Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-28T13:34:36.622Z Has data issue: false hasContentIssue false
  • English
  • Français

Suicide in recently discharged psychiatric patients: a case-control study

Published online by Cambridge University Press:  28 May 2008

I. M. Hunt ,
N. Kapur ,
R. Webb ,
J. Robinson ,
J. Burns ,
J. Shaw  and
L. Appleby
I. M. Hunt*
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University Place, University of Manchester, Manchester, UK
N. Kapur
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University Place, University of Manchester, Manchester, UK
R. Webb
Affiliation:
Centre for Women's Mental Health Research, Department of Psychiatry and Behavioural Sciences, University Place, University of Manchester, Manchester, UK
J. Robinson
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University Place, University of Manchester, Manchester, UK
J. Burns
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University Place, University of Manchester, Manchester, UK
J. Shaw
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University Place, University of Manchester, Manchester, UK
L. Appleby
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University Place, University of Manchester, Manchester, UK
*
*Address for correspondence: I. M. Hunt, Centre for Suicide Prevention, University Place, University of Manchester, Oxford Road, Manchester M13 9PL, UK. (Email: Isabelle.m.hunt@manchester.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Few controlled studies have specifically investigated aspects of mental health care in relation to suicide risk among recently discharged psychiatric patients. We aimed to identify risk factors, including variation in healthcare received, for suicide within 3 months of discharge.

Method

We conducted a national population-based case-control study of 238 psychiatric patients dying by suicide within 3 months of hospital discharge, matched on date of discharge to 238 living controls.

Results

Forty-three per cent of suicides occurred within a month of discharge, 47% of whom died before their first follow-up appointment. The first week and the first day after discharge were particular high-risk periods. Risk factors for suicide included a history of self-harm, a primary diagnosis of affective disorder, recent last contact with services and expressing clinical symptoms at last contact with staff. Suicide cases were more likely to have initiated their own discharge and to have missed their last appointment with services. Patients who were detained for compulsory treatment at last admission, or who were subject to enhanced levels of aftercare, were less likely to die by suicide.

Conclusions

The weeks after discharge from psychiatric care represent a critical period for suicide risk. Measures that could reduce risk include intensive and early community follow-up. Assessment of risk should include established risk factors as well as current mental state and there should be clear follow-up procedures for those who have self-discharged. Recent detention under the Mental Health Act and current use of enhanced levels of aftercare may be protective.

Keywords

Case-controlhospital dischargepsychiatric patientsuicide
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 3 , March 2009 , pp. 443 - 449
Copyright
Copyright © 2008 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Appleby, L, Dennehy, JA, Thomas, CS, Faragher, EB, Lewis, G (1999 a). Aftercare and clinical characteristics of people with mental illness who commit suicide: a case-control study. Lancet 353, 1397–1400.CrossRefGoogle ScholarPubMed
Appleby, L, Shaw, J, Amos, T, McDonnell, R, Harris, C, McCann, K, Kiernan, K, Davies, S, Bickley, H, Parsons, R (1999 b). Suicide within 12 months of contact with mental health services: national clinical survey. British Medical Journal 318, 1235–1239.CrossRefGoogle ScholarPubMed
Appleby, L, Shaw, J, Kapur, N, Windfuhr, K, Ashton, A, Swinson, N, While, D, Lowe, R, Bickley, H, Flynn, S, Hunt, IM, McDonnell, S, Pearson, A, Da Cruz, D, Rodway, C, Roscoe, A, Saini, P, Turnbull, P, Burns, J, Hadfield, K, Stones, P (2006). Avoidable Deaths. Five-year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. UK Department of Health: London. (http://www.medicine.manchester.ac.uk/suicideprevention/nci).Google Scholar
Appleby, L, Shaw, J, Sherratt, J, Amos, T, Robinson, J, McDonnell, R, McKann, K, Parsons, R, Hunt, IM, Burns, J, Bickley, H, Kiernan, K, Davies, S, Harris, C (2001). Safety First: Five-year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. UK Department of Health: London.Google Scholar
Busch, KA, Fawcett, J, Jacobs, DG (2003). Clinical correlates of inpatient suicide. Journal of Clinical Psychiatry 64, 14–19.CrossRefGoogle ScholarPubMed
Dennehy, JA, Appleby, L, Thomas, CS, Faragher, BE (1996). Case-control study of suicide by discharged psychiatric patients. British Medical Journal 312, 1580.CrossRefGoogle ScholarPubMed
Desai, RA, Dausey, DJ, Rosenheck, RA (2005). Mental health service delivery and suicide risk: the role of individual patient and facility factors. American Journal of Psychiatry 162, 311–318.CrossRefGoogle ScholarPubMed
Geddes, JR, Juszczak, E, O'Brien, F, Kendrick, S (1997). Suicide in the 12 months after discharge from psychiatric inpatient care, Scotland, 1968–1992. Journal of Epidemiology and Community Health 51, 430–434.CrossRefGoogle Scholar
Goldacre, M, Seagroatt, V, Hawton, K (1993). Suicide after discharge from psychiatric inpatient care. Lancet 342, 283–286.CrossRefGoogle ScholarPubMed
Ho, TP (2003). The suicide risk of discharged psychiatric patients. Journal of Clinical Psychiatry 64, 702–707.CrossRefGoogle ScholarPubMed
Høyer, EH, Olesen, AV, Mortensen, PB (2004). Suicide risk in patients hospitalized because of an affective disorder: a follow-up study, 1973–1993. Journal of Affective Disorders 78, 209–217.CrossRefGoogle ScholarPubMed
Isometsa, E, Henriksson, M, Heikkinen, M, Lonnqvist, J (1993). Suicide after discharge from psychiatric inpatient care. Lancet 342, 1055–1056.CrossRefGoogle ScholarPubMed
Kan, CK, Ho, TP, Dong, JY, Dunn, ELW (2007). Risk factors for suicide in the immediate post-discharge period. Social Psychiatry and Psychiatric Epidemiology 42, 208–214.CrossRefGoogle ScholarPubMed
Kapur, N, Hunt, IM, Webb, R, Bickley, H, Windfuhr, K, Shaw, J, Appleby, L (2006). Suicide in psychiatric in-patients in England, 1997 to 2003. Psychological Medicine 36, 1485–1492.CrossRefGoogle ScholarPubMed
King, EA, Baldwin, DS, Sinclair, JMA, Baker, NG, Campbell, MJ, Thompson, C (2001). The Wessex recent in-patient suicide study, 1: Case-control study of 234 recently discharged psychiatric patient suicides. British Journal of Psychiatry 178, 531–536.CrossRefGoogle ScholarPubMed
Linsley, KR, Schapira, K, Kelly, TP (2001). Open verdict v. suicide – importance to research. British Journal of Psychiatry 178, 465–468.CrossRefGoogle ScholarPubMed
Meehan, J, Kapur, N, Hunt, IM, Turnbull, P, Robinson, J, Bickley, H, Parsons, S, Flynn, S, Burns, A, Amos, T, Shaw, J, Appleby, L (2006). Suicide in mental health in-patients and within 3 months of discharge. National clinical survey. British Journal of Psychiatry 188, 129–134.CrossRefGoogle ScholarPubMed
Pirkis, J, Burgess, P, Jolley, D (2002). Suicide among psychiatric patients: a case control study. Australian and New Zealand Journal of Psychiatry 36, 86–91.CrossRefGoogle ScholarPubMed
Powell, J, Geddes, J, Deeks, J, Goldacre, M, Hawton, K (2000). Suicide in psychiatric hospital in-patients. Risk factors and their predictive power. British Journal of Psychiatry 176, 266–272.CrossRefGoogle ScholarPubMed
Qin, P, Nordentoft, M (2005). Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Archives of General Psychiatry 62, 427–432.CrossRefGoogle ScholarPubMed
Rossau, CD, Mortensen, PB (1997). Risk factors for suicide in patients with schizophrenia: nested case-control study. British Journal of Psychiatry 171, 355–359.CrossRefGoogle ScholarPubMed
Rubenowitz, E, Waern, M, Wilhelmson, K, Allebeck, A (2001). Life events and psychosocial factors in elderly suicides – a case-control study. Psychological Medicine 31, 1193–1202.CrossRefGoogle ScholarPubMed
Sohlman, B, Lehtinen, V (1999). Mortality among discharged psychiatric patients in Finland. Acta Psychiatrica Scandinavica 99, 102–109.CrossRefGoogle ScholarPubMed
Yim, PHW, Yip, PSF, Li, RHY, Dunn, ELW, Yeung, WS, Miao, YK (2004). Suicide after discharge from psychiatric inpatient care: a case-control study in Hong Kong. Australian and New Zealand Journal of Psychiatry 38, 65–72.CrossRefGoogle ScholarPubMed