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Suicide in recently discharged psychiatric patients: a case-control study
1National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University Place, University of Manchester, Manchester, UK. Isabelle.m.hunt@manchester.ac.uk
Psychological Medicine
|May 30, 2008
Summary
The period after psychiatric discharge is critical for suicide risk. Early, intensive follow-up and clear procedures for self-discharged patients can reduce suicide deaths.
Area of Science:
- Psychiatry
- Public Health
- Mental Healthcare Research
Background:
- Limited controlled studies exist on mental health care and suicide risk in recently discharged psychiatric patients.
- Identifying risk factors for suicide within 3 months post-discharge is crucial.
Purpose of the Study:
- To identify risk factors for suicide in psychiatric patients within 3 months of hospital discharge.
- To examine the role of healthcare received in post-discharge suicide risk.
Main Methods:
- National population-based case-control study.
- 238 psychiatric patients who died by suicide within 3 months of discharge were matched with 238 living controls.
Main Results:
- 43% of suicides occurred within one month of discharge, with 47% dying before their first follow-up appointment.
- High-risk periods include the first week and day post-discharge.
- Risk factors included self-harm history, affective disorder, recent service contact, and clinical symptoms at last contact. Self-discharge and missed appointments increased risk.
- Compulsory treatment and enhanced aftercare were associated with lower suicide risk.
Conclusions:
- The weeks following psychiatric discharge are a critical period for suicide risk.
- Intensive and early community follow-up is recommended to reduce risk.
- Risk assessment should include established factors, mental state, and follow-up for self-discharged patients.
- Detention under the Mental Health Act and enhanced aftercare may be protective factors.
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