Risk factors for suicides of inpatients with depressive psychoses

Abstract

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.

Meta‐analysis of the association between suicidal ideation and later suicide among patients with either a schizophrenia spectrum psychosis or a mood disorder

“…Twenty–six papers describing 24 studies contained data about suicidal ideation in people who subsequently died by suicide and suitable controls in groups of patients identified as having either one of the mood disorders or a schizophrenia spectrum psychosis. The 24 studies included in the analysis were made up of 13 studies of patients with schizophrenia spectrum psychosis , 10 studies of patients with mood disorders , and one study that reported on both diagnostic groups separately . Hence, there were 14 studies of patients with schizophrenia spectrum psychosis and 11 studies of mood disorders available for meta‐analysis (see Tables and ).…”

“…Only one study, with a small number of suicides, recorded the presence of suicidal ideation and suicide among both patients with schizophrenia spectrum psychosis and those with mood disorders in the same region and using the same methods . Two further pairs of studies examined similar patient groups and used similar methods . The way suicidal ideation was defined and recorded might have differed between diagnostic groups.…”

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

“…Cohort studies have found that suicide occurs in between 0.14%–0.32% of all psychiatric inpatients, while suicides are found to occur with a frequency of 0.08%–0.19% per admission [16,34,35,36,37]. …”

“…Most studies have reported rates of inpatient suicide per number of admissions or patients, probably because this type of data is easier to collect through routine clinical data. Inpatient rates have been estimated to be between 54 and 404 suicides per 100,000 admissions [31,34,36,37,38,39,40,41,42,43] and between 127 and 332 suicides per 100,000 patients [35,37,43,44,45]. Expectedly, rates calculated per inpatient are higher than rates calculated per admission, as one patient can have more than one admission.…”

“…Furthermore, most studies used a case-control design and logistic regression analyses. Some few studies were based on patients with a certain diagnosis only [30,35,38,53], or the analysis was conducted separately for different diagnoses [44] (see comments in Table 2). Only one study included a national sample of patients [16].…”