Frequent psychiatric admissions and the risk of suicide: a prospective total cohort study 2005-2023

Discharge from a psychiatric hospital is associated with an elevated risk of suicide. Previous studies have linked a higher number of psychiatric admissions to suicide risk. However, findings are mixed, and the association between admission frequency and suicide risk remains unclear. This study aimed to investigate whether frequent psychiatric admissions and the persistence of readmission patterns serve as risk factors for suicide.

This prospective total cohort study included all patients consecutively admitted to the psychiatric acute ward at Haukeland University Hospital in Bergen, Norway, between 2005 and 2014 (N = 7000). The cohort was divided into independent groups according to the number of admissions per year and the persistence of this pattern. Demographic and clinical data were collected at each admission. Patients were followed for up to 19 years by linking the cohort to the Norwegian Cause of Death Registry. Cox and competing risk regression analyses were applied to investigate the association between the frequency of admissions and the risk of suicide.

There was an approximately threefold (AHR = 2.91) increase in the risk of suicide in patients with five or more admissions on average per utilisation year, when adjusted for gender, suicidal ideation, self-harm and diagnosis. The risk was particularly high (AHR = 5.93) immediately after the last discharge.

These findings might assist the identification of a subgroup of individuals at particular risk of suicide within a population of hospitalised psychiatric patients.