Incidence and Predictors of Suicide Attempts and Suicide Deaths Among Individuals Recently Hospitalized for a Mental Disorder: A Population-Based Study

Jessica S. Enns, MD; Natalie P. Mota, PhD; James M. Bolton, MD; Okechukwu Ekuma, MSc; Dan Chateau, PhD; Michelle M. Paluszek, MA; Jitender Sareen, MD; Laurence Y. Katz, MD

J Clin Psychiatry 2022;83(4):21m14055

ABSTRACT

Objective: To examine the incidence and predictors of suicide attempts and deaths in the year after psychiatric hospitalization.

Methods: A population-based dataset was used to develop a cohort of individuals 18 years or older admitted with a mental disorder (defined by ICD-10 codes) from 2005 to 2016 (n = 26,975) in Manitoba, Canada. Using Cox regression, hazard ratios were calculated for each covariate among those who attempted and died by suicide in the year following hospitalization, while adjusting for confounders.

Results: In the year following hospitalization for a mental disorder, 0.7% of the individuals died by suicide and 3.5% attempted suicide. Statistically significant risk factors for suicide in the year after discharge from psychiatric hospitalization included male sex (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.10–1.97) and urban location (HR, 1.37; 95% CI, 1.02–1.85) and for attempting suicide included female sex (HR, 0.63; 95% CI, 0.55–0.72), living rurally (HR, 0.66; 95% CI, 0.58–0.75), a previous mental disorder (HR, 1.63; 95% CI, 1.38–1.92), justice involvement (HR, 1.48; 95% CI, 1.28–1.70), and being on income assistance (HR, 1.17; 95% CI, 1.01–1.35) (P < .05 for all). Age (HR, 0.99; 95% CI, 0.99–0.99) (P < .05) was associated with a reduced rate of suicide attempts.

Conclusions: Further research into interventions to address the identified risk factors for suicide in the recently discharged population is critical to improve management.

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References (41)

World Health Organization. Preventing Suicide: A Global Imperative. who.int/mental_health/suicide-prevention/world_report_2014/. Published 2014. Accessed July 8, 2020.
Jacobs DG, Baldessarini RJ, Conwell Y, et al. Practice Guideline for the Assessment and Treatment of Patients with Suicidal Behaviors. American Psychiatric Association. https://www.appi.org/CustomerService/Pages/Permissions.aspx.http://www.appi.org/CustomerService/Pages/Permissions.aspx. 2010.
Bickley H, Hunt IM, Windfuhr K, et al. Suicide within two weeks of discharge from psychiatric inpatient care: a case-control study. Psychiatr Serv. 2013;64(7):653–659. PubMed CrossRef
Chung DT, Ryan CJ, Hadzi-Pavlovic D, et al. Suicide rates after discharge from psychiatric facilities a systematic review and meta-analysis. JAMA Psychiatry. 2017;74(7):694–702. PubMed CrossRef
Statistics Canada. Deaths and age-specific mortality rates, by selected grouped causes: Table: 13-10-0392-01. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039201. Published 2020. Accessed June 29, 2021.
Hunt IM, Kapur N, Webb R, et al. Suicide in recently discharged psychiatric patients: a case-control study. Psychol Med. 2009;39(3):443–449. PubMed CrossRef
Deisenhammer EA, Behrndt EM, Kemmler G, et al. Suicide risk factors in patients recently discharged from a psychiatric hospital: a case-control study. J Clin Psychiatry. 2019;80(5):18m12702. PubMed CrossRef
Jiang T, Rosellini AJ, Horváth-Puhó E, et al. Using machine learning to predict suicide in the 30 days after discharge from psychiatric hospital in Denmark. Br J Psychiatry. 2021;219(2):440–447. PubMed CrossRef
O’Connell PH, Durns T, Kious BM. Risk of suicide after discharge from inpatient psychiatric care: a systematic review. Int J Psychiatry Clin Pract. 2021;25(4):356–366. PubMed
Roos LL, Nicol JP. A research registry: uses, development, and accuracy. J Clin Epidemiol. 1999;52(1):39–47. PubMed CrossRef
Chartier M, Bolton J, Mota N, et al. Mental Illness Among Adult Manitobans. University of Manitoba. http://mchp-appserv.cpe.umanitoba.ca/deliverablesList.html.
Goldberger N, Haklai Z, Pugachova I, et al. Suicides among persons with psychiatric hospitalizations. Isr J Psychiatry Relat Sci. 2015;52(1):25–31. PubMed
Goldacre M, Seagroatt V, Hawton K. Suicide after discharge from psychiatric inpatient care. Lancet. 1993;342(8866):283–286. PubMed CrossRef
Reutfors J, Brandt L, Ekbom A, et al. Suicide and hospitalization for mental disorders in Sweden: a population-based case-control study. J Psychiatr Res. 2010;44(12):741–747. PubMed CrossRef
Randall JR, Roos LL, Lix LM, et al. Emergency department and inpatient coding for self-harm and suicide attempts: validation using clinician assessment data. Int J Methods Psychiatr Res. 2017;26(3):e1559. PubMed CrossRef
Gunnell D, Bennewith O, Simkin S, et al. Time trends in coroners’ use of different verdicts for possible suicides and their impact on officially reported incidence of suicide in England: 1990-2005. Psychol Med. 2013;43(7):1415–1422. PubMed CrossRef
Bolton JM, Au W, Leslie WD, et al. Parents bereaved by offspring suicide: a population-based longitudinal case-control study. JAMA Psychiatry. 2013;70(2):158–167. PubMed CrossRef
Manitoba Center for Health Policy. Concept: Charlson Comorbidity Index. http://mchp-appserv.cpe.umanitoba.ca/viewConcept.php?conceptID=1098. Published 2019. Accessed July 8, 2020.
Quan H, Li B, Couris CM, et al. Updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676–682. PubMed CrossRef
Pilowsky DJ, Wu L-T. Psychiatric symptoms and substance use disorders in a nationally representative sample of American adolescents involved with foster care. J Adolesc Health. 2006;38(4):351–358. PubMed CrossRef
Anderson HD. Suicide ideation, depressive symptoms, and out-of-home placement among youth in the US child welfare system. J Clin Child Adolesc Psychol. 2011;40(6):790–796. PubMed CrossRef
Taussig HN, Harpin SB, Maguire SA. Suicidality among preadolescent maltreated children in foster care. Child Maltreat. 2014;19(1):17–26. PubMed CrossRef
Katz LY, Au W, Singal D, et al. Suicide and suicide attempts in children and adolescents in the child welfare system. CMAJ. 2011;183(17):1977–1981. PubMed CrossRef
Kariminia A, Law MG, Butler TG, et al. Suicide risk among recently released prisoners in New South Wales, Australia. Med J Aust. 2007;187(7):387–390. PubMed CrossRef
Stenbacka M, Romelsjö A, Jokinen J. Criminality and suicide: a longitudinal Swedish cohort study. BMJ Open. 2014;4(2):e003497. PubMed CrossRef
Webb RT, Qin P, Stevens H, et al. National study of suicide in all people with a criminal justice history. Arch Gen Psychiatry. 2011;68(6):591–599. PubMed CrossRef
Fazel S, Benning R, Danesh J. Suicides in male prisoners in England and Wales, 1978–2003. Lancet. 2005;366(9493):1301–1302. PubMed CrossRef
Casiano H, Hensel JM, Chartier MJ, et al. The intersection between criminal accusations, victimization, and mental disorders: a Canadian population-based study. Can J Psychiatry. 2020;65(7):492–501. PubMed CrossRef
Vuagnat A, Jollant F, Abbar M, et al. Recurrence and mortality 1 year after hospital admission for non-fatal self-harm: a nationwide population-based study. Epidemiol Psychiatr Sci. 2019;29:e20. PubMed
DeJong TM, Overholser JC, Stockmeier CA. Apples to oranges? a direct comparison between suicide attempters and suicide completers. J Affect Disord. 2010;124(1-2):90–97. PubMed CrossRef
Giner L, Jaussent I, Olié E, et al. Violent and serious suicide attempters: one step closer to suicide? J Clin Psychiatry. 2014;75(3):e191–e197. PubMed CrossRef
Joo SH, Wang SM, Kim TW, et al. Factors associated with suicide completion: a comparison between suicide attempters and completers. Asia-Pac Psychiatry. 2016;8(1):80–86. PubMed CrossRef
Fushimi M, Sugawara J, Saito S. Comparison of completed and attempted suicide in Akita, Japan. Psychiatry Clin Neurosci. 2006;60(3):289–295. PubMed CrossRef
Qin P. Suicide risk in relation to level of urbanicity: a population-based linkage study. Int J Epidemiol. 2005;34(4):846–852. PubMed CrossRef
Parra-Uribe I, Blasco-Fontecilla H, Garcia-Parés G, et al. Risk of re-attempts and suicide death after a suicide attempt: a survival analysis. BMC Psychiatry. 2017;17(1):163. PubMed CrossRef
Liu BP, Liu X, Jia CX. Characteristics of suicide completers and attempters in rural Chinese population. Compr Psychiatry. 2016;70:134–140. PubMed CrossRef
Randall JR, Walld R, Finlayson G, et al. Acute risk of suicide and suicide attempts associated with recent diagnosis of mental disorders: a population-based, propensity score-matched analysis. Can J Psychiatry. 2014;59(10):531–538. PubMed CrossRef
Bachmann S. Epidemiology of suicide and the psychiatric perspective. Int J Environ Res Public Health. 2018;15(7):1425. PubMed CrossRef
Ahmedani BK, Peterson EL, Hu Y, et al. Major physical health conditions and risk of suicide. Am J Prev Med. 2017;53(3):308–315. PubMed CrossRef
Racine M. Chronic pain and suicide risk: a comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):269–280. PubMed CrossRef
Wasserstein RL, Schirm AL, Lazar NA. Moving to a world beyond “p<0.05.” Am Stat. 2019;73(suppl 1):1–19. CrossRef