Suicide following an inpatient hospitalization for a suicide attempt: a Canadian follow-up study

This study contributes a Canadian perspective to a growing body of international studies examining suicide among cohorts of suicide attempters, and a much more limited literature on the epidemiology of suicide in Canada. We evaluated the 13-year mortality experience of a regional cohort of 876 first-ever inpatient hospital admissions for a suicide attempt admitted between 1979 and 1981. Compared to the general population, study subjects were 4 times more likely to die of any cause, but 25 times more likely to commit suicide and 15 times more likely to die of accidental or adverse causes. Ten years after then first hospitalization for attempted suicide, 5.9% of study subjects had committed suicide. Baseline age appeared to be a risk factor for women, but not for men. Women under 60 years had the best 10-year survival (3.6% had committed suicide) and women over 60 years had the poorest (17.5%). A total of 8.7% of men under 60 years and 10% of those over 60 years committed suicide within 10 years. The remainder of the analysis focused on those under 60 years of age at the time of their index inpatient hospitalization. Three factors were prognostic for suicide: being male, which had a relative risk (RR) of 5.0, living in a lower income area (RR = 3.2), and having used a violent method during the index attempt (RR = 2.5). The periods of greatest risk for suicide were within the 1st and 4th years following first-ever inpatient hospitalization, with the 4th year representing the time of highest risk. The identification of time periods subsequent to first-ever hospitalization when patients are at greatest risk of suicide can be used to guide the timing and duration of clinical interventions and aftercare to ensure that patients are appropriately supported during periods of highest risk.