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Cited by 752Suicide and Self-Harm StudiesPsychiatric care and mental health servicesHomicide, Infanticide, and Child Abuse

Clinical correlates of inpatient suicide

Busch, Katie A., Fawcett, Jan, Jacobs, Douglas G.·2003·The Journal of Clinical Psychiatry
DOI 10.4088/jcp.v64n0105
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Abstract

BACKGROUND: Previous suicide assessment research has led to standard predictors of risk. Despite this, there are approximately 30,000 suicides per year in the United States, 5% to 6% of which occur in hospitals. The primary purpose of this study is to improve our ability to assess risk and intervene successfully. METHOD: Charts from 76 patients who committed suicide while in the hospital, or immediately after discharge, were reviewed. The week before suicide was rated for both standard risk predictors and, using items from the Schedule for Affective Disorders and Schizophrenia (SADS), for presence and severity of symptoms found to be correlated with acute risk in recent studies. RESULTS: Regarding standard predictors, only 49% (N = 37) had any prior suicide attempt and 25% (N = 19) were admitted for this reason. Thirty-nine percent (30/76) were admitted for suicidal ideation, but 78% denied suicidal ideation at their last communication about this; 46% (N = 35) showed no evidence of psychosis; of those on precautions (N = 45), 51% (N = 23) were on q 15 minute suicide checks or 1:1 observation; and 28% (N = 21) had a no-suicide contract in effect. On SADS ratings, 79% (N = 60) met criteria for severe or extreme anxiety and/or agitation. CONCLUSION: Standard risk assessments and standard precautions used were of limited value in protecting this group from suicide. Adding severity of anxiety and agitation to our current assessments may help identify patients at acute risk and suggest effective treatment interventions. The importance of a matched comparison group to ascertain if this sample can be blindly discriminated from inpatients who do not commit suicide is clear.

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  • Most individuals who go on to die by suicide deny SI at their last clinical appointment.

    “In fact, most individuals who go on to die by suicide deny SI at their last clinical appointment (21).”

    From New methods for assessing rapid changes in suicide risk (2021) · cites this paper as [21]

  • People who later die by suicide may not report suicidal thoughts while hospitalized.

    “Future suicide decedents may deny suicidal thoughts as inpatients (265)”

    From A brain-centric model of suicidal behavior (2020) · cites this paper as [265]

  • Participants may not always provide accurate reports of their experiences for fear of intervention, as many people planning suicide explicitly deny such intentions.

    “Further, participants may not always provide accurate reports of their experiences for fear of intervention, as many people planning suicide explicitly deny such intentions (115).”

    From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [115]

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Authors
Busch, K. A., Fawcett, J., & Jacobs, D. G.
Affiliations
  • Rush University Medical Center (US)
  • Harvard University (US)
ORCID
Jacobs, Douglas G.
Venue
The Journal of Clinical Psychiatry
Publisher
Physicians Postgraduate Press, Inc
Published
2003-01-15
Volume
64
Issue
1
Pages
14-19
ISSN
0160-6689 (ISSN-L)
DOI
10.4088/jcp.v64n0105
OpenAlex
W2033428561
Cited by
750
References
0
Citations by year
2026: 15 · 2025: 15 · 2024: 32 · 2023: 33 · 2022: 45 · 2021: 51 · 2020: 34 · 2019: 39 · 2018: 53 · 2017: 31 · 2016: 41 · 2015: 39 · 2014: 44 · 2013: 31 · 2012: 29
FWCI
31.83
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
hospital suicide, suicide risk assessment, anxiety, agitation, Schedule for Affective Disorders and Schizophrenia, suicidal ideation, suicide attempts, psychiatric inpatients
MeSH terms
Suicide Prevention, Adolescent, Adult, Aged, Antidepressive Agents, Anxiety Disorders, Drug Utilization, Female, Hospitalization, Humans, Male, Medical Records, Middle Aged, Psychiatric Status Rating Scales, Psychomotor Agitation, Research Design, Severity of Illness Index, Suicide, Suicide, Attempted, Antipsychotic Agents, Outcome Assessment, Health Care, Risk Assessment

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