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Suicide and psychiatric hospital admission

 

Clinical bottom line

For several psychiatric conditions, there are two peaks of increased suicide risk. These are soon after admission to a psychiatric hospital, and soon after discharge from it.


Reference


P Qin, M Nordentoft. Suicide risk in relation to psychiatric hospitalization. Archives of General Psychiatry 2005 62: 427-432.


Study

The study involved examination of all suicide deaths in Denmark between 1981 and 1997, some 21,000 suicides accounting for 99.6% of all suicides in Denmark for this period. The completeness of record linkage allowed merging of different data from different databases, and for the collection of information on about 20 controls matched by age and sex for each suicide.

Additional data from a psychiatric central register allowed information to be used on admission to psychiatric hospital, and relationship of suicide death to admission and discharge by diagnostic coding.

Results

Among the 13,700 male suicides and 7,500 women suicides, 37% and 57% respectively had a history of admission to psychiatric hospital. The distribution of risk after admission and discharge compared with those with no admission history is given in Figures 1-4 for four diagnostic categories. There were two distinct peaks of increased risk, soon after admission, and soon after discharge.

Figure 1: Risk ratio for suicide and time since admission or discharge from psychiatric hospital for diagnosis of schizophrenia spectrum disorder

Figure 2: Risk ratio for suicide and time since admission or discharge from psychiatric hospital for diagnosis of affective disorder

Figure 3: Risk ratio for suicide and time since admission or discharge from psychiatric hospital for diagnosis of substance abuse disorder

Figure 4: Risk ratio for suicide other disorders

Multiple admission, and longer duration of psychiatric hospital stay were also associated with increased risk of suicide.

Comment

This is another detailed study from Denmark, where the unique registration numbers allow for very considerable real world research.