High suicide rates during psychiatric inpatient stay and shortly after discharge [2020]

Over recent decades, intense efforts to address suicides in psychiatric admitted people have been initiated. The aim was to calculate suicide rates, rate ratios, population attributable risks (PAR) and trends among people admitted to or recently discharged from psychiatric wards.

Using a cohort design, we obtained nationwide register‐data on 6,292,932 individuals aged 15+ living in Denmark during 1995‐2016. Of these, 178,703 (5.73%) males and 201,033 females (6.33%) had been admitted to psychiatric hospital. Incidence rate ratios (IRR) were obtained using Poisson regression analyses while adjusting for age‐ and calendar‐period. Trends were assessed using Joinpoint analyses.

In total 15075 persons died by suicide, of which 6174 had been psychiatrically admitted. Among males, the suicide rate during the first week of admission and after discharge were 3409 and 3148 per 100000 person‐years, respectively. The corresponding values for females were 1267 and 1631. Generally, estimated suicide rates were highest in those with affective or anxiety stress disorders. During first week of hospitalization, the IRR was 237 for males and of 322 for females when compared with those never hospitalized. In first week after discharge, the IRR was 225 and 425 for males and females, respectively. PAR estimates indicated 6% of male suicides and 13% of female suicides attributes to first week of admission and discharge. The inpatient suicide rate decreased annually 2.5% until 2009 followed by a 7.5% annual percentage increase. The suicide rate after discharge decreased steadily annually over the study period.

Despite finding declining post discharge suicide rates, the period surrounding a psychiatric admission was still associated with extremely high suicide rates.

Trine Madsen, Annette Erlangsen, Carsten Hjorthøj, Merete Nordentoft
Acta Psychiatrica Scandinavica, 26 July 2020