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

  • I. M. Hunt (a1), N. Kapur (a1), R. Webb (a2), J. Robinson (a1), J. Burns (a1), J. Shaw (a1) and L. Appleby (a1)...

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.


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.


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.


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.

Corresponding author
*Address for correspondence: I. M. Hunt, Centre for Suicide Prevention, University Place, University of Manchester, Oxford Road, Manchester M13 9PL, UK. (Email:
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L Appleby , JA Dennehy , CS Thomas , EB Faragher , G Lewis (1999 a). Aftercare and clinical characteristics of people with mental illness who commit suicide: a case-control study. Lancet 353, 13971400.

L Appleby , J Shaw , T Amos , R McDonnell , C Harris , K McCann , K Kiernan , S Davies , H Bickley , R Parsons (1999 b). Suicide within 12 months of contact with mental health services: national clinical survey. British Medical Journal 318, 12351239.

KA Busch , J Fawcett , DG Jacobs (2003). Clinical correlates of inpatient suicide. Journal of Clinical Psychiatry 64, 1419.

JA Dennehy , L Appleby , CS Thomas , BE Faragher (1996). Case-control study of suicide by discharged psychiatric patients. British Medical Journal 312, 1580.

RA Desai , DJ Dausey , RA Rosenheck (2005). Mental health service delivery and suicide risk: the role of individual patient and facility factors. American Journal of Psychiatry 162, 311318.

JR Geddes , E Juszczak , F O'Brien , S Kendrick (1997). Suicide in the 12 months after discharge from psychiatric inpatient care, Scotland, 1968–1992. Journal of Epidemiology and Community Health 51, 430434.

M Goldacre , V Seagroatt , K Hawton (1993). Suicide after discharge from psychiatric inpatient care. Lancet 342, 283286.

TP Ho (2003). The suicide risk of discharged psychiatric patients. Journal of Clinical Psychiatry 64, 702707.

EH Høyer , AV Olesen , PB Mortensen (2004). Suicide risk in patients hospitalized because of an affective disorder: a follow-up study, 1973–1993. Journal of Affective Disorders 78, 209217.

E Isometsa , M Henriksson , M Heikkinen , J Lonnqvist (1993). Suicide after discharge from psychiatric inpatient care. Lancet 342, 10551056.

EA King , DS Baldwin , JMA Sinclair , NG Baker , MJ 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.

KR Linsley , K Schapira , TP Kelly (2001). Open verdict v. suicide – importance to research. British Journal of Psychiatry 178, 465468.

J Pirkis , P Burgess , D Jolley (2002). Suicide among psychiatric patients: a case control study. Australian and New Zealand Journal of Psychiatry 36, 8691.

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.

B Sohlman , V Lehtinen (1999). Mortality among discharged psychiatric patients in Finland. Acta Psychiatrica Scandinavica 99, 102109.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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