Wednesday, September 21, 2016

Depressed Patients May Be At Highest Risk of Suicide Following Hospital Discharge

Patients recently discharged from psychiatric hospitals for the treatment of depressive disorders and bipolar disorder may be at the greatest short-term risk of suicide, particularly if they appear to have had little contact with the health care system for months before their hospitalization, according to a study published today in JAMA Psychiatry.

“Knowledge of which mental disorders … put adults at highest short-term risk for suicide after psychiatric hospital discharge might shed light on the mechanisms of acute risk for suicide and guide interventions to prevent suicide,” lead author Mark Olfson, M.D. (pictured left), of Columbia University Medical Center and colleagues wrote.

Olfson and colleagues used Medicaid claims data from January 1, 2001, to December 31, 2007, to examine suicide risk during the first 90 days after inpatient hospital discharge for adults aged 18 to 64 with a diagnosis of a mental disorder (depressive disorder, bipolar disorder, schizophrenia, substance use disorder, and other mental disorders). This risk was then compared with the short-term suicide risk of inpatients with a diagnosis that was not a mental disorder. A total of 370 deaths from suicide took place during the study period.

Based on an analysis of more than 1.8 million people—including 770,642 adults with mental disorders—the authors found that short-term suicide rates in the groups of adults with depressive disorder (235.1 per 100,000 person-years), bipolar disorder (216.0 per 100,000 person-years), schizophrenia (168.3 per 100,000 person-years), substance use disorder (116.5 per 100 000 person-years), and other mental disorders (160.4 per 100,000 person-years) were higher than the rates in the inpatients who were not diagnosed with a mental disorder (11.6 per 100,000 person-years) or the U.S. general population (14.2 per 100,000 person-years).

Additional analyses showed that the 90-day rate of suicide was nearly twice as high for men as women. Psychiatric inpatients who did not receive any outpatient health care in the six months prior to hospitalization were also found to be at increased risk of suicide.

“These patterns suggest that complex psychopathologic diagnoses with prominent depressive features, especially among adults who are not strongly tied into a system of care, may pose a particularly high risk,” the authors wrote. “As with many studies of completed suicide, however, the low absolute risk for suicide limits the predictive power of models based on clinical variables. These constraints highlight the critical challenge of predicting suicide among recently discharged inpatients based on readily discernible clinical characteristics.

In a related editorial, Merete Nordentoft, D.M.Sc., and colleagues wrote, “Psychiatric patients should not be considered cured at the time of discharge. They are still ill, many of their symptoms continue, treatment is ongoing, and their need for care remains. ... It is, therefore, very important to carefully plan and initiate referrals for aftercare. Ideally, outpatient treatment should be introduced before discharge, so that the patient is familiar with the persons who will care for them after discharge.”

For related information, see the Psychiatric News article “Two-Part Assessment May Help Predict Suicidal Behavior, Study Finds.”

(Photo courtesy of Columbia University Medical Center)


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