rates were calculated applying competing risk models. Independent variables included the patients' sex, age at admission, diagnosis, and length of admission. For each of these factors, subdistribution hazards ratios were calculated using a Fine-Gray model.In our sample of 18,425 discharges, when using patients with the diagnosis of substance-use-disorders as a comparator, a significant increase in hazard of post-discharge suicide for male sex (SHR = 1.67;p = 0.037) as well as the discharge diagnoses of affective disorders (SHR = 3.56;p = 0.017) and neurotic stress and somatoform disorders (SHR = 3.73;p = 0.024) were found. Interestingly, the hazard of suicide significantly decreased in more recent discharges (SHR = 0.93;p = 0.006). No statistically significant association of the length of admission with the suicide risk was found (SHR = 0.98;p = 0.834).Suicides may have been mis-identified as natural death in the national death register.Male sex and distinct diagnoses were associated with an increased risk for suicide after discharge from a psychiatric care institution. The markedly increased suicide risk within this patient collective highlights the need for the development of tools to assess suicidal behaviour in this group of patients reliably.

Authors & Co-authors:  König Gleiss Vyssoki Harrer Trojer Groemer Weber Glahn Sommer Listabarth Wippel

Study Outcome 

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Citations : 
Authors :  11
Identifiers
Doi : 10.1016/j.jad.2024.03.046
SSN : 1573-2517
Study Population
Male
Mesh Terms
Other Terms
Mental health services;Post-discharge suicide;Suicide;Tertiary psychiatric care
Study Design
Cohort Study,Cohort Study,Cohort Study,Cohort Study,Cohort Study,Cohort Study
Study Approach
Country of Study
Publication Country
Netherlands