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Abstract
Both psychiatrists and psychiatric nurses are involved in the psychiatric management of suicidal inpatients. One-to-one observation by qualified nurses and the accommodation of the patient in a room close to the infirmary are usually recommended. Suicidal risk should be reassessed periodically to check response to treatment. To compare the severity of depressive symptoms in depressed inpatients admitted after an attempted suicide and those admitted for any other reason and to assess the severity of suicide attempts and the management of suicidal risk in clinical settings. We divided the sample into two subgroups: patients with a diagnosis of depression admitted because of a recent suicide attempt and depressed patients with no recent history of attempted suicide. Socio-demographic and clinical data were gathered; assessments included the Montgomery-Asberg Depression Rating Scale and the Nurses' Global Assessment of Suicide Risk (NGASR). Forty-six patients were recruited over a 1-year period: 20 were admitted to the hospital following a suicide attempt; the other 26 had not attempted suicide and were admitted for other depression-related reasons. Multivariate analysis revealed a correlation between use of antidepressants and recent attempted suicide. Attempting suicide was not related to the severity of depressive symptoms. In the recent suicide attempt subgroup, NGASR suicide risk levels were lower at discharge than at admission. Patients with a recent history of attempted suicide had a higher number of suicide attempts in their clinical history than patients with no recent history of attempted suicide. There were no correlations between psychiatric diagnosis, severity of depressive symptoms, and recent suicide attempt. Antidepressant therapy protected against suicide attempts. History of suicide attempts was one of the best predictors of recent attempted suicide. A more thorough understanding of the complex phenomenon of suicide and the reasons for suicidal behavior is needed.
Highlights
Suicide is a significant public health problem: more than 800,000 people (11.4/100000) die by suicide every year according to the World Health Organisation [1] and in 2012 suicide was the 15th cause of death worldwide
There were no differences between the RSA and non-suicide attempters (NSA) groups with respect to physical comorbidities and we found no correlations between lifetime psychiatric diagnosis, psychiatric and physical comorbidity, and suicidal behavior
Reduction of suicide risk in psychiatric wards may be achieved by creating a safe environment and ensuring patient visibility; patients should be properly supervised and assessed through teamwork and sharing of viewpoints within the team
Summary
Suicide is a significant public health problem: more than 800,000 people (11.4/100000) die by suicide every year according to the World Health Organisation [1] and in 2012 suicide was the 15th cause of death worldwide. A suicide attempt often leads to admission to a psychiatric ward and it represents a challenge for the whole clinical team. Risk of attempted or successful suicide is highest at the time of hospitalization [4]. Predicting suicide during psychiatric hospitalization remains a challenge [5]. Large and Ryan recently claimed that, it is common to repeat assessments of suicide risk during a hospital stay, this poses several problems of interpretation, and that the predictive value of the risk categories assessed is inevitably low [6]. The risk factors most reliably associated with inpatient suicide are “static” ones, and include a diagnosis of affective disorder, a history of suicide attempts, and a suicide attempt in the week before psychiatric admission [7, 8]. The identification of suicide risk factors does not appear to contribute to a useful probabilistic estimate of inpatient suicide risk, one would expect that some suicides could be prevented by addressing them [6]
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