Completed suicide in medical/surgical patients: Who is at risk?

Abstract

Factors contributing to patients killing themselves while admitted to general hospital medical/surgical (med/surg) units have not been well described. These rare yet devastating suicides appear to have characteristics distinguishing them from suicides in psychiatric inpatients. This article emphasizes the importance of both agitation and readily available lethal means in suicides that are almost invariably impulsive. It also emphasizes how traditional risk factors such as past history of psychiatric illness, substance abuse, or suicidality typically are absent in this population, as are present depression and known suicidality. Caregivers seeking to prevent suicide in the med/surg environment therefore must appreciate the potential lethality of acute psychic and motoric agitation. Close surveillance of agitated patients, with interventions to calm them and secure their surroundings, will assure safety and save lives.

Inpatient medical–surgical suicidal behavior: a 12-year case–control study

“…Other stressors were psychosocial in nature, including difficulties at home or at work. Given that these suicide attempts in our series were largely unanticipated and most often preceded by identifiable states of physical or psychic discomfort, our findings concur with prior reports that emphasize the role of acute risk factors such as agitation and delirium in impulsive suicide attempts on medical or surgical units [11,16]. Traditional risk factors, however, should not be overlooked because the majority of patients in this series carried a prior diagnosis of major depression and several had histories of alcohol or polysubstance dependence, personality disorders or both.…”

“…Both med/surg and psychiatric suicides were typically impulsive, often angry and frequently precipitated by a discernible stress such as loss of emotional support from staff or family or severe physical discomfort stemming from pain or respiratory distress [16,17]. Suicidal behavior in a hospital setting has also been associated with withdrawal states from alcohol and episodes of disorganization and reaction to delusions or hallucinations in schizophrenic patients [10].…”

Suicide risk among general hospital inpatients

“…4 Warning signs associated with an imminent risk for suicide include irritability, increased anxiety, agitation, impulsivity, decreased emotional reaction, and refusal to eat or have visitors. [7][8][9] Marked differences exist between the modal death by suicide of a general hospital inpatient and an inpatient in a psychiatric unit or hospital. Among inpatients who die by suicide, those in general medical hospitals are more likely to be older, married, and employed compared to those in psychiatric units.…”

Response to Sher regarding Tseng et al’s “Standardized mortality ratio of inpatient suicide in a general hospital”

“…Studies comparing the characteristics of inpatient suicides at medicosurgical or psychiatric units consensually are rare. 2 In an earlier published article, we made a comparison of the characteristics between the psychiatric and nonpsychiatric suicidal inpatients. 3 In addition to having less known history of psychiatric illness, less suicide communication, rapid suicide attempts after admission and more suicide episodes during leave without giving notice may be the reasons responsible for the prevalent underestimation of suicide risk in nonpsychiatric units of general hospitals.…”