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Mental Health Service Delivery and Suicide Risk: The Role of Individual Patient and Facility Factors
Abstract
Objective This study explores suicide rates as a quality measure and identifies risk factors for suicide among psychiatric inpatients. Method Data from a prospective mortality study of psychiatric inpatients from 128 U.S. Department of Veterans Affairs hospitals throughout the United States were utilized to examine the relationship of death by suicide to patient-level sociodemographic, clinical, and mental health service delivery characteristics, as well as to facility-level measures of service delivery. Data were collected on all patients discharged with a diagnosis of schizophrenia, major depression, posttraumatic stress disorder, or bipolar disorder (N=121,933) between 1994 and 1998. Results There were 481 suicides in the study sample. Several variables were associated with higher risk for suicide risk, including length of stay less than 14 days, poorer continuity of care, and lack of readmission within 6 months. These variables were significant even after adjustment for state suicide rates, the proportion of members of racial minority groups in the state population, and state-level social capital. Conclusions Suicide rates are not likely to be a useful indicator of the quality of mental health care because of the instability of suicide rates, difficulty collecting data, and the lack of association between suicide and facility quality of care. The lack of association with facility-level variables suggests that systemic changes in these performance measures would be unlikel…
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“a LOS of less than 14 days in inpatient psychiatry was significantly associated with a higher suicide risk (Desai et al., 2005).”
From Time in treatment: Examining mental illness trajectories across inpatient psychiatric treatment (2020) · cites this paper as Desai et al., 2005
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Metadata
- Authors
- Desai, R. A., Dausey, D. J., & Rosenheck, R. A.
- Affiliations
- United States Department of Veterans Affairs (US)
- ORCID
- Rosenheck, Robert A.
- Venue
- American Journal of Psychiatry
- Published
- 2005-02
- Volume
- 162
- Issue
- 2
- Pages
- 311-318
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2149008499
- Cited by
- 183
- References
- 29
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 10 · 2023: 6 · 2022: 2 · 2021: 5 · 2020: 9 · 2019: 8 · 2018: 10 · 2017: 9 · 2016: 14 · 2015: 11 · 2014: 17 · 2013: 14 · 2012: 16
- FWCI
- 8.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
- Keywords
- suicide risk, psychiatric inpatients, mental health service delivery, mental health care quality, continuity of care, length of hospital stay, hospital readmission, veterans, schizophrenia, major depressive disorder, post-traumatic stress disorder, bipolar disorder, mortality
- MeSH terms
- Ambulatory Care, Mental Disorders, Cause of Death, Community Mental Health Centers, Continuity of Patient Care, Delivery of Health Care, Hospitals, Veterans, Humans, Length of Stay, Middle Aged, Patient Readmission, Quality Assurance, Health Care, Risk Factors, Social Environment, Suicide, United States, Quality Indicators, Health Care, Risk Adjustment
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