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Articles   |    
Suicide Within Two Weeks of Discharge From Psychiatric Inpatient Care: A Case-Control Study
Harriet Bickley, B.A.; Isabelle M. Hunt, Ph.D.; Kirsten Windfuhr, Ph.D.; Jenny Shaw, F.R.C.Psych., M.D.; Louis Appleby, F.R.C.Psych., M.D.; Navneet Kapur, M.R.C.Psych., M.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200026
View Author and Article Information

The authors are affiliated with the Centre for Mental Health and Risk, Jean McFarlane Building, University of Manchester, Manchester M13 9PL, United Kingdom (e-mail: isabelle.m.hunt@manchester.ac.uk).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Suicide risk after discharge from psychiatric inpatient care is high, particularly in the first few weeks. The aim of the study was to identify risk factors and protective factors (that is, factors associated with a reduced risk of suicide), including variation in health care received, for suicide among patients in the two-week postdischarge period.

Methods  This was a national population-based retrospective case-control study of 100 psychiatric patients in England (2004–2006), age 18–65, who died by suicide within two weeks of hospital discharge. These patients were matched on discharge date with 100 living control group patients.

Results  Fifty-five percent of suicides occurred within a week of discharge, 49% of whom died before their first follow-up appointment. Conditional logistic regression analyses indicated that recent adverse life events and a short (less than one week) final admission were independently associated with postdischarge suicide, as were older age and comorbid psychiatric disorders. Receiving enhanced aftercare (under the Care Programme Approach) was protective of suicide.

Conclusions  Discharged patients viewed as being at high risk of suicide require immediate community follow-up. Mental health services should be mindful of discharging patients after a short admission. The potential role of detrimental life experiences indicates that mental health clinicians need to be aware of the circumstances into which patients are being discharged. Use of enhanced levels of care, such as that offered by the Care Programme Approach, may play a strong role in preventing suicide within two weeks of discharge.

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Topics

inpatient ; suicide
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Table 1Sociodemographic characteristics of suicide cases within two weeks of hospital discharge and a matched control groupa
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a Univariate conditional logistic regression analyses

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b Denominators vary for explanatory variables because of missing data. Explanatory variables are 97%–100% complete.

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c Range 18–64 for suicides, 18–62 for control group

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d Value relates to significance across all strata of the explanatory variable.

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e Includes retired workers, students, and homemakers

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Table 2Behavioral and clinical characteristics of persons who died by suicide within two weeks of hospital discharge and a matched control groupa
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a Univariate conditional logistic regression analyses

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b Denominators vary for explanatory variables because of missing data. Explanatory variables are 93%–100% complete.

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c Severe mental illness (schizophrenia or affective disorder) plus alcohol or drug misuse

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d Care Programme Approach, enhanced case management services

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Table 3Contact with psychiatric services among suicide cases within two weeks of hospital discharge and a matched control groupa
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a Univariate conditional logistic regression analyses

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b Denominators vary for explanatory variables due to missing data. Explanatory variables are 94%–100% complete.

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c Includes self-discharge, discharge after breach of ward rules or patient contract, patient request, and other patient-initiated discharge

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Table 4Independent predictors of postdischarge suicide risk in the final multivariate conditional logistic regression modela
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a Multivariate model was created with 85% (170 of 200) of the whole sample. McFadden’s pseudo r2=.53

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b Care Programme Approach, enhanced case management services

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