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  • Currently known as: Epidemiology and Psychiatric Sciences Title history
    Epidemiologia e Psichiatria Sociale, Volume 19, Issue 1
  • March 2010, pp. 8-15

Suicides in psychiatric in-patients: what are we doing wrong?

Abstract
Abstract

Given the uncontested role of psychiatric illnesses in both fatal and non-fatal suicidal behaviours, efforts are continuously made in improving mental health care provision. In cases of severe mental disorder, when intensified treatment protocols and continuous supervision are required due to individual's impaired emotional, cognitive and social functioning (including danger to self and others), psychiatric hospitalisation is warranted. However, to date there is no convincing evidence that in-patient care prevents suicide. In fact, quite paradoxically, both admissions to a psychiatric ward and recent discharge from it have been found to increase risk for suicidal behaviours. What elements in the chain of well-intentioned approaches to treating psychiatric illness and suicidality fail to protect this vulnerable population is still unclear. The same holds true for the identifications of factors that may increase the risk for suicide. This editorial discusses current knowledge on this subject, proposing strategies that might improve prevention.

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Copyright
Corresponding author
Professor D. de Leo, Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, and National Centre of Excellence in Suicide Prevention, Mt Gravatt campus, Griffith University, Griffith, QLD 4122 (Australia). Fax: +61-7-3735.3450
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L. Appleby , J.A. Dennehy , C.S. Thomas , E.B. Faragher & G. Lewis (1999). Aftercare and clinical characteristics of people with mental illness who commit suicide: a case-control study. Lancet 353, 1397–p1400.

G. Arsenault-Lapierre , C. Kim & G. Turecki (2004). Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 4, 37.

J.M. Bertolote , A. Fleischmann , D. De Leo & D. Wasserman (2004). Psychiatric diagnoses and suicide: Revisiting the evidence. Crisis 25, 147155.

P.A. Blain & L.J. Donaldson (1995). The reporting of in-patient suicides: identifying the problem. Public Health 109, 293301.

B. Burgess , J. Pirkis , J. Morton & E. Croke (2000). Lessons from a comprehensive clinical audit of users of psychiatric services who committed suicide. Psychiatric Services 51, 15551560.

K.A Busch , J. Fawcett & Jacobs D.G. (2003). Clinical correlates of inpatient suicide. Journal of Clinical Psychiatry 64, 1419.

C. Cassells , B. Paterson , D. Dowding & R. Morrison (2005). Long- and short-term risk factors in the prediction of inpatient suicide: A review of the literature. Crisis 26, 5363.

J.T.O. Cavanagh , A.J. Carson , M. Sharpe & S.M. Lawrie (2003). Psychological autopsy studies of suicide: A systematic review. Psychological Medicine 33, 395405.

P. Cheung (1992). Suicide precautions for psychiatric inpatients: a review. Australian and New Zealand Journal of Psychiatry 26, 592598.

S. Cooper , D. Lezotte , J. Jacobellis & C. Diguiseppi (2006). Does availability of mental health resources prevent recurrent suicidal behavior? Suicide and Life-Threatening Behavior 36, 409417.

M. Crawford , (2004). Suicide following discharge from in-patient psychiatric care. Advances in Psychiatric Treatment 10, 434438.

D. De Leo & T. Heller (2007). Intensive case management in suicide attempters following discharge from inpatient psychiatric care. Australian Journal of Primary Health 13, 4959.

D. De Leo & K. Krysinska (2008). Suicidal behaviour by train collision in Queensland, 1990–2004. Australian and New Zealand Journal of Psychiatry 42, 772779.

E.A. Deisenhammer , C. DeCol , M. Honeder , H. Hinterhuber & W.W. Fleischhacker (2000). In-patient suicide in psychiatric hospitals. Acta Psychiatrica Scandinavica 102, 290294.

E.A. Deisenhammer , M. Huber , G. Kemmler , E.M. Weiss & H. Hinterhuber (2007). Psychiatric hospitalizations during the last 12 months before suicide. General Hospital Psychiatry 29, 6365.

M. Eklund (1996). Working relationship, participation, and outcome in a psychiatric day care unit based on occupational therapy. Scandinavian Journal of Occupational Therapy 3, 106113.

D.M. Fergusson , J. Horwood , E.M. Ridder & A.L. Beautrais (2005). Subthreshold depression in adolescence and mental health outcomes in adulthood. Archives of General Psychiatry 62, 6672.

T. Forsner , A.A. Wistedt , M. Brommels & Y. Forsell (2008). An approach to measure compliance to clinical guidelines in psychiatric care. BMC Psychiatry 8, 84–72.

C.H. Fung , Y.W. Lim , S. Mattke , C. Damberg & P.G. Shekelle (2008)., Systematic review: the evidence that publishing patient care performance data improves quality of care. Annals of Internal Medicine 148, 111123.

S.G. Gowers & L. Rowlands (2005). Inpatient services. Current Opinion in Psychiatry 18, 445448.

E.C. Harris & B. Barraclough (1997). Suicide as an outcome for mental disorders: a meta-analysis. British Journal of Psychiatry 170, 205228.

N. Hodelet & M. Hughson (2001). What to do when a patient commits suicide. Psychiatric Bulletin 25, 4345.

W.R. Holcomb , J.C. Parker , G.B. Leong , J. Thiele & J. Higdon (1998). Customer satisfaction and self-reported treatment outcomes among psychiatric inpatients. Psychiatric Services 49, 929934.

E.A. Hoyer , A.V. Olesen & P.B. Mortensen (2004). Suicide risk in patients hospitalised because of an affective disorder: a follow-up study, 1973–1993. Journal of Affective Disorders 78, 209217.

N. Huband & D. Tantam (2000) Attitudes to self-injury within a group of mental health staff. British Journal of Medical Psychology 73, 495504.

I.M. Hunt , N. Kapur , R. Webb , J. Robinson , J. Burns , P. Turnbull , J. Shaw & L. Appleby (2007). Suicide in current psychiatric in-patients: a case-control study: the national confidential inquiry into suicide and homicide. Psychological Medicine 37, 831837.

A. Jones & D. Crossley (2008). ‘In the mind of another’ shame and acute psychiatric inpatient care: an exploratory study. A report on phase one: service users. Journal of Psychiatric and Mental Health Nursing 15, 749757.

H.A. Johannessen , G. Dieserud , F. Jakhelln , P.H. Zahl & D. De Leo (2009). Changes in institutional psychiatric care and suicidal behaviour: a follow-up study of inpatient suicide attempters in Baerum, Norway. Social Psychiatry and Psychiatric Epidemiology 44, 845851.

C.K. Kan , T.P. Ho , J.Y. Dong & E.L. Dunn (2007). Risk factors for suicide in the immediate post-discharge period. Social Psychiatry and Psychiatric Epidemiology 42, 208214.

N. Kapur , I.M. Hunt , R.W. Webb , H. Bickley , K. Windfuhr , J. Shaw & L. Appleby (2006). Suicide in psychiatric in-patients in England, 1997 to 2003. Psychological Medicine 36, 14851492.

E.A. King , D.S. Baldwin , J.M.A. Sinclair , N. Baker , M.J. Campbell & C. Thompson (2001). The Wessex recent in-patient suicide study 1: case-control study of 234 recently discharged psychiatric patient suicides. British Journal of Psychiatry 178, 531536.

D.Z. Lieberman , H.L.P. Resnik & V. Holder-Perkins (2004). Environmental risk factors in hospital suicide. Suicide and Life Threatening Behavior 34, 448453.

B. Lloyd-Evans , M. Slade , D. Jagielska & S. Johnson (2009). Residential alternatives to acute psychiatric hospital admissions: systematic review. British Journal of Psychiatry 195, 109117.

V. Lorant , C. Depuydt , B. Gillain , A. Guillet & V. Dubois (2007). Involuntary commitment in psychiatric care: what drives the decision? Social Psychiatry and Psychiatric Epidemiology 42, 360365.

J.B. Luoma , C.E. Martin & J.L. Pearson (2002). Contact with mental health and primary care providers before suicide: a review of the evidence. American Journal of Psychiatry 159, 909916.

C.E. Mann & M.J. Himelein (2004). Factors associated with stigmatization of persons with mental illness. Psychiatric Services 55, 185187.

C.D. Mathers & D Loncar (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 3, e442.

M. McAllister , W. Moyle , S. Billett & M. Zimmer-Gembeck (2009). ‘I can actually talk to them now’: qualitative results of an educational intervention for emergency nurses caring for clients who self-injure. Journal of Clinical Nursing 18, 28382845.

J. Meehan , N. Kapur , I.M. Hunt , P. Turnbull , J. Robinson , H. Bickley , R. Parsons , S. Flynn , J. Burns , T. Amos , J. Shaw & L. Appleby (2006). Suicide in mental health in-patients and within 3 months of discharge: national clinical survey. British Journal of Psychiatry 188, 129134.

H.G. Morgan & P. Priest (1991). Suicide and other unexpected deaths among psychiatric inpatients: the Bristol confidential inquiry. British Journal of Psychiatry 158, 368374.

J. Motto & A. Bostrom (2001). A randomized controlled trial of postcrisis suicide prevention. Psychiatric Service 52, 828833.

P. Patterson , R. Whittington & J. Bogg (2007). Testing the effectiveness of an educational intervention aimed at changing attitudes to selfharm. Journal of Psychiatric and Mental Health Nursing 14, 100105.

S. Pirkola , B. Sohlman , H. Heilä & K. Wahlbeck (2007). Reductions in post-discharge suicide after deinstitutionalization and decentralization: a nationwide register study in Finland. Psychiatric Services 58, 221226.

J. Powell , J. Geddes , J. Deeks , M. Goldacre & K. Hawton (2000). Suicide in psychiatric hospital in-patients: risk factors and their predictive power. British Journal of Psychiatry 176, 266272.

P. Qin & M. Nordentoft (2005). Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Archives of General Psychiatry 62, 427432.

J.B. Ritsher & J.C. Phelan (2004). Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Research 129, 257265.

H.J. Salize & H. Dressing (2004). Epidemiology of involuntary placement of mentally ill people across the European Union. British Journal of Psychiatry 184, 163168.

S. Saxena , G. Thornicroft , M. Knapp & H. Whiteford (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet 370, 878889.

A. Shah & T. Ganesvaran (2001). Completed suicide among psychiatric in-patients with depression in an Australian mental hospital. International Journal of Methods in Psychiatric Research 9, 2531.

V. Sharma , E. Persad & K. Kueneman (1998). A closer look at inpatient suicide. Journal of Affective Disorders 47, 123129.

R. Simon & T.G. Gutheil (2009). Sudden improvement among highrisk suicidal patients: should it be trusted? Psychiatric Services 60, 387389.

H. Spiessl , B. Hubner-Liebermann & C. Cording (2002). Suicidal behaviour of psychiatric in-patients. Acta Psychiatrica Scandinavica 106, 134138.

G. Thornicroft & M. Tansella (2004). Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence. British Journal of Psychiatry 185, 283290.

C.T. Tishler & N.S. Reiss (2009). Inpatient suicide: preventing a common sentinel event. General Hospital Psychiatry 31, 103109.

M. Välimäki , J. Taipale & R. Kaltiala-Heino (2001). Deprivation of liberty in psychiatric treatment: a Finnish perspective. Nursing Ethics 8, 522532.

M. Webber & P. Huxley (2004). Social exclusion and risk of emergency compulsory admission: A case-control study. Social Psychiatry and Psychiatric Epidemiology 39, 10001009.

L. Williams (1998). A ‘classic’ case of borderline personality disorder. Psychiatric Services 49, 173174.

L.R. Wingate , T.E. Joiner , R.L. Walker , M.D. Rudd & D.A. Jobes (2004). Empirically informed approaches to topics in suicide risk assessment. Behavioral Sciences and the Law 22, 651665.

H.U. Wittchen & F. Jacobi (2005). Size and burden of mental disorders in Europe: a critical review and appraisal of 27 studies. European Neuropsychopharmacology 15, 357–336.

M. Wolfersdorf (2000). Suicide among psychiatric inpatients. In The International Handbook of Suicide and Attempted Suicide (ed. K. Hawton and K. van Heeringen ), pp. 457466. John Wiley & Sons: West Sussex.

A. Wysocker (1999). Suicide: risk management strategies. Journal of the American Psychiatric Nurses Association 5, 164166.

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