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Cited by 172Suicide and Self-Harm StudiesPsychiatric care and mental health servicesHomicide, Infanticide, and Child Abuse

Aftercare and clinical characteristics of people with mental illness who commit suicide: a case–control study

Appleby, Louis, Dennehy, John A, Thomas, Christopher S, Faragher, E Brian, Lewis, Glyn·1999·The Lancet
DOI 10.1016/s0140-6736(98)10014-4
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Abstract

Background Suicide prevention is now a health priority in many countries. In the UK, there are specific targets for reducing the suicide rate in the general population and in people with mental illness. However, there is almost no evidence for the effectiveness of health services in reducing suicide, and little evidence linking suicide to any aspect of health-service care.Method We conducted a case-control study of people who committed suicide after discharge from psychiatric inpatient care. Cases were a 30-month sample of 149 people who had received an inquest verdict of suicide or open verdict in Greater Manchester, and who had a history of psychiatric admission in the 5 years before death. Controls were surviving psychiatric patients individually matched for age, sex, diagnosis, and date of last admission. Cases and controls were compared on aspects of psychiatric care, and on clinical and social variables, information being obtained from case notes.Findings Those who took their own lives were more likely to have had their care reduced (odds ratio 3.7 [95% CI 1.8-7.6]) at the final appointment in the community before death. Suicide was also associated with a history of self-harm (3.1 [1.7-5.7]), suicidal thoughts during aftercare (1.9 [1.0-3.5]) and the most recent admission as the first illness (2.0 [1.1-3.6]). The associations reported above took account of a number of confounding factors, including the predictable risk of suicide judged from case notes. Only 34% of suicides had an identifiable key worker, the essence of the Care Programme Approach. This frequency was no higher than that for controls, reflecting the difficulty of identifying those likely to commit suicide.Interpretation Reductions in care are strongly associated with suicide by people with mental illness, and may be contributory. The implication is that maintaining care beyond the point of clinical recovery is important in protecting high-risk individuals. Several clinical variables indicate high risk but greater risk is not generally addressed in health service provisions.

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  • Patients who are psychiatrically hospitalized for a suicide attempt or suicidal ideation are at very high risk for suicide following discharge, with rates of suicide shortly postdischarge more than 100 times greater than the rate in the general population.

    “Patients who are psychiatrically hospitalized for a suicide attempt or suicidal ideation (SI) are at very high risk for suicide following discharge [1 -3], with rates of suicide shortly postdischarge more than 100 times greater than the rate in the general population [4].”

    From Feasibility and utility of positive psychology exercises for suicidal inpatients (2014) · cites this paper as [1]

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Authors
Appleby, L., Dennehy, J. A., Thomas, C. S., Faragher, E. B., & Lewis, G.
Affiliations
  • University of Manchester (GB)
  • Cardiff University (GB)
Corresponding author
Appleby, Louis
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
1999-04
Volume
353
Issue
9162
Pages
1397-1400
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(98)10014-4
OpenAlex
W2132123279
Cited by
172
References
12
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 9 · 2019: 7 · 2018: 3 · 2017: 4 · 2016: 7 · 2015: 5 · 2014: 3 · 2013: 12 · 2012: 8
FWCI
12.66
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
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
suicide, mental illness, follow-up care, psychiatric inpatient care, suicide prevention, self-harm, suicidal ideation, Care Programme Approach, essential workers, community mental health services, suicide risk
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Mental Disorders, Female, Humans, Male, Middle Aged, Risk Factors, Suicide, Case-Control Studies

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