Wednesday, May 31, 2017

Suicide Risk Remains Elevated for Years After Discharge From Psychiatric Hospital

Patients admitted into psychiatric hospitals because of suicidal thoughts and behaviors are known to be at a particularly heightened risk of suicide upon discharge. A report published today in JAMA Psychiatry suggests that suicide risk is markedly elevated in all patients after psychiatric hospital discharge, even those with no reported history of suicidal thoughts. 

“It has been argued that a way of combating post-discharge suicide is to focus on individual patients with clinical characteristics that signify a high suicide risk. However, the very high suicide rates calculated in this study and the known limitations of suicide risk assessment suggest that a focus on clinical risk assessment might mislead clinicians into thinking that some patients can be regarded as having low risk after discharge,” Matthew Michael Large, B.Sc., M.B.B.S., D.Med.Sci., of the University of New South Wales, Australia, and colleagues wrote.  

The findings were based on a meta-analysis of 100 studies of post-discharge suicide rates carried out over the past 50 years. The pooled estimate discharge suicide rate was 484 per 100,000 person-years—a figure the authors noted is “44 times the global suicide rate of 11.4 per 100,000 patients per year in 2012.” 

The suicide rate was highest within three months after discharge (1,132 per 100,000) and among patients admitted with suicidal ideas or behaviors (2,078 per 100,000). Pooled suicide rates per 100,000 patient-years were 654 for studies with follow-up periods of three months to one year, 494 for studies with follow-up periods of one to five years, 366 for studies with follow-up periods of five to 10 years, and 277 for studies with follow-up periods longer than 10 years.

“The clinical message of these findings is clear: universal and continuing suicide prevention interventions are needed for patients after psychiatric hospital discharge, with a higher level of clinical monitoring and support for patients during the first few months after hospital discharge and for patients with a history of suicidal behavior,” Mark Olfson, M.D., M.P.H., of the Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute wrote in a related editorial. “A greater appreciation of the enduring elevated risk of psychiatric inpatients after discharge might help build support for the clinical resources to reduce the unacceptably large number of individuals who die by suicide each year.”

For related information, see the Psychiatric News article “Emergency Department Intervention May Reduce Suicide Attempts in At-Risk Patients.”

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