Patients with depression who have been discharged from psychiatric hospitals have the highest risk of dying by suicide in the first three days after discharge, with some risk factors increasing that risk further, according to a study published this week in JAMA Psychiatry.
Of all people dying by suicide, more than half had depression, and approximately 40% had been recently hospitalized, wrote Kari Aaltonen, M.D., Ph.D., of the University of Helsinki and colleagues. Therefore, people hospitalized for depression are at significant risk of suicide following their discharge. “Such a population with a distinct high-risk period in contact with psychiatric care forms a prioritizable target for selective suicide prevention,” they wrote.
Aaltonen and colleagues used data from Finnish registers such as the Care Register for Health Care and Statistics Finland, which included information on hospital admissions, discharges, diagnoses, and causes of death. They identified all psychiatric hospitalizations for depression among participants aged 18 years and older from 1996 to 2017; patients with comorbid major psychotic disorder or bipolar disorder were excluded. Each patient was followed for up to two years after discharge. For those with multiple hospitalizations, each discharge marked the beginning of a new follow-up period.
A total of 193,197 hospitalizations occurred during the study period among 91,161 participants (56.2% female; mean age 44 years). A total of 1,219 men and 757 women died by suicide during the study period. Additional findings included the following:
- During the first three days after discharge, the suicide incidence rate was 6,062 per 100,000 person-years. The authors noted that this rate exceeded the rate within the general population in Finland by 330-fold.
- The suicide rate remained high throughout the first week after discharge (3,884 per 100,000 person-years on days four to seven), but then fell steadily, dropping to 478 per 100,000 person-years after one year.
- Individuals who were admitted to the hospital due to a suicide attempt by firearm or hanging had the highest risk of death by suicide in the first three days after discharge. Other factors associated with immediate suicide risk included severe or psychotic depression, severe illness with impaired function, a history of attempted suicide, male sex, and age 40 and above.
- Some factors showed temporal trends. Having a higher household disposable income was associated with immediate suicide risk after discharge, but later it was associated with a lower risk compared with those with lower income. Individuals hospitalized with comorbid alcohol use disorder had a lower immediate suicide risk than those without, but then a higher risk over time.
“Although we found a decreasing trend over time, the high-risk post-discharge period still requires intensified attention,” the authors wrote. “Continuity of care and access to enhanced psychiatric outpatient care within days of discharge should be imperative.”
For related information, see the Psychiatric News article “Army STARRS Study Finds Risks to Progression From Suicidal Ideation to Attempts.”
(Image: Getty Images/iStock/Abdullah Durmaz)
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