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Articles   |    
Systematic Suicide Risk Assessment for Patients With Schizophrenia: A National Population-Based Study
Charlotte Gjørup Pedersen, Ph.D., M.H.Sc.; Signe Olrik Wallenstein Jensen, M.Sc.; Jaimie Gradus, Ph.D., M.H.Sc.; Søren Paaske Johnsen, Ph.D., M.D.; Jan Mainz, Ph.D., M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200021
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Dr. Pedersen and Ms. Jensen are with the Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg, Denmark (e-mail: chargjo@gmail.com). Dr. Gradus is with the National Center for PTSD, Veterans Affairs Boston Healthcare System. Dr. Johnsen is with the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Dr. Mainz is Executive Deputy Director, Aalborg University Hospital, and is a quality-of-care professor at the University of Southern Denmark, Odense.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objectives  Systematic suicide risk assessment is recommended for patients with schizophrenia; however, little is known about the implementation of suicide risk assessment in routine clinical practice. The study aimed to determine the use of systematic suicide risk assessment at discharge and predictors of suicide attempt among hospitalized patients with schizophrenia in Denmark.

Methods  A one-year follow-up study was conducted of 9,745 patients with schizophrenia who were discharged from psychiatric wards and registered in a national population-based schizophrenia registry between 2005 and 2009.

Results  The proportion of patients receiving suicide risk assessment at discharge from a psychiatric ward increased from 72% (95% confidence interval [CI]=71%−74%) in 2005, when the national monitoring began, to 89% (CI=89%−90%) in 2009. Within one year after discharge, 1% of all registered patients had died by suicide and 8% had attempted suicide. One out of three patients who died by suicide had no documented suicide risk assessment before discharge.

Conclusions  The use of systematic suicide risk assessment at discharge among patients with schizophrenia increased in Denmark between 2005 and 2009, in accordance with recommendations in national clinical guidelines and monitoring in a national clinical registry. Additional efforts are warranted to ensure a lower risk of suicidal behavior after hospital discharge.

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Figure 1 Danish patients assessed for suicide risk at psychiatric ward discharge, 2005–2009a

a Years began on April 1 and ended on March 31. Error bars indicate 95% confidence intervals.

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Table 1Patient- and treatment-related characteristics according to use of systematic suicide risk assessment for discharged psychiatric patients
Table Footer Note

a Adjusted for sex, age, abuse, Global Assessment of Functioning (GAF) score, antipsychotic medical treatment, contact with relatives, and psychoeducation during hospitalization

Table Footer Note

b CNS, central nervous system

Table Footer Note

c Possible scores range from 0 to 100, with higher scores indicating better functioning.

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Table 2Association between treatment characteristics and suicide risk assessment among patients with a new schizophrenia diagnosis
Table Footer Note

a Adjusted for psychopathology assessments performed by a medical specialist or by interview test and for cognitive test and contact with social worker

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