The effect of sex on suicide risk during and after psychiatric inpatient care in 12 countries—An ecological study

Listabarth, Stephan; Vyssoki, Benjamin; Glahn, Alexander; Gmeiner, Andrea; Pruckner, Nathalie; Vyssoki, Sandra; Wippel, Andreas; Waldhoer, Thomas; König, Daniel

doi:10.1192/j.eurpsy.2020.83

Cited by 10 publications

(3 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adjustment disorders are not frequently included in epidemiological mental health studies, and further research is needed to determine their exact role with regard to suicide risk. Second, although postdischarge suicide rates in this study were higher among males compared with females (1.3% vs 0.9%), consistent with an earlier study, females had disproportionately high suicide rates compared with the general population (SMR, 47.6), in line with previous evidence and potentially explained by higher treatment-seeking rates among females with severe disorders . In line with a study among Danish patients, we found that admission for bipolar disorder was associated with postdischarge suicide among females.…”

Section: Discussionsupporting

confidence: 92%

“…Adjustment disorders are not frequently included in epidemiological mental health studies, and further research is needed to determine their exact role with regard to suicide risk. Second, although postdischarge suicide rates in this study were higher among males compared with females (1.3% vs 0.9%), consistent with an earlier study, 29 females had disproportionately high suicide rates compared with the general population (SMR, 47.6), in line with previous evidence 30 and potentially explained by higher treatment-seeking rates among females with severe disorders. 31 In line with a study among Danish patients, 32 we found that admission for bipolar disorder was associated with postdischarge suicide among females.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge

Mortier,

Conde,

Alayo

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceThere is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization.ObjectiveTo compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization.Design, Setting, and ParticipantsThis retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024.ExposuresSocioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations.Main Outcomes and MeasuresPostdischarge premature death (ie, all-cause death before age 70 years) and suicide (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted.ResultsA total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males).Conclusions and RelevanceIn this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.

show abstract

Section: Discussionsupporting

confidence: 92%

“…Adjustment disorders are not frequently included in epidemiological mental health studies, and further research is needed to determine their exact role with regard to suicide risk. Second, although postdischarge suicide rates in this study were higher among males compared with females (1.3% vs 0.9%), consistent with an earlier study, 29 females had disproportionately high suicide rates compared with the general population (SMR, 47.6), in line with previous evidence 30 and potentially explained by higher treatment-seeking rates among females with severe disorders. 31 In line with a study among Danish patients, 32 we found that admission for bipolar disorder was associated with postdischarge suicide among females.…”

Section: Discussionsupporting

confidence: 91%

Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge

Mortier,

Conde,

Alayo

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…Such findings may be relevant compared to a study investigating gender inequalities in inpatient suicide rates during psychiatric inpatient treatment and after discharge in 12 countries. The authors reported a similar gender gap in suicide risk, with females having higher suicide rates during and after hospitalization [ 40 ]. However, contrasting results have been reported, with a higher risk in male patients [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

High depression symptomatology and mental pain characterize suicidal psychiatric patients

et al. 2022

View full text Add to dashboard Cite

Background Symptoms of depression are transdiagnostic heterogenous features frequently assessed in psychiatric disorders, that impact the response to first-line treatment and are associated with higher suicide risk. This study assessed whether severe mental pain could characterize a specific phenotype of severely depressed high-risk psychiatric patients. We also aimed to analyze differences in treatments administered. Methods 2,297 adult patients (1,404 females and 893 males; mean age = 43.25 years, SD = 15.15) treated in several Italian psychiatric departments. Patients were assessed for psychiatric diagnoses, mental pain, symptoms of depression, hopelessness, and suicide risk. Results More than 23% of the patients reported high depression symptomatology and high mental pain (HI DEP/HI PAIN). Compared to patients with lower symptoms of depression, HI DEP/HI PAIN is more frequent among females admitted to an inpatient department and is associated with higher hopelessness and suicide risk. In addition, HI DEP/HI PAIN (compared to both patients with lower symptoms of depression and patients with higher symptoms of depression but lower mental pain) were more frequently diagnosed in patients with personality disorders and had different treatments. Conclusions Patients reporting severe symptoms of depression and high mental pain presented a mixture of particular dangerousness (high trait hopelessness and the presence of suicide ideation with more frequency and less controllability and previous suicide behaviors). The presence of severe mental pain may act synergically in expressing a clinical phenotype that is likewise treated with a more complex therapeutic regime than that administered to those experiencing symptoms of depression without mental pain.

show abstract

MUW researcher of the month

2021

Wien Klin Wochenschr

View full text Add to dashboard Cite

The effect of sex on suicide risk during and after psychiatric inpatient care in 12 countries—An ecological study

Cited by 10 publications

References 26 publications

Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge

Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge

High depression symptomatology and mental pain characterize suicidal psychiatric patients

MUW researcher of the month

Contact Info

Product

Resources

About