Skip to main content

Suicide in psychiatric hospital in-patients: Risk factors and their predictive power

  • John Powell (a1), John Geddes (a1), Jonathan Deeks (a2), Michael Goldacre (a3) and Keith Hawton (a1)...

Psychiatric hospital inpatients are known to be at high risk of suicide, yet there is little reliable knowledge of risk factors or their predictive power.


To identify risk factors for suicide in psychiatric hospital in-patients and to evaluate their predictive power in detecting people at risk of suicide.


Using a case–control design, 112 people who committed suicide while in-patients in psychiatric hospitals were compared with 112 randomly selected controls. Univariate analysis and multivariate analyses were used to estimate odds ratios and adjusted likelihood ratios.


The rate of suicide in psychiatric in-patients was 13.7 (95% CI 11.7–16.1) per 10 000 admissions. There were five predictive factors with likelihood ratios >2, following adjustment: planned suicide attempt, 4.1; actual suicide attempt, 4.9; recent bereavement, 4.0; presence of delusions, 2.3; chronic mental illness, 2.2; and family history of suicide, 4.6. On this basis, only two of the patients who committed suicide had a predicted risk of suicide above 5%.


Although several factors were identified that were strongly associated with suicide, their clinical utility is limited by low sensitivity and specificity, combined with the rarity of suicide, even in this high-risk group.

Corresponding author
Dr John Geddes, Warneford Hospital, Oxford OX3 7JX. Tel: 01865 226480, fax: 01865 793101, e-mail:
Hide All

Declaration of interest

No conflict of interest. Financial support detailed in Acknowledgements.

Hide All
Appleby, L. (1992) Suicide in psychiatric patients: risk and prevention. British Journal of Psychiatry, 161, 749758.
Appleby, L., Shaw, J., Amos, J., et al (1999a) Safer Services. Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. London: Stationery Office.
Appleby, L., Dennehy, J. A., Thomas, C. S., et al (1999b) Aftercare and clinical characteristics of people with mental illness who commit suicide: a case-control study. Lancet, 353, 13971400.
Blain, P. A. & Donaldson, L. J. (1995) The reporting of inpatient suicides: identifying the problem. Public Health, 109, 293301.
Charlton, J., Kelly, S., Dunnell, K., et al (1993) Suicide deaths in England and Wales: trends in factors associated with suicide deaths. Population Trends, 71, 3442.
Copas, J. B. & Robin, A. (1982) Suicide in psychiatric in-patients. British Journal of Psychiatry, 141, 503511.
Dean, A. G., Dean, J. A., Coulombier, D., et al (1995) Epi Info, Version 6: A Word-Processing, Database, and Statistics Program for Public Health on IBM-compatible Microcomputers. Atlanta, GA: Centers for Disease Control and Prevention.
Dennehy, J. A., Appleby, L., Thomas, C. S., et al (1996) Case–control study of suicide by discharged psychiatric patients. British Medical Journal, 312, 1580.
Feinstein, A. R. (1977) Clinical biostatistics XXXIX: The haze of Bayes, the aerial palaces of decision analysis, and the computerized Ouija board. Clinical Pharmacology and Therapeutics, 21, 482496.
Fernando, S. & Storm, V. (1984) Suicide among psychiatric patients of a district general hospital. Psychological Medicine, 14, 661672.
Geddes, J. R. (1999) Suicide and homicide in mentally ill patients. British Medical Journal, 318, 12251226.
Goldacre, M. J., Simmons, H., Henderson, J., et al (1988) Trends in episode-based and person-based rates of admission to hospital in the Oxford Record Linkage Study area. British Medical Journal, 296, 583584.
Goldstein, R. B., Black, D. W., Nasrallah, A., et al (1991) The prediction of suicide. Sensitivity, specificity, and predictive value of a multivariate model applied to suicide among 1906 patients with affective disorders. Archives of General Psychiatry, 48, 418422.
Hawton, K. (1987) Assessment of suicide risk. British Journal of Psychiatry, 150, 145153.
Langley, G. E. & Bayatti, N. N. (1984) Suicides in Exe Vale Hospital, 1972–1981. British Journal of Psychiatry, 145, 463467.
McGuffin, P., Farmer, A. E. & Harvey, I. (1991) A polydiagnostic application of operational criteria in studies of psychotic illness: development and reliability of the OPCRIT system. Archives of General Psychiatry, 48, 764770.
Modestin, J., Zarro, I. & Waldvogel, D. (1992) A study of suicide in schizophrenic in-patients. British Journal of Psychiatry, 160, 398401.
Morgan, H. G. & Priest, P. (1991) Suicide and other unexpected deaths among psychiatric in-patients. The Bristol confidential inquiry. British Journal of Psychiatry, 158, 368374.
Morgan, H. G. & Stanton, R. (1997) Suicide among psychiatric in-patients in a changing clinical scene. Suicidal ideation as a paramount index of short-term risk. British Journal of Psychiatry, 171, 561563.
Pokorny, A. D. (1983) Prediction of suicide in psychiatric patients. Report of a prospective study. Archives of General Psychiatry, 40, 249257.
Proulx, F., Lesage, A. D. & Grunberg, F. (1997) One hundred in-patient suicides. British Journal of Psychiatry, 171, 247250.
Read, D. A., Thomas, C. S. & Mellsop, G. W. (1993) Suicide among psychiatric inpatients in the Wellington region. Australian and New Zealand Journal of Psychiatry, 27, 392398.
Roy, A. & Draper, R. (1995) Suicide among psychiatric hospital inpatients. Psychological Medicine, 25, 199202.
Sharma, V., Persad, E. & Kueneman, K. (1998) A closer look at inpatient suicide. Journal of Affective Disorders, 47, 123129.
Spiegelhalter, D. J. & Knill-Jones, R. P. (1984) Statistical and knowledge-based approaches to clinical decision-support systems, with an application in gastroenterology. Journal of the Royal Statistical Society, 147, 3577.
SPSS (1997) SPSS 8.0 for Windows. Chicago, IL: SPSS.
StataCorp (1999) Stata Statistical Software: Release 6.0. College Station, TX: Stata Corporation.
Statistics and Epidemiology Research Corporation (1991) EGRET. Seattle, WA: SERC.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 20 *
Loading metrics...

Abstract views

Total abstract views: 80 *
Loading metrics...

* Views captured on Cambridge Core between 3rd January 2018 - 19th March 2018. This data will be updated every 24 hours.

Suicide in psychiatric hospital in-patients: Risk factors and their predictive power

  • John Powell (a1), John Geddes (a1), Jonathan Deeks (a2), Michael Goldacre (a3) and Keith Hawton (a1)...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *