Cited by 129Suicide and Self-Harm StudiesPsychiatric care and mental health servicesHomicide, Infanticide, and Child Abuse

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Suicide Within Two Weeks of Discharge From Psychiatric Inpatient Care: A Case-Control Study

Bickley, Harriet, Hunt, Isabelle M., Windfuhr, Kirsten, Shaw, Jenny, Appleby, Louis, Kapur, Navneet·2013·Psychiatric Services

DOI 10.1176/appi.ps.201200026

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Abstract

OBJECTIVE: Suicide risk after discharge from psychiatric inpatient care is high, particularly in the first few weeks. The aim of the study was to identify risk factors and protective factors (that is, factors associated with a reduced risk of suicide), including variation in health care received, for suicide among patients in the two-week postdischarge period. METHODS: This was a national population-based retrospective case-control study of 100 psychiatric patients in England (2004-2006), age 18-65, who died by suicide within two weeks of hospital discharge. These patients were matched on discharge date with 100 living control group patients. RESULTS: Fifty-five percent of suicides occurred within a week of discharge, 49% of whom died before their first follow-up appointment. Conditional logistic regression analyses indicated that recent adverse life events and a short (less than one week) final admission were independently associated with postdischarge suicide, as were older age and comorbid psychiatric disorders. Receiving enhanced aftercare (under the Care Programme Approach) was protective of suicide. CONCLUSIONS: Discharged patients viewed as being at high risk of suicide require immediate community follow-up. Mental health services should be mindful of discharging patients after a short admission. The potential role of detrimental life experiences indicates that mental health clinicians need to be aware of the circumstances into which patients are being discharged. Use of enhanced levels of care, such as that offered by the Care Programme Approach, may play a strong role in preventing suicide within two weeks of discharge.

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“Although most published studies use death date as the index date, 14,15 we replicated our previous, more robust, definition of index date, 20 which excluded contacts during which the individual died.”
Result
Self-harm hospitalised morbidity and mortality risk using a matched population-based cohort design
Mitchell, R. J., & Cameron, C. M. (2017) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867417717797 · Cited by 8
“Email: r.mitchell@mq.edu.au Australian & New Zealand Journal of Psychiatry, 52(3) in quantifying the burden of self-harm on the health care system (Bickley et al., 2013; Owens et al., 2002; Perry et al., 2012).”
BackgroundInfluential
Peer Intervention following Suicide-Related Emergency Department Presentation: Evaluation of the PAUSE Pilot Program
Gibson, M., Moreau, N., Balzamo, E., & Crompton, D. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043763 · Cited by 8
“Indeed, previous research has reported that people experiencing these adverse life events and stressors are more likely to die in the weeks following discharge from psychiatric admissions than those who are discharged who were not also experiencing such stressors [15].”
BackgroundInfluential
Making Progress in Clinical Trials for Suicide Prevention
Wilkinson, S. T., Bryan, C. J., Alphs, L. D., Canuso, C. M., Ostacher, M. J., Price, R. B., Bloch, M. H., Zarate, C. A., & Rhee, T. G. (2025) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2024.4810 · Cited by 7
Unwarranted clinical variation in the care of children and young people hospitalised for injury: a population-based cohort study
Lystad, R. P., Bierbaum, M., Curtis, K. A., Braithwaite, J., & Mitchell, R. J. (2018) · Injury · doi:10.1016/j.injury.2018.07.009 · Cited by 7
Structured Evaluation of Rehabilitation Programs Outcomes in Psychiatry: Application of a Recovery-Centered Model
Vanzetto, S., Zabotto, M., Fasciana, F., Varinelli, A., Cirnigliaro, G., Ferrara, L., Dell’Osso, B. M., & Viganò, C. A. (2021) · Psychiatric Quarterly · doi:10.1007/s11126-021-09884-0 · Cited by 7
Suizidprävention im Kontext des assistierten Suizids
Lewitzka, U. (2022) · Der Nervenarzt · doi:10.1007/s00115-022-01382-3 · Cited by 7
“Studien haben gezeigt, dass nur ungefähr die Hälfte der Patienten einen Nachsorgetermin indererstenWochenach der Entlassung wahrnimmt/wahrnehmen kann [42], obwohl das Suizidrisiko in der ersten Woche nach der Entlassung mehr als dreimal so hoch [43] ist.”
Background
Sequential multiple assignment randomised trial of a brief contact intervention for suicide risk management among discharged psychiatric patients: an implementation study protocol
Liu, H., Chen, G., Li, J., Hao, C., Zhang, B., Bai, Y., Song, L., Chen, C., Xie, H., Liu, T., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-054131 · Cited by 6
Coexisting service-related factors preceding suicide: a network analysis
Rex, M., Brezicka, T., Carlström, E., Wærn, M., & Ali, L. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-050953 · Cited by 6
Integrative Review of Mobile Phone Contacts and Medication Adherence in Severe Mental Illness
Bright, C. E. (2018) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390318754986 · Cited by 6
“When patients are due for discharge, providers, caregivers and patients may perceive that they can take care of themselves, but they need support despite apparent recovery (Bickley et al., 2013).”
Background
Improving Quality Outcomes in Veteran-Centric Care
Tave, T. T., Wyers, D. R., Schreiber-Jones, C., Fogger, S. A., & McGuinness, T. M. (2017) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20170119-07 · Cited by 6
Suicide in services for mental health and substance use: A national hybrid registry surveillance system
Myhre, M. Ø., Kildahl, A. T., Astrup, H., Bergsager, D., & Walby, F. A. (2023) · Health Informatics Journal · doi:10.1177/14604582231167439 · Cited by 5
“NCISH has provided valuable knowledge on this important high-risk group for suicide (for example 9 – 11), which has been the basis for service recommendations, where some have been found to reduce the suicide rates in the services.”
Preventing post-discharge suicides in psychiatric patients: insights from patients, lay healthcare supporters, and mental health professionals—a qualitative analysis
Fu, T., Liu, H., Chen, C., Zhang, B., Chen, G., Bai, Y., Li, J., & Hou, F. (2024) · BMC Public Health · doi:10.1186/s12889-023-17475-w · Cited by 7
“However, the effectiveness of community follow-up care in reducing suicide risk has yielded inconsistent findings, likely due do different continuity of care, social and cultural factors, and potential selection bias [13, 14, 18, 27].”
Background
Suicide Within 72 Hours After Discharge From Health Care Settings
Drake, S. A., Garza, B. W., Cron, S. G., & Wolf, D. A. (2015) · American Journal of Forensic Medicine & Pathology · doi:10.1097/paf.0000000000000211 · Cited by 5
“That 17 of the 30 patients were discharged home alone (or with no documentation in the record of availability of family or companion) is a finding consistent with study results that isolation or lack of family support is a risk factor for postdischarge suicide.(6,7) This points to 2 possible avenues for improvement in…”
Result
Psychotic Symptoms Predict Suicidal Behavior Postdischarge in High Risk Psychiatric Inpatients
Barzilay, S., Assounga, K., Kim, H.-J., RUDNER, E., Yaseen, Z. S., & GALYNKER, I. I. (2019) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000421 · Cited by 5
Is It Time for the Mental Health Field to Consider Unplanned Discharge a Key Metric of Patient Safety?
Riblet, N. B., Gottlieb, D. J., Watts, B. V., Levis, M., Scott, R., & Shiner, B. (2022) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001425 · Cited by 5
Suicide: a concept analysis
Ngwena, J., Hosany, Z., & Sibindi, I. (2016) · Journal of Public Health · doi:10.1007/s10389-016-0768-x · Cited by 12
“In spite of these measures, the rate of suicide occurring within a week of discharge stands at 50 % (Bickley et al. 2013) with 49 % doing so 2 weeks before their initial appointments.”
National study comparing the characteristics of patients diagnosed with schizophrenia who committed homicide vs. those who died by suicide
Baird, A., Shaw, J. J., Hunt, I. M., Kapur, N., Appleby, L., & Webb, R. T. (2018) · Journal of Forensic Psychiatry and Psychology · doi:10.1080/14789949.2018.1434226 · Cited by 5
“, 2013) and also upon their discharge (Bickley et al., 2013).”
Background
Suicidal ideation among mental health patients at hospital discharge: prevalence and risk factors
Mao, W., Shalaby, R., Owusu, E., Elgendy, H. E., Agyapong, B., Eboreime, E., Silverstone, P. H., Chue, P. S., Li, X., Vuong, W., et al. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06547-3 · Cited by 7
“Other clinical risk factors include non-adherence to treatment [16, 17, 19], a brief final admission [10, 11, 20, 21], and a history of/current self-harm [19, 22].”
Safety Planning: Why It Is Essential on the Day of Discharge From In-patient Psychiatric Hospitalization in Reducing Future Risks of Suicide
Schuster, H., Jones, N. M., & Qadri, S. F. (2021) · Cureus · doi:10.7759/cureus.20648 · Cited by 4
“Those patients especially at high risk for suicide in the post-discharge period have a history of self-harm or suicide attempt and endorse depressive symptoms and hopelessness [6,23,25,27-30].”
Background
Dispelling myths and challenging neglect in ‘borderline personality disorder’ healthcare: a lived-experience perspective
Aves, W. (2023) · Journal of Psychosocial Studies · doi:10.1332/147867323x16881441383633 · Cited by 6
Online Anomaly Detection for Smartphone-Based Multivariate Behavioral Time Series Data
Liu, G., & Onnela, J.-P. “. (2022) · Sensors · doi:10.3390/s22062110 · Cited by 4
“Meta-analyses of suicide rates after discharge from psychiatric facilities suggest that these rates remain high for several years, but are particularly high in the ﬁrst few weeks and months post-discharge [8–10].”
Background
Postdischarge Behavioral Health Treatment and 6-Month Reattempt Rate for Veterans Hospitalized for Suicide Attempt
Bernet, A. C. (2015) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390315592130 · Cited by 4
“One group of investigators found that in the 2 weeks after psychiatric discharge, face-to-face visits were slightly protective against suicide, compared to telephone visits (Bickley et al., 2013).”
Effectiveness of Nursing Preventive Interventions in Suicide re- Attempts
Ghanbari, B., Malakouti, S., Nojomi, M., Alavi, K., Khaleghparast, S., & Sohrabzadeh, A. (2016) · Iran Journal of Nursing · doi:10.29252/ijn.29.99.100.34 · Cited by 4
Mehr Fokus auf poststationäre Suizide!
Spießl, H. (2019) · Psychiatrische Praxis · doi:10.1055/a-0790-3114 · Cited by 4
“Fast 50% der Patienten versterben durch Suizid noch vor dem ersten ambulanten Termin nach Entlassung [11, 13].”
Background
Absolute risks of self-harm and interpersonal violence by diagnostic category following first discharge from inpatient psychiatric care
Mok, P. L. H., Walter, F., Carr, M., Antonsen, S., Kapur, N., Steeg, S., Shaw, J. J., Pedersen, C. B., & Webb, R. T. (2023) · European Psychiatry · doi:10.1192/j.eurpsy.2022.2352 · Cited by 3
Development of a Checklist for Predicting Suicidality Based on Risk and Protective Factors: The Gwangju Checklist for Evaluation of Suicidality
Kim, S., Park, W.-Y., Kim, H., Jhon, M., Kim, J., Kang, H., Kim, S., Ryu, S., Lee, J., Shin, I., et al. (2022) · Psychiatry Investigation · doi:10.30773/pi.2022.0063 · Cited by 4
Risk factors associated with suicidal ideation in newly admitted working-age nursing home residents
Hugunin, J., Yuan, Y., Rothschild, A. J., Lapane, K. L., & Ulbricht, C. M. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.08.042 · Cited by 3
The Impact of Physical Activity on Suicide Attempt in Children: A Systematic Review
Patel, M., Branjerdporn, G., & Woerwag‐Mehta, S. (2025) · Children · doi:10.3390/children12070890 · Cited by 2
“The most vulnerable timeframe for completed suicide is within 12 months following SA and during the post-hospital discharge period [10,11].”
Demographic characteristics of individuals admitted to the Hospital for Suicidal Ideation in the emergency department
Chang, B., Sano, E. D., Suh, E. H., & Tichter, A. M. (2016) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2016.03.054 · Cited by 2
The Feasibility and Clinical Utility of Conducting a Confidential Inquiry Into Suicide in Southwestern Ontario
Eynan, R., Shah, R., Heisel, M. J., Eden, D., Jhirad, R., & Links, P. S. (2017) · Crisis · doi:10.1027/0227-5910/a000500 · Cited by 2
Exploring the role of social workers in suicide prevention
Slater, T. (2014) · ORCA Online Research @Cardiff (Cardiff University) · Cited by 2
How carers' needs can be met by staff within inpatient settings: a qualitative study
Berry, K., King, J., Vikram, A., & Muller, C. (2024) · British Journal of Mental Health Nursing · doi:10.12968/bjmh.2023.0003 · Cited by 1
Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case–control study
Musgrove, R., Carr, M., Kapur, N., Chew-Graham, C. A., Mughal, F., Ashcroft, D. M., & Webb, R. T. (2024) · BJGP Open · doi:10.3399/bjgpo.2023.0165 · Cited by 2
“20,27 This may indicate premature discharge in some instances.”
Protocol of the Tailored Evidence-based Enhancements in Mental Health-Gamified and Individualized Follow-Up Treatment for Suicide (TEEM-GIFTS): a Multiphase Optimization Strategy (MOST) study implementing a gamified mHealth intervention to reduce postdischarge suicide risk in patients with mental disorders in Shenzhen
Hou, F., Liu, H., Bai, Y., Peng, B., Chen, G., Zhang, Y., Wu, D., Fu, T., Hu, L., & Li, J. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-092339 · Cited by 1
Nomogram for estimating the risk of suicide attempts in major depressive disorder: integrating demographic, clinical and biochemical markers – a cross-sectional study
Lyu, N., Zhao, Q., Dutta, R., Wang, H., Wang, G., & Young, A. H. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1634164 · Cited by 2
Research Proposal for Developing Best Practices for Promoting Timely Follow Up Care for Patients in Non-rural Settings Discharged from Inpatient Psychiatric Care with Comorbid Chemical Dependency
Brody, R. (2022) · Digital Archive @ GSU · doi:10.57709/8014901 · Cited by 1

Authors: Bickley, H., Hunt, I. M., Windfuhr, K., Shaw, J., Appleby, L., & Kapur, N.
Affiliations: University of Manchester (GB)
ORCID: Bickley, Harriet
Hunt, Isabelle M.
Windfuhr, Kirsten
Shaw, Jenny
Appleby, Louis
Kapur, Navneet
Venue: Psychiatric Services
Publisher: American Psychiatric Association Publishing
Published: 2013-07
Volume: 64
Issue: 7
Pages: 653-659
ISSN: 0022-1597 (ISSN-L)
1075-2730
1557-9700
DOI: 10.1176/appi.ps.201200026
OpenAlex: W2139460385
Cited by: 129
References: 33
Citations by year: 2026: 2 · 2025: 10 · 2024: 14 · 2023: 10 · 2022: 10 · 2021: 11 · 2020: 15 · 2019: 7 · 2018: 14 · 2017: 9 · 2016: 12 · 2015: 4 · 2014: 10 · 2013: 1
FWCI: 10.00
Type: journal article
Language: en
Open access: closed
Locations: Psychiatric Services (publishedVersion)
PubMed (publishedVersion)
Research Explorer (The University of Manchester) (publishedVersion)
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 hospital discharge, suicide risk factors, protective factors, life events, Care Programme Approach, follow-up care, community follow-up, psychiatric comorbidity, old age
MeSH terms: Suicide Prevention, Adolescent, Adult, Aftercare, Age Factors, Aged, Mental Disorders, England, Epidemiologic Methods, Female, Hospitals, Psychiatric, Humans, Length of Stay, Life Change Events, Male, Middle Aged, Patient Care Planning, Patient Discharge, Suicide, Comorbidity, Young Adult

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Suicide Within Two Weeks of Discharge From Psychiatric Inpatient Care: A Case-Control Study

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