Meta‐analysis of suicide rates among people discharged from non‐psychiatric settings after presentation with suicidal thoughts or behaviours

Abstract

analysis of suicide rates among people discharged from non-psychiatric settings after presentation with suicidal thoughts or behaviours.Objective: To quantify the suicide rate among people discharged from nonpsychiatric settings after presentations with suicidal thoughts or behaviours. Method: Meta-analysis of studies reporting suicide deaths among people with suicidal thoughts or behaviours after discharge from emergency departments or the medical or surgical wards of general hospitals. Results: A total of 115 studies reported 167 cohorts and 3747 suicide deaths among 248 005 patients during 1 263 727 person-years. The pooled suicide rate postdischarge was 483 suicide deaths per 100 000 person-years (95% confidence interval (CI) 445-520, prediction interval (PI) 200-770) with high between-sample heterogeneity (I 2 = 92). The suicide rate was highest in the first year postdischarge (851 per 100 000 person-years) but remained elevated in the long term. Suicide rates were elevated among samples of men (716 per 100 000 person-years) and older people (799 per 100 000 person-years) but were lower in samples of younger people (107 per 100 000 person-years) and among studies published between 2010 and 2018 (329 per 100 000 person-years). Conclusions: People with suicidal thoughts or behaviours who are discharged from non-psychiatric settings have highly elevated rates of suicide despite a clinically meaningful decline in these suicide rates in recent decades. Summations• The pooled suicide rate among patients with suicidal thoughts or behaviours following discharge from a non-psychiatric setting was 483 per 100 000 person-years (95% CI 445-520).• Suicide rates were lower among samples of younger people (<25 years of age) and among more recently published studies, but were higher in the first year after discharge, among older people (>55 years of age), and men.• All patients presenting to emergency departments and general hospitals with suicidal thoughts or behaviours warrant a careful assessment and individualized treatment planning. Considerations• High between-study heterogeneity limits the extent to which the results can be regarded as generalizable.• The meta-analysis could not examine a range of clinical factors that might contribute to variation in suicide rates.• Few studies from low-and middle-income countries could be included.

Preventing suicide, promoting resilience: Is this achievable from a global perspective?

“…Although the people who provide the gate keeper role have a significant opportunity to recognize mental health symptoms and suicidal ideas early, a review their training showed that it is not standardized globally, especially as some gatekeeper training is delivered face to face and some by e‐learning. This makes it difficult to draw conclusions about the ingredients of the intervention that make the gatekeeper role effective in preventing suicide (Yonemoto, Kawashima, Endo, & Yamada, ).…”

Suizidalität – ein psychiatrischer Notfall in der Praxis

“…▪ Suizidversuche und parasuizidale Handlungen in der Vorgeschichte [5,7] erhöhen das Risiko eines Suizids, ebenso wie ▪ Suizide in der persönlichen Umgebung, Suizide in der Familiengeschichte oder in Medienberichten [5,8]. ▪ Ein erhöhtes Risiko für einen Suizid besteht im ersten Monat, im ersten Jahr, etwas geringer sogar darüber hinaus nach Entlassung aus einer psychiatrischen Klinik oder einer nicht psychiatrischen Klinik bei dort aufgetretenen Suizidgedanken [9,10]. ▪ Belastende "life events" oder schwierige Lebenssituationen (durch Arbeitslosigkeit oder fehlende Bindungen), chronische und lebensverändernde Erkrankungen sowie schwere Schmerzen bergen das Risiko von Suizidgedanken oder suizidalen Handlungen [5,6] ebenso wie ▪ die Erfahrung mit psychotischen Episoden [11].…”

Comparing the predictive value of suicide risk screening to the detection of suicide risk using electronic health records in an urban pediatric emergency department

“…The increase in risk following healthcare contact is also seen among patients discharged from non-psychiatric settings, including emergency departments (EDs), as well. 9 The identification of suicide risk at healthcare facilities is a major priority in suicide prevention efforts. However, in recent years two distinct approaches have emerged regarding how best to do this.…”

“…Second, the acute time period following discharge from a healthcare facility is often characterized by elevated risk for suicide attempt and death. 9–11 Chung et al 10 showed that across 100 studies, the rate of suicide during the first 3 months after discharge from a psychiatric facility was approximately 100 times higher than the global suicide rate. The increase in risk following healthcare contact is also seen among patients discharged from non-psychiatric settings, including emergency departments (EDs), as well.…”

“…The increase in risk following healthcare contact is also seen among patients discharged from non-psychiatric settings, including emergency departments (EDs), as well. 9…”