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Original Investigation
November 2016

Short-term Suicide Risk After Psychiatric Hospital Discharge

Author Affiliations
  • 1New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York
  • 2Center for Health Services Research on Pharmacotherapy, Chronic Disease Management and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick
  • 3Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway
  • 4Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
JAMA Psychiatry. 2016;73(11):1119-1126. doi:10.1001/jamapsychiatry.2016.2035
Key Points

Question  Which inpatients are at highest short-term risk for suicide after hospital discharge?

Findings  In this national retrospective longitudinal cohort of almost 1.9 million adult inpatients in the Medicaid program, suicide risk during the first 90 days after hospital discharge was highest for patients with first-listed depressive disorders, followed by those with bipolar disorder, schizophrenia, and substance use disorders and lowest for patients with nonmental disorders.

Meaning  Recently discharged psychiatric inpatients, especially those with mood disorders, are at exceptionally high short-term risk for suicide.

Abstract

Importance  Although psychiatric inpatients are recognized to be at increased risk for suicide immediately after hospital discharge, little is known about the extent to which their short-term suicide risk varies across groups with major psychiatric disorders.

Objective  To describe the risk for suicide during the 90 days after hospital discharge for adults with first-listed diagnoses of depressive disorder, bipolar disorder, schizophrenia, substance use disorder, and other mental disorders in relation to inpatients with diagnoses of nonmental disorders and the general population.

Design, Setting, and Participants  This national retrospective longitudinal cohort included inpatients aged 18 to 64 years in the Medicaid program who were discharged with a first-listed diagnosis of a mental disorder (depressive disorder, bipolar disorder, schizophrenia, substance use disorder, and other mental disorder) and a 10% random sample of inpatients with diagnoses of nonmental disorders. The cohort included 770 643 adults in the mental disorder cohort, 1 090 551 adults in the nonmental disorder cohort, and 370 deaths from suicide from January 1, 2001, to December 31, 2007. Data were analyzed from March 5, 2015, to June 6, 2016.

Main Outcomes and Measures  Suicide rates per 100 000 person-years were determined for each study group during the 90 days after hospital discharge and the demographically matched US general population. Adjusted hazard ratios (ARHs) of short-term suicide after hospital discharge were also estimated by Cox proportional hazards regression models. Information on suicide as a cause of death was obtained from the National Death Index.

Results  In the overall population of 1 861 194 adults (27% men; 73% women; mean [SD] age, 35.4 [13.1] years), suicide rates for the cohorts with depressive disorder (235.1 per 100 000 person-years), bipolar disorder (216.0 per 100 000 person-years), schizophrenia (168.3 per 100 000 person-years), substance use disorder (116.5 per 100 000 person-years), and other mental disorders (160.4 per 100 000 person-years) were substantially higher than corresponding rates for the cohort with nonmental disorders (11.6 per 100 000 person-years) or the US general population (14.2 per 100 000 person-years). Among the cohort with mental disorders, AHRs of suicide were associated with inpatient diagnosis of depressive disorder (AHR, 2.0; 95% CI, 1.4-2.8; reference cohort, substance use disorder), an outpatient diagnosis of schizophrenia (AHR, 1.6; 95% CI, 1.1-2.2), an outpatient diagnosis of bipolar disorder (AHR, 1.6; 95% CI, 1.2-2.1), and an absence of any outpatient health care in the 6 months preceding hospital admission (AHR, 1.7; 95% CI, 1.2-2.5).

Conclusions and Relevance  After psychiatric hospital discharge, adults with complex psychopathologic disorders with prominent depressive features, especially patients who are not tied into a system of health care, appear to have a particularly high short-term risk for suicide.

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