[Increasing suicides of psychiatric inpatients: reality or artefact? (author's transl)]

In several countries the suicide rate for psychiatric inpatients has increased more than that for admissions and suicides in the general population. This was also the case in our clinic. This hypothesis was tested: today, because of more liberal management, suicides are committed during hospitalization that in an earlier and more restrictive age would have taken place after discharge. All suicides taking place 1960-1979 in the clinic's main catchment area were examined for previous hospitalization. The hypothesis was not supported. Over twenty years neither the suicide cases nor all discharged patients changed significantly in distribution of age, sex, number of previous admissions, duration of hospitalization, or diagnosis. Therefore, none of these variables explain the increase. In both decades, on the other hand, patients that committed suicide during their stay at the clinic had been hospitalized longer; those that committed suicide within three months after discharge had been hospitalized for a shorter time than the sum of discharged patients. Among the suicides that occurred after discharge, the percentage of depressives and addicts was higher and the percentage of schizophrenic patients was smaller than among all discharged patients. A change in patient management (more time off, more working outside, more open wards) has preceded the increase in suicides; medical staff, however, has doubled over the decades considered here. Rising pressure for resocialization to avoid hospitalism may heighten suicidal behavior. Preventive measures are discussed.