June 01, 2017
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Suicide risk highest within 3 months of psychiatric discharge

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Findings from a meta-analysis indicated risk for suicide is highest within 3 months of discharge from psychiatric facilities, but remains high for several years following discharge.

“The rate of suicide after discharge from psychiatric hospitals and wards is very high. A recent U.S. study reported a suicide rate of 178 per 100,000 person-years in the first 3 months after discharge, a figure that is approximately 15 times the U.S. national suicide rate. Studies from the United Kingdom and Nordic countries with similar durations of follow-up after discharge have reported higher suicide rates,” Daniel Thomas Chung, of the University of New South Wales, Australia, and colleagues wrote. “Currently, there are no accepted benchmarks for postdischarge suicide rates.”

To determine rates of suicide after discharge from psychiatric facilities and identify moderators of those rates, researchers conducted a systematic review and meta-analysis of 100 studies among 183 patient samples, which included 17,857 suicides during 4,725,445 person-years.

Pooled estimate postdischarge suicide rate was 484 suicides per 100,000 person-years (95% CI, 422-555).

Researchers noted high heterogeneity between samples.

Suicide rates were highest within 3 months after discharge (1,132 per 100,000 person-years; 95% CI, 874-1,467) and among participants admitted with suicidal ideation or behavior (2,078 per 100,000 person-years; 95% CI, 1,512-2,856).

Pooled suicide rates were 654 per 100,000 person-years among studies with 3 months to 1 year of follow-up; 494 per 100,000 person-years among studies with 1 to 5 years of follow-up; and 277 per 100,000 person-years among studies with more than 10 years of follow-up.

Mark Olfson, MD, MPH
Mark Olfson

Suicide rates were higher among samples collected from 1995 to 2004 (656 per 100,000 person-years; 95% CI, 518-831) and 2005 to 2016 (672 per 100,000 person-years; 95% CI, 428-1,055), compared with earlier samples.

“Suicide has proven to be a stubbornly difficult threat to health. To make meaningful progress, system-wide reforms in monitoring patients after hospital discharge will likely need to be complemented with traditional suicide-specific patient interventions, such as safety planning, crisis lines, crisis counseling services and on-call mental health services,” Mark Olfson, MD, MPH, of Columbia University, New York, wrote in an accompanying 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.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.