Risk of suicide according to level of psychiatric treatment: a nationwide nested case–control study

Hjorthøj, Carsten; Madsen, Trine; Agerbo, Esben; Nordentoft, Merete

doi:10.1007/s00127-014-0860-x

Cited by 91 publications

(74 citation statements)

References 28 publications

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“…This risk varies across different clinical populations, with psychiatric inpatients showing the highest risk of suicide within the next year. 13 The risk of suicide seems to be greatest during the first few months after diagnosis across all mental disorders. [16][17][18] The risk of suicide is also influenced by treatment factors, which will be described later in the review.…”

Section: Epidemiologymentioning

confidence: 99%

Suicide risk assessment and intervention in people with mental illness

Bolton

Gunnell

Turecki

2015

BMJ

237

188

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Suicide is the 15th most common cause of death worldwide. Although relatively uncommon in the general population, suicide rates are much higher in people with mental health problems. Clinicians often have to assess and manage suicide risk. Risk assessment is challenging for several reasons, not least because conventional approaches to risk assessment rely on patient self reporting and suicidal patients may wish to conceal their plans. Accurate methods of predicting suicide therefore remain elusive and are actively being studied. Novel approaches to risk assessment have shown promise, including empirically derived tools and implicit association tests. Service provision for suicidal patients is often substandard, particularly at times of highest need, such as after discharge from hospital or the emergency department. Although several drug based and psychotherapy based treatments exist, the best approaches to reducing the risk of suicide are still unclear. Some of the most compelling evidence supports long established treatments such as lithium and cognitive behavioral therapy. Emerging options include ketamine and internet based psychotherapies. This review summarizes the current science in suicide risk assessment and provides an overview of the interventions shown to reduce the risk of suicide, with a focus on the clinical management of people with mental disorders.

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Section: Epidemiologymentioning

confidence: 99%

Suicide risk assessment and intervention in people with mental illness

Bolton

Gunnell

Turecki

2015

BMJ

237

188

View full text Add to dashboard Cite

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“…Overall, psychiatric inpatients have a rate of 147 suicides per 100,000 patient-years [14], which is almost 13 times higher than the annual global age-standardized suicide rate of 11.4 per 100,000, provided by the World Health Organization (WHO) [25]. While acknowledging that not all people with mental disorders receive treatment, a recent study found that the risk of suicide varies according to the level of mental health care received; people admitted as psychiatric inpatients within the last year had a 44-fold higher risk of suicide than the general population, whereas those receiving outpatient care or psychiatric medication had an 8- or 6-fold higher risk, respectively [15]. It would probably be wrong to conclude that the treatment causally increases risk of suicide; presumably, effective treatment would decrease the risk of suicide compared to a scenario in which that person did not receive treatment.…”

Section: Relative Riskmentioning

confidence: 99%

“…The risk of suicide in psychiatric patients varies over time, and an excessive risk of suicide has been found in patients who are currently admitted or who have been recently discharged from a psychiatric hospital [14,15,16,17]. Although suicides among hospitalised psychiatric patients are rare, it is considered to be a public health problem [18].…”

Section: Introductionmentioning

confidence: 99%

Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide—An Overview

Madsen

Erlangsen

Nordentoft

2017

IJERPH

Self Cite

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People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools.

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“…Observational cohort studies have also produced inconsistent results regarding the association of both medical and psychiatric inpatient admission with risk of repeat self-harm and suicide [12, 13]. However, a recent study suggested psychiatric admission in particular may be associated with an increased risk of suicide [14]. These data have led to the suggestion that this association may be causal [15], but the limitations of confounding that are inherent in observational analysis mean these results are difficult to interpret [16].…”

Section: Introductionmentioning

confidence: 99%

Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation

Carroll

Corcoran

Griffin

et al. 2016

Soc Psychiatry Psychiatr Epidemiol

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PurposeSelf-harm patient management varies markedly between hospitals, with fourfold differences in the proportion of patients who are admitted to a medical or psychiatric inpatient bed. The current study aimed to investigate whether differences in admission practices are associated with patient outcomes (repeat self-harm) while accounting for differences in patient case mix.MethodsData came from the National Self-Harm Registry Ireland. A prospective cohort of 43,595 self-harm patients presenting to hospital between 2007 and 2012 were included. As well as conventional regression analysis, instrumental variable (IV) methods utilising between hospital differences in rates of hospital admission were used in an attempt to gain unbiased estimates of the association of admission with risk of repeat self-harm.ResultsThe proportion of self-harm patients admitted to a medical bed varied from 10 to 74 % between hospitals. Conventional regression and IV analysis suggested medical admission was not associated with risk of repeat self-harm. Psychiatric inpatient admission was associated with an increased risk of repeat self-harm in both conventional and IV analyses. This increased risk persisted in analyses stratified by gender and when restricted to self-poisoning patients only.ConclusionsNo strong evidence was found to suggest medical admission reduces the risk of repeat self-harm. Models of health service provision that encourage prompt mental health assessment in the emergency department and avoid unnecessary medical admission of self-harm patients appear warranted. Psychiatric inpatient admission may be associated with a heightened risk of repeat self-harm in some patients, but these findings could be biased by residual confounding and require replication.

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Risk of suicide according to level of psychiatric treatment: a nationwide nested case–control study

Abstract: Psychiatric admission in the preceding year was highly associated with risk of dying from suicide. Furthermore, even individuals who have been in contact with psychiatric treatment but who have not been admitted are at highly increased risk of suicide.

Cited by 91 publications

References 28 publications

Suicide risk assessment and intervention in people with mental illness

Suicide risk assessment and intervention in people with mental illness

Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide—An Overview

Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation

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