Suicidal Risk Following Hospital Discharge: A Review

Alberto Maria Forte · Andrea Buscajoni · Andrea Fiorillo · Maurizio Pompili · Ross J. Baldessarini

150 citations0/0 files storedHarvard Review of Psychiatry

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Suicide and Self-Harm Studies Psychiatric care and mental health services Homicide, Infanticide, and Child Abuse

Abstract

LEARNING OBJECTIVES: After participating in this activity, learners should be better able to:• Evaluate risk of suicide and suicide attempts following psychiatric hospitalization• Assess the relationship between suicide attempts and completed suicides BACKGROUND: Suicidal risks among psychiatric patients appear to be especially high soon after hospitalization. Given the importance of such outcomes, and the lack of recent reviews of post-discharge suicide attempt risks, we evaluated reported findings on the risk of suicide and attempts following psychiatric hospitalization. METHODS: With systematic, computerized searching, we identified 48 studies (1964-2017) involving 1,700,785 subjects. Follow-up was limited to ≥12 months after discharge from psychiatric hospitalization to avoid inflation of annualized rates due to shorter exposure times. RESULTS: The overall observed pooled, annualized rate of completed suicide was 241 (confidence interval, 238-243) per 100,000 person-exposure years in 41 studies, and for attempts, 722 (698-746) in 13 studies. In six studies (64,848 subjects) reporting on both suicides and attempts, the ratio of annualized rates for attempts/completed suicides was 8.79 (6.63-12.0). Among all 48 studies, cumulative distribution of suicidal events included 26.4% (25.9-26.9) within the initial month, 40.8% (40.2-41.4) within 3 months, and 73.2% (72.7-73.7) within 12 months of discharge. CONCLUSIONS: Among patients recently discharged from psychiatric hospitalization, rates of suicide deaths and attempts were far higher than in the general population or even in unselected clinical samples of comparable patients, with a strong inverse association with time post-discharge. Improved monitoring and care of patients discharged from psychiatric hospitalization are needed, ideally with detailed planning and implementation of aftercare prior to discharge.

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References

2009The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration 2016Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.2008Cross-national prevalence and risk factors for suicidal ideation, plans and attempts 1997Suicide as an outcome for mental disorders 2015Suicide and suicidal behaviour 2009Suicide 2005Trends in Suicide Ideation, Plans, Gestures, and Attempts in the United States, 1990-1992 to 2001-2003 2005The Lifetime Risk of Suicide in Schizophrenia

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