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Protective and risk factors for inpatient suicides: a nested case-control study.

Shi-Kwang Lin1, Tsui-Mei Hung2, Ya-Tang Liao3

  • 1Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, Yang-Ming University, Taipei, Taiwan.

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Summary

Implementing standardized suicide precautions significantly reduced inpatient suicides, especially for shorter stays. Depression symptoms like low mood and loss of energy remain key risk factors requiring targeted prevention.

Keywords:
DepressionInpatient suicideProtective factorsRisk factorsSuicide precaution

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Area of Science:

  • Psychiatry
  • Public Health
  • Clinical Risk Management

Background:

  • Inpatient suicides pose a significant challenge in psychiatric care.
  • Effective suicide prevention strategies are crucial for patient safety.
  • Previous research indicates a need to evaluate the impact of implemented precautions.

Purpose of the Study:

  • To estimate the protective effect of standardized suicide precautions against inpatient suicides.
  • To identify clinical risk factors associated with inpatient suicides.
  • To compare suicide rates before and after the implementation of a new precaution system.

Main Methods:

  • A nested case-control study design was used.
  • Data from 33,121 admissions (1998-2008) post-implementation and 13,515 admissions (1985-1995) pre-implementation were analyzed.
  • Conditional logistic regression estimated risk and protective factors for inpatient suicides.

Main Results:

  • The post-implementation cohort showed a significantly lower adjusted risk ratio (0.157) for inpatient suicides compared to the pre-implementation cohort, particularly for shorter lengths of stay.
  • Depressed mood (ARR=2.11), loss of energy (ARR=1.99), and psychomotor retardation (ARR=1.67) were identified as significant risk factors.
  • Standardized suicide precautions demonstrated a protective effect against inpatient suicides.

Conclusions:

  • Standardized suicide precautions are effective in reducing inpatient suicides.
  • Enhanced assessment and prevention strategies are necessary, focusing on patients with depression-related symptoms.
  • Continued vigilance and refinement of safety protocols are essential in psychiatric settings.