Suicide Risk Factors in Patients Recently Discharged From a Psychiatric Hospital: A Case-Control Study

The first weeks after discharge from a psychiatric hospital constitute a period of considerably increased risk for suicide. Most studies on risk factors have investigated a relatively long time frame after discharge or have identified unmodifiable factors. This case-control study focused on factors describing the interaction between patient and hospital and studied variables during the entire course of the hospital stay.

Suicide cases were identified by linking the Tyrol Suicide Register (all suicides occurring in the Austrian state of Tyrol) with the registers of the 3 psychiatric hospitals in the state. Postdischarge suicide cases were defined as suicides occurring within 12 weeks after discharge. Control subjects were patients who had also been inpatients in the respective psychiatric unit but had not committed suicide. Matching variables included sex, age, hospital, diagnosis, and date of discharge. The study period comprised 7 years (February 1, 2004-January 31, 2011).

A total of 89 suicide cases and 144 controls were included. Factors differentiating cases from controls included a history of suicidal behavior or threats (odds ratio [OR] = 4.65; P < .001), depressive symptoms (OR = 3.63; P = .004) and disordered thought content (OR = 2.68; P = .001) at admission, admission mode (patient self-referral less often [OR = 0.28; P = .009]), a change from one ward to another (OR = 1.87; P = .035), discharge initiated by the patient (OR = 10.34; P = .013), depressive symptoms at this point in time (OR = 4.42; P < .001), discharge mode (less often into institutional care [OR = 0.17; P = .002]), and linkage with postdischarge care (fixed appointment with a general practitioner less often [OR = 0.53; P = .024]).

The results of this study point to suicide preventive measures that may be implemented during and after hospitalization, including clear information transfer in case of unavoidable ward change and optimization of follow-up care organization.