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Clinical Correlates of Inpatient Suicide
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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“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]
In the citing paper
“Future suicide decedents may deny suicidal thoughts as inpatients (265)”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [265]
In the citing paper
“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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Chapter 8. Safety Management of the Patient at Risk for Suicide
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Chapter 1. Suicide Risk Assessment
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Chapter 11. Imminent Suicide, Passive Suicidal Ideation, and Other Intractable Myths
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Chapter 7. Patients at Acute and Chronic High Risk for Suicide
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Chapter 10. Suicide Risk Assessment Forms
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Chapter 3. Assessing and Enhancing Protective Factors Against Suicide Risk
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Chapter 6. Sudden Improvement in Patients at High Risk for Suicide
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Chapter 5. Psychiatric Disorders and Suicide Risk
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Chapter 9. Gun Safety Management of Suicidal Patients
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Chapter 12. Quality Assurance Review of Suicide Risk Assessments
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Chapter 2. Enhancing Suicide Risk Assessment Through Evidence-Based Psychiatry
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Metadata
- 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)
- 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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