Risk of suicide according to the level of psychiatric contact in the older people: Analysis of national health insurance databases in Taiwan

Abstract

PurposeSuicide in the older people is a serious problem worldwide; however the effect of psychiatric contact on the risk of suicide has not been fully explored. The aim of this study was to investigate the relationship between psychiatric contact and suicide in the older people in Taiwan. MethodsA population-based database was used in this national case–control study. Propensity score matching was used to match older people who did and did not commit suicide from 2010 to 2012 by calendar year, gender, age, and area of residence. The level of psychiatric contact in the preceding year was classified as “no psychiatric contact,” “only outpatient psychiatric contact,” “psychiatric emergency room contact,” or “psychiatric hospital admission”. Conditional logistic regression analysis was used to assess associations between variables and the risk of suicide. ResultsA total of 2528 older people committed suicide from 2010 to 2012, with a crude suicide mortality rate of 3.37/10,000. Compared to those who had no psychiatric contact in the preceding year, the adjusted odds ratios of suicide were 10.15 (95% CI=5.8–17.7) for those who had psychiatric emergency room contact, 6.57 (95% CI=3.7–11.6) for those who had psychiatric hospital admissions, and 3.64 (95% CI=3.0–4.4) for those with only outpatient psychiatric contact. The risk of suicide was higher in those who had depression (OR=3.49, 95% CI=2.2–5.4) and bipolar disorder (OR=1.98, 95% CI=1.1–3.6). Patients with cancer were associated with suicide (OR=8.96, 95% CI=5.6–14.4). ConclusionsThe positive association with suicide and the level of psychiatric contact in the preceding year in older people indicated that the health personnel need to do a better job in determining possible risk for older people who had psychiatric contact, especially in emergency visit or psychiatric admission. A systematic approach to quality improvement in these settings is both available and necessary. Careful discharge planning and safe transitions of care to outpatient services are required for suicide prevention of high-risk patients after discharge.