Research on identifying the relevant risk factors for suicides is faced with a multitude of methodological problems. The present study attempts to improve on some of these problems and to isolate those risk factors that are accessible in the early stages of the treatment of inpatients. A total of 3792 inpatients with monopolar or bipolar depression were treated during the period 1981-1992. Suicides (n=33) and controls (n=3759) were compared with respect to 77 sociodemographic and anamnestic variables and 195 standardised items of the admission summary. In addition to an analysis of contingency tables a discriminant analysis was performed. The suicide rate of patients with depressive psychosis was 2.7 times higher than the average rate of 0.324% for the entire clinic. Suicidal tendencies on admission proved to be the best predictor with a frequency of 91% in the suicide group and 40% in the control group, previous attempted suicide being the second best predictor. We conclude that the rate of inpatient suicide may have been underestimated for methodological reasons in the past decades. Many of the risk factors discussed in the literature may be of little predictive value at least in the initial stages of hospital treatment.

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For all 5,352 patients treated for schizophrenia at the Psychiatric Hospital of the University of Munich in 1981 and 1992, detailed routine and data processing-assisted documentations were made of the psychopharmacological therapies. Nineteen of the patients committed suicide while undergoing inpatient treatment; the control group consisted of all other patients (n = 5,333). More than 77 sociodemographic and anamnestic variables as well as 195 items from the admission summaries were taken into account while comparing the groups. Furthermore, the pharmacological data were classified according to drug groups and comparison was based on the mean frequency of prescription of each group. We analyzed the mean number of prescriptions for neuroleptics, tranquilizers, and antidepressants, which were further differentiated into sedating and nonsedating types. For frequently administered drugs, mean daily doses were also compared. Bivariate analysis of the data suggests that the suicide cases presented depressive signs, symptoms, and tendencies already present on admission more frequently than with controls; the same applies to previously attempted suicides. Discriminating analysis showed that the variables "feeling of loss of feelings," thought insertion," "visible depression," "free-floating anxiety," "suicidal tendencies," and "previously attempted suicide" have the greatest predictive value with respect to suicide, in descending order. No differences in psychopharmacological treatment between suicides and controls were found, apart from a significantly higher percentage of antidepressive treatments and a higher mean number of antidepressant prescriptions for the suicides.

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