Suicide Immediately After Discharge From Psychiatric Inpatient Care: A Cohort Study of Nearly 2.9 Million Discharges
Abstract
OBJECTIVE: The risk of suicide is elevated after discharge from a psychiatric hospital. This study aimed to investigate how recent suicidal behavior affects the risk of suicide in patients with different psychiatric diagnoses immediately after discharge. METHODS: Registers with national coverage were linked to create a study cohort including all individuals discharged from psychiatric hospitals in Sweden from 1973 through 2009. Hazard ratios for discharge diagnoses were calculated. The risk of suicide within 30 days after discharge in each diagnostic category when suicidal behavior had been registered within 30 days before admission was estimated. RESULTS: A total of 3,695 suicides occurred after 2,883,088 discharges. If recent suicidal behavior was registered, the risk of completed suicide increased prominently in all diagnostic categories, but particularly for schizophrenia (hazard ratio [HR] = 8.9; 95% CI, 6.4-12.4) and other nonorganic psychosis (HR = 6.8; 95% CI, 5.1-9.0). Patients suffering from depression had the highest overall risk of suicide postdischarge (HR = 3.0; 95% CI, 2.7-3.3). This finding applied especially to male patients with depression (HR = 4.5; 95% CI, 4.0-5.0) or with reaction to crisis (HR = 3.6; 95% CI 3.0-4.4). CONCLUSIONS: A distinct elevation of the risk of suicide was seen in all diagnostic groups if a recent self-harm event had occurred, particularly among patients with psychotic disorders. Overall, the immediate risk of suicide after discharge was high regardless of recent suicidal behavior. The findings in this study have relevance for clinical decisions about immediate after-care and treatment in connection with discharge from psychiatric inpatient care.
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The acute management of suicidality during hospitalization is paramount, especially in depressed patients.
“Namely, that the acute management of suicidality during hospitalization is paramount, especially in depressed patients (54).”
From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [54]
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- Authors
- Haglund, A., Lysell, H., Larsson, H., Lichtenstein, P., & Runeson, B.
- Affiliations
- Karolinska Institutet (SE)
- Örebro University (SE)
- Corresponding author
- Haglund, Axel
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2019-02-12
- Volume
- 80
- Issue
- 2
- ISSN
- 0160-6689 (ISSN-L)
- 1555-2101
- OpenAlex
- W2913176950
- Cited by
- 66
- References
- 0
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 10 · 2023: 9 · 2022: 13 · 2021: 10 · 2020: 9 · 2019: 4
- FWCI
- 10.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical 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, self-harm, schizophrenia, psychosis, depression, follow-up care, psychiatric inpatients
- MeSH terms
- Mental Disorders, Female, Hospitals, Psychiatric, Humans, Length of Stay, Male, Patient Discharge, Registries, Risk Factors, Sex Factors, Suicide, Sweden, Cohort Studies, Suicidal Ideation
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