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Cited by 651Suicide and Self-Harm StudiesPsychiatric care and mental health servicesHomicide, Infanticide, and Child Abuse

Suicide Rates After Discharge From Psychiatric Facilities: A Systematic Review and Meta-analysis

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Chung, Daniel Thomas, Ryan, Christopher James, Hadzi-Pavlovic, Dusan, Singh, Swaran Preet, Stanton, Clive, Large, Matthew Michael·2017·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2017.1044PMC PMC5710249
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Abstract

Importance: High rates of suicide after psychiatric hospitalization are reported in many studies, yet the magnitude of the increases and the factors underlying them remain unclear. Objectives: To quantify the rates of suicide after discharge from psychiatric facilities and examine what moderates those rates. Data Sources: English-language, peer-reviewed publications published from January 1, 1946, to May 1, 2016, were located using MEDLINE, PsychINFO, and EMBASE with the search terms ((suicid*).ti AND (hospital or discharg* OR inpatient or in-patient OR admit*).ab and ((mortality OR outcome* OR death*) AND (psych* OR mental*)).ti AND (admit* OR admis* or hospital* OR inpatient* OR in-patient* OR discharg*).ab. Hand searching was also done. Study Selection: Studies reporting the number of suicides among patients discharged from psychiatric facilities and the number of exposed person-years and studies from which these data could be calculated. Data Extraction and Synthesis: The meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. A random-effects model was used to calculate a pooled estimate of postdischarge suicides per 100 000 person-years. Main Outcomes and Measures: The suicide rate after discharge from psychiatric facilities was the main outcome, and the association between the duration of follow-up and the year of the sampling were the main a priori moderators. Results: A total of 100 studies reported 183 patient samples (50 samples of females, 49 of males, and 84 of mixed sex; 129 of adults or unspecified patients, 20 of adolescents, 19 of older patients, and 15 from long-term or forensic discharge facilities), including a total of 17 857 suicides during 4 725 445 person-years. The pooled estimate postdischarge suicide rate was 484 suicides per 100 000 person-years (95% CI, 422-555 suicides per 100 000 person-years; prediction interval, 89-2641), with high between-sample heterogeneity (I2 = 98%). The suicide rate was highest within 3 months after discharge (1132; 95% CI, 874-1467) and among patients admitted with suicidal ideas or behaviors (2078; 95% CI, 1512-2856). Pooled suicide rates per 100 000 patients-years were 654 for studies with follow-up periods of 3 months to 1 year, 494 for studies with follow-up periods of 1 to 5 years, 366 for studies with follow-up periods of 5 to 10 years, and 277 for studies with follow-up periods longer than 10 years. Suicide rates were higher among samples collected in the periods 1995-2004 (656; 95% CI, 518-831) and 2005-2016 (672; 95% CI, 428-1055) than in earlier samples. Conclusions and Relevance: The immediate postdischarge period is a time of marked risk, but rates of suicide remain high for many years after discharge. Patients admitted because of suicidal ideas or behaviors and those in the first months after discharge should be a particular focus of concern. Previously admitted patients should be able to access long-term care and assistance.

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  • In a modeled example based on published post-discharge suicide rates and sensitivity and specificity estimates from Large et al., the ratio of false positives to correct predictions increases from approximately 77 per correct prediction over one year to an estimated 4,600 or more over a single day.

    “The pattern is nonetheless striking: even in the post-discharge period, one of the highest-risk contexts in clinical psychiatry, the ratio of false positives to correct predictions increases from approximately 77 per correct prediction over one year to an estimated 4,600 or more over a single day.”

    From Suicide risk assessment: clinical implications of the unpredictability of suicidal behavior (2026) · cites this paper as [30]

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  • Suicide occurs at high rates in psychiatric units during admission and after discharge.

    “Moreover, suicide occurs at high rates in psychiatric units during admission and after discharge, questioning the efficacy of this procedure.7”

    From Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial (2022) · cites this paper as [7]

  • The suicide rate after psychiatric hospital discharge is between 3,000/100,000 person-years in the first week after discharge and 650/100,000 person-years 4-12 months after discharge.

    “that the suicide rate after psychiatric hospital discharge is between 3,000/100,000 person-years in the first week after discharge and 650/100,000 person-years 4–12 months after discharge (49, 91)”

    From Using Administrative Data to Predict Suicide After Psychiatric Hospitalization in the Veterans Health Administration System (2020) · cites this paper as [49]

  • Patients admitted with suicidal thoughts or behaviors have a suicide rate nearly 200 times the global suicide rate.

    “This risk is particularly heightened among patients admitted with suicidal thoughts or behaviors, with the rate of suicide for these patients being nearly 200 times the global suicide rate.5”

    From A pilot study using frequent inpatient assessments of suicidal thinking to predict short-term postdischarge suicidal behavior (2021) · cites this paper as [5]

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Research works printed but not linked: 2

  1. Stroup DF, Berlin JA, Morton SC, et al; Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. Meta-analysis of Observational Studies in Epidemiology: a proposal for reporting. JAMA. 2000;283(15):2008-2012.
  2. Menezes PR, Mann AH. Mortality among patients with non-affective functional psychoses in a metropolitan area of south-eastern Brazil. Rev Saude Publica. 1996;30(4):304-309.

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Authors
Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M.
Affiliations
  • UNSW Sydney (AU)
  • The University of Sydney (AU)
  • University of Warwick (GB)
  • The Prince of Wales Hospitals, Randwick, New South Wales, Australia
Corresponding author
Large, Matthew Michael
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2017-07-01
Volume
74
Issue
7
Pages
694
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2017.1044
PMC
PMC5710249
OpenAlex
W2618096691
Cited by
651
References
128
Citations by year
2026: 81 · 2025: 89 · 2024: 67 · 2023: 61 · 2022: 81 · 2021: 100 · 2020: 71 · 2019: 56 · 2018: 31 · 2017: 12
FWCI
7.10
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
psychiatric hospitalization, psychiatric inpatients, suicide rates, follow-up duration, suicidal ideation, suicide attempts, psychiatric hospital discharge, suicide prevention, mental health services, forensic psychiatric patients, long-term psychiatric patients, suicide prevention funding, suicide prevention research
MeSH terms
Hospitals, Psychiatric, Humans, Patient Discharge, Suicide

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