Psychiatric in-patient care and suicide in England, 1997 to 2008: a longitudinal study

Kapur, Navneet; Hunt, Isabelle M.; Windfuhr, Kirsten; Rodway, Cathryn; Webb, Roger T.; Rahman, Mohammad Shaiyan; Shaw, Jenny; Appleby, Louis

doi:10.1017/s0033291712000864

Cited by 55 publications

(50 citation statements)

References 25 publications

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“…Because prisoners who self-harm usually have several psychiatric comorbidities and psychosocial difficulties, 34,35 interventions might need to be more complex than in the general community, be multidisciplinary, and include speciality input. Restriction of access to means for self-harm is also important, similar to suicide prevention in psychiatric inpatients 36 . Overall, our findings are consistent with calls for greater health-care involvement in the management and prevention of self-harm in prisons 37 .…”

Section: Discussionsupporting

confidence: 82%

Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide

et al. 2014

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SummaryBackgroundSelf-harm and suicide are common in prisoners, yet robust information on the full extent and characteristics of people at risk of self-harm is scant. Furthermore, understanding how frequently self-harm is followed by suicide, and in which prisoners this progression is most likely to happen, is important. We did a case-control study of all prisoners in England and Wales to ascertain the prevalence of self-harm in this population, associated risk factors, clustering effects, and risk of subsequent suicide after self-harm.MethodsRecords of self-harm incidents in all prisons in England and Wales were gathered routinely between January, 2004, and December, 2009. We did a case-control comparison of prisoners who self-harmed and those who did not between January, 2006, and December, 2009. We also used a Bayesian approach to look at clustering of people who self-harmed. Prisoners who self-harmed and subsequently died by suicide in prison were compared with other inmates who self-harmed.Findings139 195 self-harm incidents were recorded in 26 510 individual prisoners between 2004 and 2009; 5–6% of male prisoners and 20–24% of female inmates self-harmed every year. Self-harm rates were more than ten times higher in female prisoners than in male inmates. Repetition of self-harm was common, particularly in women and teenage girls, in whom a subgroup of 102 prisoners accounted for 17 307 episodes. In both sexes, self-harm was associated with younger age, white ethnic origin, prison type, and a life sentence or being unsentenced; in female inmates, committing a violent offence against an individual was also a factor. Substantial evidence was noted of clustering in time and location of prisoners who self-harmed (adjusted intra-class correlation 0·15, 95% CI 0·11–0·18). 109 subsequent suicides in prison were reported in individuals who self-harmed; the risk was higher in those who self-harmed than in the general prison population, and more than half the deaths occurred within a month of self-harm. Risk factors for suicide after self-harm in male prisoners were older age and a previous self-harm incident of high or moderate lethality; in female inmates, a history of more than five self-harm incidents within a year was associated with subsequent suicide.InterpretationThe burden of self-harm in prisoners is substantial, particularly in women. Self-harm in prison is associated with subsequent suicide in this setting. Prevention and treatment of self-harm in prisoners is an essential component of suicide prevention in prisons.FundingWellcome Trust, National Institute for Health Research, National Offender Management Service, and Department of Health.

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Section: Discussionsupporting

confidence: 82%

Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide

et al. 2014

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“…The rate of suicide has been reported at five per 1000 occupied beds each year. 19 A meta-analysis of 27 studies reported a rate of 147 suicides per 100 000 inpatient years, with individual studies reporting figures as high as 860 suicides per 100 000 inpatient years. 20 Suicide tends to occur early .…”

Section: Inpatients and Recent Dischargementioning

confidence: 99%

Suicide risk assessment and intervention in people with mental illness

Bolton

Gunnell

Turecki

2015

BMJ

243

188

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Suicide is the 15th most common cause of death worldwide. Although relatively uncommon in the general population, suicide rates are much higher in people with mental health problems. Clinicians often have to assess and manage suicide risk. Risk assessment is challenging for several reasons, not least because conventional approaches to risk assessment rely on patient self reporting and suicidal patients may wish to conceal their plans. Accurate methods of predicting suicide therefore remain elusive and are actively being studied. Novel approaches to risk assessment have shown promise, including empirically derived tools and implicit association tests. Service provision for suicidal patients is often substandard, particularly at times of highest need, such as after discharge from hospital or the emergency department. Although several drug based and psychotherapy based treatments exist, the best approaches to reducing the risk of suicide are still unclear. Some of the most compelling evidence supports long established treatments such as lithium and cognitive behavioral therapy. Emerging options include ketamine and internet based psychotherapies. This review summarizes the current science in suicide risk assessment and provides an overview of the interventions shown to reduce the risk of suicide, with a focus on the clinical management of people with mental disorders.

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“…While Walsh et al [14] noted in their meta-analyses that previous studies found lower suicide rates than more recent studies, only few studies have actually addressed the period effects of inpatient suicide rates. Large cohort studies from England, Israel, and Denmark have reported a significant decreasing trend in inpatient suicide rates from the late 1990s into the new millennium [49,50,51]. The English study found that the decrease was highest in the youngest age group (15–44 years) and among patients with schizophrenia, whereas the Danish study noted that the decrease was most pronounced among female patients.…”

Section: Prevalence Rates and Time Change Of Inpatient Suicidementioning

confidence: 99%

“…Both studies found that the suicide rate had changed among those patients recently discharged. In England, the rate of post-discharge suicide rose from 1.39 per 1000 discharges in 1997/98 to 1.66 per 1000 discharges in 2007/08 [50], whereas, in Denmark, the post-discharge suicide rate was found to have decreased [52]. …”

Section: Prevalence Rates and Time Change Of Inpatient Suicidementioning

confidence: 99%

Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide—An Overview

Madsen

Erlangsen

Nordentoft

2017

IJERPH

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People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools.

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Psychiatric in-patient care and suicide in England, 1997 to 2008: a longitudinal study

Cited by 55 publications

References 25 publications

Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide

Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide

Suicide risk assessment and intervention in people with mental illness

Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide—An Overview

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