Abstract
People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools.
Highlights
People with mental illness have an elevated risk of dying prematurely from both natural and unnatural causes [1,2], and their average life span is found to be about 15–20 years shorter than that of the general population [3]
A large national cohort study from Denmark noted a decreasing suicide rate among psychiatric inpatients towards the end of the last century but at a significantly slower pace compared to the rate of people who had not been admitted to psychiatric hospital [21], suggesting that the excess mortality by suicide among psychiatric inpatients had grown over time
Several studies have examined the predictors of inpatient suicide in those admitted to a psychiatric hospital
Summary
People with mental illness have an elevated risk of dying prematurely from both natural and unnatural causes [1,2], and their average life span is found to be about 15–20 years shorter than that of the general population [3]. Large national register-based studies have shown that about 44% of all people who die by suicide have been admitted to a psychiatric hospital [7,8]. Approximately 4%–5% of people admitted to a psychiatric hospital will die by suicide [6]. Suicides among hospitalised psychiatric patients are rare, it is considered to be a public health problem [18]. This paper aims to provide an overview of the scientific literature addressing the risk of suicide associated with a psychiatric inpatient stay. We will be addressing the relative risk, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients and conclude with a discussion and implication of the available evidence based peer-reviewed literature
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