In the Journals

Psychiatric inpatients have high risk for suicide after hospital discharge

Individuals with mental health disorders had increased risk for suicide 3 months after discharge from a psychiatric hospital, particularly those who did not receive outpatient health care 6 months before hospital admission.

“The period immediately after psychiatric hospital discharge poses an exceptionally high risk for suicide. Although only about 6% of mental health outpatients receive psychiatric inpatient care each year, approximately one-third of all suicides among patients with mental disorders occur within 3 months of discharge from an inpatient psychiatric unit,” Mark Olfson, MD, MPH, of New York State Psychiatric Institute, Columbia University, New York, and colleagues wrote. “Knowledge of which mental disorders and other readily identifiable patient characteristics 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.”

Mark Olfson, MD, MPH
Mark Olfson

To assess risk for suicide 90 days after psychiatric hospital discharge among individuals diagnosed with mental disorders, researchers evaluated a national retrospective longitudinal cohort of inpatients in the Medicaid program who were discharged with a first-listed diagnosis of depression, bipolar disorder, schizophrenia, substance use disorder and other mental disorder (n = 770,643). Analysis also included a 10% random sample of inpatient adults diagnosed with nonmental disorders (n = 1,090,551). Study participants had a mean age of 35.4 years.

From 2001 through 2007, there were 370 suicide deaths.

Suicide rates were 235.1 per 100,000 person-years for depression; 216 per 100,000 person-years for bipolar disorder; 168.3 per 100,000 for schizophrenia; 116.5 per 100,000 for substance use disorder; and 160.4 per 100,000 person-years for other mental disorders. These rates were significantly higher than the rate among individuals with nonmental disorders (11.6 per 100,000 person-years) and the general U.S. population (14.2 per 100,000 person-years).

Adjusted hazard ratios for suicide among individuals with mental disorders were associated with inpatient diagnosis of depression (aHR = 2; 95% CI, 1.4-2.8); outpatient diagnosis of schizophrenia (aHR = 1.6; 95% CI, 1.1-2.2); outpatient diagnosis of bipolar disorder (aHR = 1.6; 95% CI, 1.2-2.1); and no outpatient health care within 6 months preceding psychiatric hospital admission (aHR = 1.7; 95% CI, 1.2-2.5).

“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. Many of these patients remain at increased risk for suicide. It is, therefore, very important to carefully plan and initiate referrals for aftercare,” Merete Nordentoft, DMSc, of the Mental Health Centre Copenhagen, Denmark, and colleagues wrote in an accompanying editorial. “Ideally, outpatient treatment should be introduced before discharge, so that the patient is familiar with the persons who will care for them after discharge. In the week immediately after discharge, the risk for suicide is at its highest, which underscores the need for establishing contact and arranging an appointment to outpatient care ahead of discharge.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.

Individuals with mental health disorders had increased risk for suicide 3 months after discharge from a psychiatric hospital, particularly those who did not receive outpatient health care 6 months before hospital admission.

“The period immediately after psychiatric hospital discharge poses an exceptionally high risk for suicide. Although only about 6% of mental health outpatients receive psychiatric inpatient care each year, approximately one-third of all suicides among patients with mental disorders occur within 3 months of discharge from an inpatient psychiatric unit,” Mark Olfson, MD, MPH, of New York State Psychiatric Institute, Columbia University, New York, and colleagues wrote. “Knowledge of which mental disorders and other readily identifiable patient characteristics 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.”

Mark Olfson, MD, MPH
Mark Olfson

To assess risk for suicide 90 days after psychiatric hospital discharge among individuals diagnosed with mental disorders, researchers evaluated a national retrospective longitudinal cohort of inpatients in the Medicaid program who were discharged with a first-listed diagnosis of depression, bipolar disorder, schizophrenia, substance use disorder and other mental disorder (n = 770,643). Analysis also included a 10% random sample of inpatient adults diagnosed with nonmental disorders (n = 1,090,551). Study participants had a mean age of 35.4 years.

From 2001 through 2007, there were 370 suicide deaths.

Suicide rates were 235.1 per 100,000 person-years for depression; 216 per 100,000 person-years for bipolar disorder; 168.3 per 100,000 for schizophrenia; 116.5 per 100,000 for substance use disorder; and 160.4 per 100,000 person-years for other mental disorders. These rates were significantly higher than the rate among individuals with nonmental disorders (11.6 per 100,000 person-years) and the general U.S. population (14.2 per 100,000 person-years).

Adjusted hazard ratios for suicide among individuals with mental disorders were associated with inpatient diagnosis of depression (aHR = 2; 95% CI, 1.4-2.8); outpatient diagnosis of schizophrenia (aHR = 1.6; 95% CI, 1.1-2.2); outpatient diagnosis of bipolar disorder (aHR = 1.6; 95% CI, 1.2-2.1); and no outpatient health care within 6 months preceding psychiatric hospital admission (aHR = 1.7; 95% CI, 1.2-2.5).

“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. Many of these patients remain at increased risk for suicide. It is, therefore, very important to carefully plan and initiate referrals for aftercare,” Merete Nordentoft, DMSc, of the Mental Health Centre Copenhagen, Denmark, and colleagues wrote in an accompanying editorial. “Ideally, outpatient treatment should be introduced before discharge, so that the patient is familiar with the persons who will care for them after discharge. In the week immediately after discharge, the risk for suicide is at its highest, which underscores the need for establishing contact and arranging an appointment to outpatient care ahead of discharge.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.