Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation
Open accessAbstract
Objective: To assess the magnitude of suicide rates in the first week and first month postdischarge following psychiatric hospitalisation. Design: Meta-analysis of relevant English-language, peer-reviewed papers published in MEDLINE, PsycINFO or Embase between 01 January 1945 and 31 March 2017 and supplemented by hand searching and personal communication. A generalised linear effects model was fitted to the number of suicides, with a Poisson distribution, log link and log of person years as an offset. A random effects model was used to calculate the overall pooled rates and within subgroups in sensitivity analyses. Outcome measures: Suicides per 100 000 person years in the first week and the first month after discharge from psychiatric hospitalisation. Results: Thirty-four included papers comprised 29 studies that reported suicides in the first month postdischarge (3551 suicides during 222 546 patient years) and 24 studies that reported suicides in the first week postdischarge (1928 suicides during 60 880 patient years). The pooled estimate of the suicide rate in the first month postdischarge suicide was 2060 per 100 000 person years (95% CI=1300 to 3280, I 2 =90). The pooled estimate of the suicide rate in the first week postdischarge suicide was 2950 suicides per 100 000 person years (95% CI=1740 to 5000, I 2 =88). Eight studies that were included after personal communication had lower pooled rates of suicide than studies included after data extraction and there was evidence of publication bias towards papers reporting a higher rate of postdischarge suicide. Conclusion: Acknowledging the presence of marked heterogeneity between studies and the likelihood of bias towards publication of studies reporting a higher postdischarge suicide rate, the first week and first month postdischarge following psychiatric hospitalisation are periods of extraordinary suicide risk. Short-term follow-up of discharged patients should be augmented with greater focus on safe transition from hospital to community care. PROSPERO registration number: PROSPERO registration CRD42016038169
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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 [31]
The Results report pooled suicide rates for the first week and first month after psychiatric discharge, supporting the use of this paper for post-discharge rates. The paper does not report the modeled false-positive ratios of approximately 77 over a year or 4,600 over a day, or the sensitivity and specificity estimates needed to calculate them. (LLM, conf=0.87)
Experimental — accuracy not yet measuredAfter seeking help for suicidal thoughts or low-lethality suicide attempts in the emergency department, discharged patients have an elevated suicide attempt rate.
“After seeking help for suicidal thoughts or low-lethality suicide attempts in the emergency department, discharged patients have an elevated suicide attempt rate.”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [236]
The suicide death rate is 300 times higher in the first week and 200 times higher in the first month among patients discharged from inpatient psychiatric care compared with the general population.
“The suicide death rate is 300 times higher in the first week and 200 times higher in the first month among patients discharged from inpatient psychiatric care compared with the general population (236).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [236]
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 [91]
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“The fi gures shown are not empirical results, but a modeled example based on published post-discharge suicide rates (30, 31) combined with the sensitivity and speci fi city estimates reported by Large et al. (17); the underlying calculations are summarized in the table note.”
- Authors
- Chung, D., Hadzi-Pavlovic, D., Wang, M., Swaraj, S., Olfson, M., & Large, M.
- Affiliations
- UNSW Sydney (AU)
- Columbia University (US)
- Corresponding author
- Large, Matthew
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2019-03
- Volume
- 9
- Issue
- 3
- Pages
- e023883
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC6475206
- OpenAlex
- W2923859006
- Cited by
- 191
- References
- 63
- Citations by year
- 2026: 25 · 2025: 31 · 2024: 25 · 2023: 19 · 2022: 37 · 2021: 31 · 2020: 20 · 2019: 3
- FWCI
- 3.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (acceptedVersion)
- Funders
- Janssen Scientific Affairs
- 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, psychiatric hospitalization, suicide risk, hospital discharge, transition to community care, suicide prevention, publication bias
- MeSH terms
- Hospitals, Psychiatric, Humans, Patient Discharge, Suicide
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