People with mental illness are at a high suicide risk. About 5% of these suicides occur during psychiatric inpatient treatment. Few data are available on demographic and risk factors for this population. Therefore, we analysed all psychiatric inpatient suicides from 1992 – 2004 in a catchment area of about 1.2m population in Switzerland.

Charts review.

We identified 142 patients who committed suicide while in the hospital wherefrom 125 charts could be reviewed. 52% were male. 52% were diagnosed with an affective and 26% with a psychotic disorder, respectively. 59% were admitted due to suicidal ideations. 58% had a history of suicide attempt(s). 74% reported serious life events previous to the index hospitalisation. 74% committed suicide outside the hospital. Most suicides occurred in month 3-6 after admission. In the last assessment before the suicide, 88% had affective symptoms, 66% anxiety, 63% hopelessness, 42% psychotic symptoms and 36% agitation/restlessness. Of those with affective symptoms, 79% received antidepressive medication. 77% with psychotic medication had antipsychotics and 42% of those with anxiety received anxiolytics. 64% denied in their last interview before committing suicide suicidal ideations, 42% had a “non-suicide agreement” with their clinicians. According to a clinical assessment, 80% of those who committed suicide were at low or at no suicide risk.

Most inpatients suicide occurred unexpectedly. A more rigorous treatment of anxiety, but also affective and antipsychotic symptoms could lead to decrease suicide in inpatient settings. “Non-suicide agreements” could not prevent suicides.