Suicides following inpatient psychiatric hospitalization: A nationwide case control study

Petr Winkler; Karolína Mladá; Ladislav Csémy; Blanka Nechanská; Cyril Höschl

doi:10.1016/j.jad.2015.05.039

Suicides following inpatient psychiatric hospitalization: A nationwide case control study

J Affect Disord. 2015 Sep 15:184:164-9. doi: 10.1016/j.jad.2015.05.039. Epub 2015 Jun 10.

Authors

Petr Winkler¹, Karolína Mladá², Ladislav Csémy², Blanka Nechanská³, Cyril Höschl²

Affiliations

¹ Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom. Electronic address: petr.winkler@nudz.cz.
² Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic.
³ Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; Institute of Health Information and Statistics, Palackého nám. 4 , P.O. BOX 60, Praha 2 - Nové Město 128 01, Czech Republic.

PMID: 26093829
DOI: 10.1016/j.jad.2015.05.039

Abstract

Background: Research shows the elevated risk of suicide associated with current or recent inpatient psychiatric hospitalization. However, it is unclear whether this applies in the area of post-communist Central and Eastern Europe where mental health care has not been deinstitutionalized yet. The present study aims to examine the rates of suicides among psychiatric patients during and shortly after discharge from inpatient hospitalization in the Czech Republic.

Methods: All inpatient psychiatric hospitalizations and all suicides committed between 2008 and 2012 have been merged on an individual data basis. The time horizon between the admission and two months after the discharge from inpatient psychiatric facility was utilized and multiple logistic regression was performed to calculate the odds of committing suicide.

Results: A total of 137,290 inpatients were hospitalized in Czech psychiatric facilities between 2008 and 2012, and 402 of the inpatients committed suicide during the hospitalization or within the 2 months after the discharge. Highly elevated risks of suicides were found to be associated with being a male, having a history of multiple hospitalizations, and having a diagnosis of affective, anxiety, or personality disorder.

Limitations: Limitations are related to the design of the study, and its reliance on routinely collected data. Also, it was not possible to assess the odds of suicide associated with inpatient psychiatric hospitalization against the odds of suicide in general population.

Conclusions: During psychiatric treatment and recovery, suicial behavior and idealiation is increased. In psychiatry, hospitalization may be a risky period for suicide behavior. Suicide rates during and soon after the psychiatric hospitalization identified in this study from Central and Eastern Europe are similar to the findings from Western Europe. Preventive strategies should be tailored accordingly.

Keywords: Case control study; Central and Eastern Europe; Psychiatric hospitalization; Suicide.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Anxiety Disorders / mortality
Case-Control Studies
Czech Republic / epidemiology
Female
Hospitalization / statistics & numerical data*
Hospitals, Psychiatric
Humans
Inpatients
Male
Mental Disorders / mortality*
Middle Aged
Mood Disorders / mortality
Patient Discharge
Personality Disorders / mortality
Psychiatric Department, Hospital
Sex Factors
Socioeconomic Factors
Suicidal Ideation
Suicide / psychology*
Suicide / statistics & numerical data*
Treatment Outcome
Young Adult