Risk factors for suicide within a year of discharge from psychiatric hospital: a systematic meta-analysis
Abstract
BACKGROUND: The increased risk of suicide in the period after discharge from a psychiatric hospital is a well-recognized and serious problem. OBJECTIVE: The aim of this study was to establish the risk factors for suicide in the year after discharge from psychiatric hospitals and their usefulness in categorizing patients as high or low risk for suicide in the year following discharge. METHOD: A systematic meta-analysis of controlled studies of suicide within a year of discharge from psychiatric hospitals. RESULTS: There was a moderately strong association between both a history of self-harm (OR = 3.15) and depressive symptoms (OR = 2.70) and post-discharge suicide. Factors weakly associated with post-discharge suicide were reports of suicidal ideas (OR = 2.47), an unplanned discharge (OR = 2.44), recent social difficulty (OR = 2.23), a diagnosis of major depression (OR = 1.91) and male sex (OR = 1.58). Patients who had less contact with services after discharge were significantly less likely to commit suicide (OR = 0.69). High risk patients were more likely to commit suicide than other discharged patients, but the strength of this association was not much greater than the association with some individual risk factors (OR = 3.94, sensitivity = 0.40, specificity = 0.87). CONCLUSIONS: No factor, or combination of factors, was strongly associated with suicide in the year after discharge. About 3% of patients categorized as being at high risk can be expected to commit suicide in the year after discharge. However, about 60% of the patients who commit suicide are likely to be categorized as low risk. Risk categorization is of no value in attempts to decrease the numbers of patients who will commit suicide after discharge.
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In two separate meta-analyses, the odds ratios for most risk and protective factors ranged from 1.0 to 2.5 (rs ~ 0.26-0.57; Franklin et al., 2017) and few exceeded 3.0 (r ~ 0.64; Large et al., 2011).
“In two separate meta-analyses, the odds ratios for most risk and protective factors ranged from 1.0 to 2.5 (i.e., rs ~ 0.26–0.57; Franklin et al., 2017) and few exceeded 3.0 (r ~ 0.64; Large et al., 2011).”
From The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. (2017) · cites this paper as Large et al., 2011
Studies published after the Troister et al. review found similar predictors.
“Studies published after the Troister et al. review found similar predictors (20, 26–28).”
From Using Administrative Data to Predict Suicide After Psychiatric Hospitalization in the Veterans Health Administration System (2020) · cites this paper as [26]
Clinical evaluations are not more accurate than structured assessments in predicting subsequent suicides and SRBs.
“But are clinical evaluations any more accurate than structured assessments in predicting subsequent suicides and SRBs? The evidence suggests not.”
From Using Administrative Data to Predict Suicide After Psychiatric Hospitalization in the Veterans Health Administration System (2020) · cites this paper as [26]
A meta-analysis of 13 studies examining risk factors for suicide within 12 months of psychiatric hospital discharge found that clinical judgments at discharge were not much stronger predictors of subsequent suicides than were several other social, historical, and clinical variables assessed by patient self-report or extracted from administrative databases.
“a meta-analysis of 13 studies examining risk factors for suicide within 12 months of psychiatric hospital discharge found that clinical judgments at discharge were not much stronger predictors of subsequent suicides than were several other social, historical, and clinical variables assessed by patient self-report or extracted from administrative databases (26).”
From Using Administrative Data to Predict Suicide After Psychiatric Hospitalization in the Veterans Health Administration System (2020) · cites this paper as [26]
Contrasting results have been reported, with a higher risk in male patients.
“However, contrasting results have been reported, with a higher risk in male patients [41].”
From High depression symptomatology and mental pain characterize suicidal psychiatric patients (2022) · cites this paper as [41]
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- Authors
- Large, M., Sharma, S., Cannon, E., Ryan, C., & Nielssen, O.
- Affiliations
- UNSW Sydney (AU)
- Prince of Wales Hospital (AU)
- The University of Sydney (AU)
- Corresponding author
- Large, Matthew
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2011-08
- Volume
- 45
- Issue
- 8
- Pages
- 619-628
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W1971677694
- Cited by
- 234
- References
- 36
- Citations by year
- 2026: 11 · 2025: 8 · 2024: 16 · 2023: 15 · 2022: 13 · 2021: 10 · 2020: 23 · 2019: 12 · 2018: 20 · 2017: 14 · 2016: 22 · 2015: 13 · 2014: 24 · 2013: 12 · 2012: 16
- FWCI
- 2.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian & New Zealand 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
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- suicide, psychiatric hospital discharge, suicide risk factors, self-harm history, depressive symptoms, suicidal ideation, major depressive disorder, male sex, risk classification, suicide prevention
- MeSH terms
- Depression, Female, Hospitals, Psychiatric, Humans, Male, Patient Discharge, Risk Factors, Sex Factors, Suicide, Self-Injurious Behavior, Risk Assessment
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