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Suicides in psychiatric in-patients: what are we doing wrong?

Published online by Cambridge University Press:  11 April 2011

Diego De Leo  and
Jerneja Sveticic
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Abstract

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Given the uncontested role of psychiatric illnesses in both fatal and non-fatal suicidal behaviours, efforts are continuously made in improving mental health care provision. In cases of severe mental disorder, when intensified treatment protocols and continuous supervision are required due to individual's impaired emotional, cognitive and social functioning (including danger to self and others), psychiatric hospitalisation is warranted. However, to date there is no convincing evidence that in-patient care prevents suicide. In fact, quite paradoxically, both admissions to a psychiatric ward and recent discharge from it have been found to increase risk for suicidal behaviours. What elements in the chain of well-intentioned approaches to treating psychiatric illness and suicidality fail to protect this vulnerable population is still unclear. The same holds true for the identifications of factors that may increase the risk for suicide. This editorial discusses current knowledge on this subject, proposing strategies that might improve prevention.

Type
Editorials
Information
Epidemiology and Psychiatric Sciences , Volume 19 , Issue 1 , March 2010 , pp. 8 - 15
Copyright
Copyright © Cambridge University Press 2010

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th Ed. American Psychiatric Press: Washington.Google Scholar
Appleby, L. (2000). Prevention of suicide in psychiatric patients. In The International Handbook of Suicide and Attempted Suicide (ed. Hawton, K. and van Heeringen, K.), pp. 617–630. John Wiley & Sons: West Sussex.Google Scholar
Appleby, L., Dennehy, J.A., Thomas, C.S., Faragher, E.B. & Lewis, G. (1999). Aftercare and clinical characteristics of people with mental illness who commit suicide: a case-control study. Lancet 353, 1397–p1400.CrossRefGoogle ScholarPubMed
Arsenault-Lapierre, G., Kim, C. & Turecki, G. (2004). Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 4, 37.Google Scholar
Bertolote, J.S., Fleischmann, A., De Leo, D. & Wasserman, D. (2003). Suicide and mental disorders: do we know enough? British Journal of Psychiatry 183M, 382–383.Google Scholar
Bertolote, J.M., Fleischmann, A., De Leo, D. & Wasserman, D. (2004). Psychiatric diagnoses and suicide: Revisiting the evidence. Crisis 25, 147–155.Google Scholar
Blain, P.A. & Donaldson, L.J. (1995). The reporting of in-patient suicides: identifying the problem. Public Health 109, 293–301.CrossRefGoogle ScholarPubMed
Burgess, B., Pirkis, J., Morton, J. & Croke, E. (2000). Lessons from a comprehensive clinical audit of users of psychiatric services who committed suicide. Psychiatric Services 51, 1555–1560.CrossRefGoogle ScholarPubMed
Busch, K.A, Fawcett, J. & Jacobs D.G. (2003). Clinical correlates of inpatient suicide. Journal of Clinical Psychiatry 64, 14–19.CrossRefGoogle ScholarPubMed
Cassells, C., Paterson, B., Dowding, D. & Morrison, R. (2005). Long- and short-term risk factors in the prediction of inpatient suicide: A review of the literature. Crisis 26, 53–63.CrossRefGoogle ScholarPubMed
Cavanagh, J.T.O., Carson, A.J., Sharpe, M. & Lawrie, S.M. (2003). Psychological autopsy studies of suicide: A systematic review. Psychological Medicine 33, 395–405.Google Scholar
Cheung, P. (1992). Suicide precautions for psychiatric inpatients: a review. Australian and New Zealand Journal of Psychiatry 26, 592–598.CrossRefGoogle ScholarPubMed
Combs, H. & Romm, S. (2007). Psychiatric inpatient suicide: a literature review. Primary Psychiatry 14, 67–74.Google Scholar
Cooper, S., Lezotte, D., Jacobellis, J. & Diguiseppi, C. (2006). Does availability of mental health resources prevent recurrent suicidal behavior? Suicide and Life-Threatening Behavior 36, 409–417.Google Scholar
Crawford, M., (2004). Suicide following discharge from in-patient psychiatric care. Advances in Psychiatric Treatment 10, 434–438.CrossRefGoogle Scholar
De Leo, D. & Heller, T. (2007). Intensive case management in suicide attempters following discharge from inpatient psychiatric care. Australian Journal of Primary Health 13, 49–59.CrossRefGoogle Scholar
De Leo, D. & Krysinska, K. (2008). Suicidal behaviour by train collision in Queensland, 1990–2004. Australian and New Zealand Journal of Psychiatry 42, 772–779.Google Scholar
Deisenhammer, E.A., DeCol, C., Honeder, M., Hinterhuber, H. & Fleischhacker, W.W. (2000). In-patient suicide in psychiatric hospitals. Acta Psychiatrica Scandinavica 102, 290–294.Google Scholar
Deisenhammer, E.A., Huber, M., Kemmler, G., Weiss, E.M. & Hinterhuber, H. (2007). Psychiatric hospitalizations during the last 12 months before suicide. General Hospital Psychiatry 29, 63–65.Google Scholar
Eklund, M. (1996). Working relationship, participation, and outcome in a psychiatric day care unit based on occupational therapy. Scandinavian Journal of Occupational Therapy 3, 106–113.CrossRefGoogle Scholar
Fergusson, D.M., Horwood, J., Ridder, E.M. & Beautrais, A.L. (2005). Subthreshold depression in adolescence and mental health outcomes in adulthood. Archives of General Psychiatry 62, 66–72.Google Scholar
Forsner, T., Wistedt, A.A., Brommels, M. & Forsell, Y. (2008). An approach to measure compliance to clinical guidelines in psychiatric care. BMC Psychiatry 8, 84–72.Google Scholar
Fung, C.H., Lim, Y.W., Mattke, S., Damberg, C. & Shekelle, P.G. (2008)., Systematic review: the evidence that publishing patient care performance data improves quality of care. Annals of Internal Medicine 148, 111–123.Google Scholar
Goldberg, J.F., Ernst, C.L. & Bird, S. (2007). Predicting hospitalization versus discharge of suicidal patients presenting to a psychiatric emergency service. Psychiatric Services 4, 561–565.CrossRefGoogle Scholar
Gowers, S.G. & Rowlands, L. (2005). Inpatient services. Current Opinion in Psychiatry 18, 445–448.Google Scholar
Harris, E.C. & Barraclough, B. (1997). Suicide as an outcome for mental disorders: a meta-analysis. British Journal of Psychiatry 170, 205–228.CrossRefGoogle ScholarPubMed
Hodelet, N. & Hughson, M. (2001). What to do when a patient commits suicide. Psychiatric Bulletin 25, 43–45.CrossRefGoogle Scholar
Holcomb, W.R., Parker, J.C., Leong, G.B., Thiele, J. & Higdon, J. (1998). Customer satisfaction and self-reported treatment outcomes among psychiatric inpatients. Psychiatric Services 49, 929–934.CrossRefGoogle ScholarPubMed
Hoyer, E.A., Olesen, A.V. & Mortensen, P.B. (2004). Suicide risk in patients hospitalised because of an affective disorder: a follow-up study, 1973–1993. Journal of Affective Disorders 78, 209–217.CrossRefGoogle ScholarPubMed
Huband, N. & Tantam, D. (2000) Attitudes to self-injury within a group of mental health staff. British Journal of Medical Psychology 73, 495–504.CrossRefGoogle ScholarPubMed
Hunt, I.M., Kapur, N., Webb, R., Robinson, J., Burns, J., Turnbull, P., Shaw, J. & Appleby, L. (2007). Suicide in current psychiatric in-patients: a case-control study: the national confidential inquiry into suicide and homicide. Psychological Medicine 37, 831–837.Google Scholar
Jacobs, D.G., Baldessarini, R.J., Conwell, Y., Fawcett, J.A., Horton, L., Meltzer, H., Pfeffer, C.R. & Simon, R.I. (2003). Practice guideline for the assessment and treatment of patients with suicidal behaviors. American Journal of Psychiatry 160, 1–60.Google Scholar
Janofsky, J.S. (2009). Reducing inpatient suicide risk: using human factors analysis to improve observation practices. Journal of the American Academy of Psychiatry and the Law 37, 15–24.Google Scholar
Jones, A. & Crossley, D. (2008). ‘In the mind of another’ shame and acute psychiatric inpatient care: an exploratory study. A report on phase one: service users. Journal of Psychiatric and Mental Health Nursing 15, 749–757.Google Scholar
Johannessen, H.A., Dieserud, G., Jakhelln, F., Zahl, P.H. & De Leo, D. (2009). Changes in institutional psychiatric care and suicidal behaviour: a follow-up study of inpatient suicide attempters in Baerum, Norway. Social Psychiatry and Psychiatric Epidemiology 44, 845–851.CrossRefGoogle ScholarPubMed
Joint Commission on Accreditation of Healthcare Organization (2009). Sentinel event policy and procedures. Retrieved December 15, 2009, from http://www.jointcommission.org/SentinelEvents/PolicyandProcedures/Google Scholar
Kaltiala-Heino, R. (2009). Involuntary commitment and detainment in adolescent psychiatric inpatient care. Social Psychiatry and Psychiatric Epidemiology. Published online: 19 August 2009. doi: 10.1007/s00127–009–0116–3.CrossRefGoogle Scholar
Kan, C.K., Ho, T.P., Dong, J.Y. & Dunn, E.L. (2007). Risk factors for suicide in the immediate post-discharge period. Social Psychiatry and Psychiatric Epidemiology 42, 208–214.Google Scholar
Kapur, N., Hunt, I.M., Webb, R.W., Bickley, H., Windfuhr, K., Shaw, J. & Appleby, L. (2006). Suicide in psychiatric in-patients in England, 1997 to 2003. Psychological Medicine 36, 1485–1492.CrossRefGoogle ScholarPubMed
King, E.A., Baldwin, D.S., Sinclair, J.M.A., Baker, N., Campbell, M.J. & Thompson, C. (2001). The Wessex recent in-patient suicide study 1: case-control study of 234 recently discharged psychiatric patient suicides. British Journal of Psychiatry 178, 531–536.Google Scholar
Lieberman, D.Z., Resnik, H.L.P. & Holder-Perkins, V. (2004). Environmental risk factors in hospital suicide. Suicide and Life Threatening Behavior 34, 448–453.Google Scholar
Lloyd-Evans, B., Slade, M., Jagielska, D. & Johnson, S. (2009). Residential alternatives to acute psychiatric hospital admissions: systematic review. British Journal of Psychiatry 195, 109–117.Google Scholar
Lorant, V., Depuydt, C., Gillain, B., Guillet, A. & Dubois, V. (2007). Involuntary commitment in psychiatric care: what drives the decision? Social Psychiatry and Psychiatric Epidemiology 42, 360–365.CrossRefGoogle ScholarPubMed
Luoma, J.B., Martin, C.E. & Pearson, J.L. (2002). Contact with mental health and primary care providers before suicide: a review of the evidence. American Journal of Psychiatry 159, 909–916.Google Scholar
Mann, C.E. & Himelein, M.J. (2004). Factors associated with stigmatization of persons with mental illness. Psychiatric Services 55, 185–187.CrossRefGoogle ScholarPubMed
Mathers, C.D. & Loncar, D (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 3, e442.Google Scholar
McAllister, M., Moyle, W., Billett, S. & Zimmer-Gembeck, M. (2009). ‘I can actually talk to them now’: qualitative results of an educational intervention for emergency nurses caring for clients who self-injure. Journal of Clinical Nursing 18, 2838–2845.Google Scholar
Meehan, J., Kapur, N., Hunt, I.M., Turnbull, P., Robinson, J., Bickley, H., Parsons, R., Flynn, S., Burns, J., Amos, T., Shaw, J. & Appleby, L. (2006). Suicide in mental health in-patients and within 3 months of discharge: national clinical survey. British Journal of Psychiatry 188, 129–134.Google Scholar
Mehlum, L. (2009). Treatment of suicide attempts and suicidality in psychiatric care. In Oxford Textbook of Suicidology and Suicide Prevention: A Global Perspective (ed. Wasserman, D. and Wasserman, C.), pp. 471–476.Oxford University Press: New York.Google Scholar
Morgan, H.G. & Priest, P. (1991). Suicide and other unexpected deaths among psychiatric inpatients: the Bristol confidential inquiry. British Journal of Psychiatry 158, 368–374.CrossRefGoogle ScholarPubMed
Motto, J. & Bostrom, A. (2001). A randomized controlled trial of postcrisis suicide prevention. Psychiatric Service 52, 828–833.Google Scholar
Nock, M.K., Hwang, I., Sampson, N., Kessler, R.C., Angermeyer, M., Beautrais, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., de Graaf, R., Florescu, S., Gureje, O., Haro, J.M., Hu, C., Huang, Y., Karam, E.G., Kawakami, N., Kovess, V., Levinson, D., Posada-Villa, J., Sagar, R., Tomov, T., Viana, M.C. & Williams, D.R. (2009). Crossnational analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Medicine. Published online: 11 August 2009. doi:10.1371/journal.pmed.1000123.Google Scholar
Paris, J. (2007). Half in Love with Death: Managing the Chronically Suicidal Patient. Lawrence Erlbaum Associated: Mahwah, NJ.Google Scholar
Patterson, P., Whittington, R. & Bogg, J. (2007). Testing the effectiveness of an educational intervention aimed at changing attitudes to selfharm. Journal of Psychiatric and Mental Health Nursing 14, 100–105.Google Scholar
Pirkola, S., Sohlman, B., Heilä, H. & Wahlbeck, K. (2007). Reductions in post-discharge suicide after deinstitutionalization and decentralization: a nationwide register study in Finland. Psychiatric Services 58, 221–226.Google Scholar
Powell, J., Geddes, J., Deeks, J., Goldacre, M. & Hawton, K. (2000). Suicide in psychiatric hospital in-patients: risk factors and their predictive power. British Journal of Psychiatry 176, 266–272.Google Scholar
Qin, P. & Nordentoft, M. (2005). Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Archives of General Psychiatry 62, 427–432.CrossRefGoogle ScholarPubMed
Ritsher, J.B. & Phelan, J.C. (2004). Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Research 129, 257–265.Google Scholar
Rosenhan, D.L. (1973). On being sane in insane places. Science, 250–258.Google Scholar
Salize, H.J. & Dressing, H. (2004). Epidemiology of involuntary placement of mentally ill people across the European Union. British Journal of Psychiatry 184, 163–168.Google Scholar
Saxena, S., Thornicroft, G., Knapp, M. & Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet 370, 878–889.Google Scholar
Shah, A. & Ganesvaran, T. (2001). Completed suicide among psychiatric in-patients with depression in an Australian mental hospital. International Journal of Methods in Psychiatric Research 9, 25–31.CrossRefGoogle Scholar
Sharma, V., Persad, E. & Kueneman, K. (1998). A closer look at inpatient suicide. Journal of Affective Disorders 47, 123–129.CrossRefGoogle Scholar
Simon, R. & Gutheil, T.G. (2009). Sudden improvement among highrisk suicidal patients: should it be trusted? Psychiatric Services 60, 387–389.Google Scholar
Spiessl, H., Hubner-Liebermann, B. & Cording, C. (2002). Suicidal behaviour of psychiatric in-patients. Acta Psychiatrica Scandinavica 106, 134–138.Google Scholar
Tanney, B.L. (2000). Psychiatric diagnoses and suicidal acts. In Comprehensive Textbook of Suicidology (ed. Maris, R.W., Berman, A.L. and Silverman, M.M), pp. 311–341. Guilford Press: New York.Google Scholar
Thornicroft, G. & Tansella, M. (2004). Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence. British Journal of Psychiatry 185, 283–290.Google Scholar
Tidemalm, D., Waern, M., Stefansson, C.-G., Elofsson, S. & Runeson, B. (2008). Excess mortality in persons with severe mental disorder in Sweden: a cohort study of 12 103 individuals with and without contact with psychiatric services. Clinical Practice and Epidemiology in Mental Health 4, 23–31.Google Scholar
Tishler, C.T. & Reiss, N.S. (2009). Inpatient suicide: preventing a common sentinel event. General Hospital Psychiatry 31, 103–109.CrossRefGoogle ScholarPubMed
Traskman-Bendz, L. & Sunnqvist, C. (2009). A specialized inpatient unit for suicidal patients: dvantages and disadvantages. In Oxford Textbook of Suicidology and Suicide Prevention: A Global Perspective (ed. Wasserman, D. and Wasserman, C.), pp. 477–482.Oxford University Press: New York.Google Scholar
Välimäki, M., Taipale, J. & Kaltiala-Heino, R. (2001). Deprivation of liberty in psychiatric treatment: a Finnish perspective. Nursing Ethics 8, 522–532.Google Scholar
Van Egmond, N. & Diekstra, R.F. (1990). The predictability of suicidal behavior: the results of a meta-analysis. Crisis 11, 57–84.Google Scholar
Webber, M. & Huxley, P. (2004). Social exclusion and risk of emergency compulsory admission: A case-control study. Social Psychiatry and Psychiatric Epidemiology 39, 1000–1009.Google Scholar
Williams, L. (1998). A ‘classic’ case of borderline personality disorder. Psychiatric Services 49, 173–174.CrossRefGoogle ScholarPubMed
Wingate, L.R., Joiner, T.E., Walker, R.L., Rudd, M.D. & Jobes, D.A. (2004). Empirically informed approaches to topics in suicide risk assessment. Behavioral Sciences and the Law 22, 651–665.Google Scholar
Wittchen, H.U. & Jacobi, F. (2005). Size and burden of mental disorders in Europe: a critical review and appraisal of 27 studies. European Neuropsychopharmacology 15, 357–336.Google Scholar
Wolfersdorf, M. (2000). Suicide among psychiatric inpatients. In The International Handbook of Suicide and Attempted Suicide (ed. Hawton, K. and van Heeringen, K.), pp. 457–466. John Wiley & Sons: West Sussex.Google Scholar
World Health Organization (2001). The World Health Report, 2001. Mental Health: New Understanding, New Hope. WHO: Geneva.Google Scholar
Wysocker, A. (1999). Suicide: risk management strategies. Journal of the American Psychiatric Nurses Association 5, 164–166.Google Scholar
Yew, Thong J., Hc, Su A., Huak, Chan Y. & Hock, Chia B. (2008). Suicide in psychiatric patients: case-control study in Singapore. Australian and New Zealand Journal of Psychiatry 42, 509–519Google Scholar