Nosocomial suicide

British Journal of Psychiatry, 2000

BackgroundPsychiatric hospital inpatients are known to be at high risk of suicide, yet there is little reliable knowledge of risk factors or their predictive power.AimsTo identify risk factors for suicide in psychiatric hospital in-patients and to evaluate their predictive power in detecting people at risk of suicide.MethodUsing a case–control design, 112 people who committed suicide while in-patients in psychiatric hospitals were compared with 112 randomly selected controls. Univariate analysis and multivariate analyses were used to estimate odds ratios and adjusted likelihood ratios.ResultsThe rate of suicide in psychiatric in-patients was 13.7 (95% CI 11.7–16.1) per 10 000 admissions. There were five predictive factors with likelihood ratios >2, following adjustment: planned suicide attempt, 4.1; actual suicide attempt, 4.9; recent bereavement, 4.0; presence of delusions, 2.3; chronic mental illness, 2.2; and family history of suicide, 4.6. On this basis, only two of the patie...

Social psychiatry and psychiatric epidemiology, 2014

Asian Journal of Psychiatry, 2016

General Hospital Psychiatry, 2009

Objectives: This study aimed to compare the characteristics of psychiatric and nonpsychiatric suicidal inpatients in one general hospital and examine the predictors of completed suicide in the patients with suicidal acts during hospitalization. Methods: One hundred ten study subjects were identified by the adverse event reports of suicidal acts during hospitalization from 1995 to 2004. Demographic data and clinical information were collected by chart reviews. Results: Psychiatric inpatients with suicidal acts were mainly younger females with psychiatric diagnoses and previous suicide attempts. Nonpsychiatric suicidal inpatients had less suicide communication, performed suicidal acts more rapidly after admission and used more violent suicidal methods than the psychiatric inpatients did. Suicidal acts performed outside the hospital, use of violent suicidal methods and male gender increased the risk of suicide mortality in our suicidal inpatients. Conclusion: This study suggests that suicide prevention efforts need to be tailored in psychiatric and nonpsychiatric wards according to differing patient risk characteristics in these patient cohorts.

Journal of Affective Disorders, 2013

Background: Around a quarter of in-patient suicides occur within the first week of admission to psychiatric in-patient care. Little is known on the factors associated with suicide during this critical time. We aimed to identify risk factors for suicide among in-patients within the first week of admission. Methods: A national population-based case-control study of 107 current psychiatric in-patients in England who died by suicide within a week of admission, matched on admission date with 107 living controls. Results: Forty-two (40%) suicide cases died within the first 3 day of admission. A fifth of all suicides were on authorised leave at the time of death, but 34% were off the ward without staff agreement compared to only 1% of controls. Independent risk factors for suicide included previous self-harm, recent adverse life events, and a short (o12 months) duration of illness. Limitations: This is a retrospective study, using clinical data mainly collected from case records. Clinicians were not blind to case/control status. Conclusions: The first few days of admission should be recognised as the period of highest risk. Careful risk evaluation is needed at this time, particularly in those with recent illness onset or previous suicide attempts. Knowledge of life events experienced before admission should be incorporated into risk assessments. Improvements to the ward environment to lessen the distress of an admission may be an important preventative measure. Protocols may require adapting to improve the safety of those on agreed leave, and prevent absconding through increased vigilance and closer observation of ward exits.

BJPsych open, 2017

Being a current psychiatric in-patient is one of the strongest statistical risk factors for suicide. It is usually assumed that this strong association is not causal but is a result of the combination of the selection of high-risk patients for admission and the imperfect protection from suicide afforded by psychiatric wards. Logically, a third factor, which is causal, might play a role in the association. It has recently been suggested that adverse experiences in psychiatric units such as trauma, stigma and loss of social role might precipitate some in-patient suicides. To consider whether there is a causal association between psychiatric hospitalisation and suicide. We used the framework of Austin Bradford Hill's criteria for assessing causality in epidemiology to consider the possibility that psychiatric hospitalisation might causally contribute to the extent and variation in in-patient suicide rates. The association between psychiatric hospitalisation and suicide clearly meet...

British Journal of Psychiatry, 2001

Journal of Affective Disorders, 2005

Background: A significant number of patients committed suicide while receiving in-patient treatment in psychiatric hospitals. Most previous studies on psychiatric in-patient suicides were conducted in the West. This study aimed to describe the characteristics and identify risk factors of suicides occurring during psychiatric in-patient care in Hong Kong. Method: The case record data of suicide cases (Coroner's verdicts of suicides and undetermined deaths) from all public psychiatric hospitals in the entire region within a 3 years' period (N = 93) were compared with matched controls. Results: In-patient suicide rate was 269/100,000 admissions. Majority had schizophrenia. Suicide usually occurred after the first month of admission, during leave, and by jump from heights. There were little case-control differences in treatment received. Multiple conditional logistic regression found 5 risk factors: previous history of deliberate self-harm (OR = 4.60, 95% CI = 1.57-13.5); admitted because of suicidal behaviour (OR = 3.92, 95% CI = 1.3-11.9); depressive symptoms at time of suicide (OR = 8.53, 95% CI = 1.4-52); away without leave at anytime during index admission (OR = 17, 95% CI = 1.76-163); and extrapyramidal side effects/akathisia at time of suicide (OR = 10.8, 95% CI = 1.75-66.7). Limitations: Retrospective case record review depended on non-standardized and variable quality of case notes entry. Matching for hospitals in this study would make the comparison between hospitals impossible. Although this is the second largest casecontrol study of psychiatric in-patient suicide, the estimated power suggested subtle risk factors would be missed. Conclusion: Majority of in-patient suicides occurred at a time of perceived low risk. A high sensitivity to the risk of suicide and vigorous treatment of depressive symptoms were indicated. The care processes during the index admission could bear strong influences on the risk of in-patient suicides. D

British Journal of Psychiatry, 2006

BackgroundSuicide prevention is a health service priority. Suicide risk may be greatest during psychiatric in-patient admission and following discharge.AimsTo describe the social and clinical characteristics of a comprehensive sample of in-patient and post-discharge cases of suicide.MethodA national clinical survey based on a 4-year (1996–2000) sample of cases of suicide in England and Wales who had been in recent contact with mental health services (n=4859).ResultsThere were 754 (16%) current in-patients and a further 1100 (23%) had been discharged from psychiatric in-patient care less than 3 months before death. Nearly a quarter of the in-patient deaths occurred within the first 7 days of admission; 236 (31%) occurred on the ward, the majority by hanging. Post-discharge suicide was most frequent in the first 2 weeks after leaving hospital; the highest number occurred on the first day.ConclusionsSuicide might be prevented among in-patients by improving ward design and removing fixt...

Psychological Medicine, 2007

Background. Few controlled studies have investigated factors associated with suicide in current in-patients. We aimed to identify psychosocial, behavioural and clinical risk factors, including variations in care, for in-patient suicide.