Suicide‐related behavior after psychiatric hospital discharge: implications for risk assessment and management

Abstract

Suicide-related behavior (SRB), including suicide attempts and instrumental SRB, occurs far more often than completed suicide and exacts a toll on patients, their loved ones, and society. Nevertheless, few prospective studies of SRB have been conducted. In this study, 954 patients were interviewed in a psychiatric hospital and then followed for one year after discharge. During this one-year period, nearly one-quarter of patients (23%) engaged in SRB, with the rate of suicide attempts (18%) three times greater than the rate of instrumental SRB (5%). Risk factors for SRB were demographic (White ethnicity, female gender), clinical (past SRB, depression, impaired functioning), and contextual (unemployment, large social networks). In contrast with other studies, there was no "peak" in the risk of SRB shortly after hospital discharge. Instead, patients' rate of SRB was relatively constant over the one-year follow-up. Implications for risk assessment and management in acute inpatient settings are discussed.

Suicide Risk and Acute Psychiatric Readmissions: A Prospective Cohort Study

“…An increased risk was also found in patients who had a history of psychiatric hospitalisation before their index admission and during readmissions after their index discharge. These findings are supported by two previous studies (33,100). The most plausible explanation for these findings is that those patients considered to be at high risk for suicidal behaviour were given more frequent outpatient consultations and/or were returned to psychiatric inpatient care.…”

“…This was a registerbased study of all patients discharged during 1 year from all psychiatric hospitals in England, and outcome data included somatic and psychiatric hospital admissions due to self-harm within 12 months after psychiatric discharge (17). In addition, the literature search identified four interview studies of unselected cohorts, which provided data on self-reported self-harm after discharge from psychiatric hospitals (33,(66)(67)(68). Five interview studies included data on selfreported self-harm after discharge of patients whose psychiatric index admission was related to self-harm (irrespective of suicide intent) (14,15,(69)(70)(71).…”

“…The corresponding risk was nearly threefold in patients whose PAU admissions were related to suicide attempt or suicidal ideation. Since non-suicidal self-harm has been suggested to function as a means to regulate emotions, relieve distress, and communicate with, or elicit help from, others (46), it has often been dismissed as manipulative and hence is considered less serious than suicide attempt (27,33). Therefore, findings from Study II related to the non-suicidal self-harm variable may support those from a previous study (97), which found no significant difference between the objective lethality of non-suicidal self-harm and that of suicide attempt.…”

“…The only study (17), which has presented data on somatic hospital admissions due to self-harm after psychiatric discharge in an unselected patient cohort found that 6.5% of all patients discharged over a year were readmitted to somatic or psychiatric hospitals due to self-harm within 12 months after discharge. Self-harm, whether suicidal or non-suicidal, has a profound impact on patients and their families (18), health-care providers, and society at large (19).…”

“…For example, parasuicide, unsuccessful suicide, deliberate self-harm, self-harm, non-fatal selfharm, suicide attempt, suicidal acts, suicidal behaviour, instrumental suicidal behaviour, non-suicidal self-injury, non-suicidal self-harm, and self-mutilation (33)(34)(35). Such diversity of terms and definitions complicate both clinical practice and research.…”