Suicide ideation in hospitalized psychiatric patients and postdischarge suicide

Leo Sher, M.D.

A research report, “A false sense of security: Rapid improvement as a red flag for death by suicide” was published in 2022 in the Journal of Consulting and Clinical Psychology (1).

Postdischarge from inpatient psychiatry is the highest risk period for suicide. The majority of deaths by suicide postdischarge happened within the first week, with most suicides occurring the day after discharge. The authors sought to determine whether there were predictable patterns in suicide ideation in hospitalized psychiatric patients.

The authors examined a sample of 2,970 adult’s ages 18–87 admitted to an extended length of stay inpatient psychiatric hospital between 2012 and 2018. The average length of inpatient stay for the sample was about 44 days. The authors used group-based trajectory modeling via the SAS macro PROC TRAJ to quantitatively determine four suicide ideation groups: nonresponders (i.e., high suicide ideation throughout treatment), responders (i.e., steady improvement in suicide ideation across treatment), resolvers (i.e., rapid improvement in suicide ideation across treatment), and no-suicide ideation (i.e., never significant suicide ideation in treatment). The authors compared groups to clinical and suicide-specific outcomes, including death by suicide.

The authors found that resolvers were the most likely to die by suicide postdischarge relative to all other suicide ideation groups. Resolvers also demonstrated significant improvement in all clinical outcomes from admission to discharge. The authors suggested that clinicians should not be lulled into a false sense of security when hospitalized adults rapidly improve in terms of suicide ideation. Instead, inpatient psychiatric treatment teams should increase caution regarding the patient’s risk level and postdischarge treatment planning.

Reference

1. Rufino KA, Beyene H, Poa E, Boland RJ, Patriquin MA. A false sense of security: Rapid improvement as a red flag for death by suicide. J Consult Clin Psychol. 2022 May;90(5):405-412. doi: 10.1037/ccp0000723. Epub 2022 Apr 14.