The potential iatrogenic effects of psychiatric hospitalization for suicidal behavior: A critical review and recommendations for research.

Abstract

Suicide rates have risen in the United States, and there has been a simultaneous, nearly ubiquitous decrease in services provided on psychiatric inpatient units (e.g., shorter stays, almost exclusive emphasis on crisis management). Despite limited research demonstrating its efficacy for reducing suicide risk, inpatient hospitalization remains the treatment of choice (and often legally mandated) for highly suicidal individuals. In this review, we discuss the sometimes-confusing guidelines providers follow concerning psychiatric hospitalization for suicidal individuals. We then highlight the considerable evidence of heightened suicide risk and other negative outcomes during and immediately following hospitalization. Finally, we propose critical research directions to rigorously evaluate whether psychiatric hospitalization is iatrogenic, at least for some individuals. Such research has far-reaching implications for practice and policy. Public Health Significance StatementInpatient psychiatric hospitalization is a common, expected, and often legally required treatment for suicidal individuals; however, there is limited research on whether hospitalization actually reduces suicidal behavior. In this review, we summarize national and international evidence suggesting an increased risk for suicide and other negative outcomes during and following psychiatric hospitalization. We recommend crucial research that is necessary to determine whether such hospitalization is harmful, at least for some individuals.

From everyday life predictions to suicide prevention: Clinical and ethical considerations in suicide predictive analytic tools

“…One area that is of particular interest is the potential iatrogenic effects of psychiatric hospitalization for suicidal behavior. According to a recent review, while psychiatric hospitalization remains the standard of care for handling acute suicide risk, the empirical support for its efficacy is limited and potential negative psychological and functional consequences such as humiliation and coercion cannot be overlooked (Ward‐Ciesielski & Rizvi, 2020). The consideration of these potential negative consequences is especially important when the psychiatric hospitalization is involuntary and/or involved law enforcement.…”

Identifying harmful therapies: Setting the research agenda.

“…Ward-Ciesielski and Rizvi (2020) focus on provocative questions about the potential for negative effects after inpatient hospitalization for suicidal behaviors. Although inpatient hospitalization is often utilized to keep people safe, these authors point to suggestive data highlighting greater risk of suicide during and shortly after psychiatric hospitalization.…”

Risk management in dialectical behavior therapy: Treating life-threatening behaviors as problems to be solved.

“…Remaining in this environment creates new learning opportunities for clients to experience these behaviors (e.g., adaptive coping) as effective in eliciting help. Hospitalization often prevents this new learning from occurring, and furthermore, there is little evidence that hospitalization is an effective strategy for reducing the likelihood of future suicide attempts (Ward-Ciesielski & Rizvi, 2021). Ultimately, the goal of DBT is to help the client build a life worth living such that they no longer view suicide or other life-threatening behaviors as a solution to their problems.…”