Suicide risk after discharge from psychiatric care in South Korea

Abstract

Background: Patients with psychiatric disorders are considered to be at increased suicide risk following discharge. We aimed to identify suicide risk during one year after discharge among adults with psychiatric disorders compared to those without psychiatric disorders.

Method: This study used a nationally representative cohort including patients discharged with an initial primary diagnosis of a psychiatric disorder and control subjects selected by 1:3 case-control propensity matching between 2005 and 2012. The dependent variable was death by suicide during one year after discharge. Adjusted hazard ratios (AHR) of suicide risk were estimated by the Cox proportional hazard model.

Results: In a cohort of 50,868 adults, the suicide rate was higher for patients with a psychiatric disorder compared to non-psychiatric patients (AHR 7.2, 95% confidence interval [CI] 4.9-10.6), especially in young adults (AHR 18.6, 95%CI 6.4-54.1), and patients with multiple psychiatric disorders (AHR 12.5, 95%CI 7.9-20.0). Among psychiatric disorder categories, the suicide rate was highest for depressive disorder, followed by bipolar disorder, substance use disorder, schizophrenia. Patients with psychiatric disorders who received outpatient care during one year after discharge were at lower risk of suicide than those who did not receive or otherwise received fewer outpatient treatments.

Limitations: Data were not available on risk factors such as suicide attempts. The suicide risk for shorter periods could not be determined due to the limited data.

Conclusions: Patients with psychiatric disorders are at high suicide risk during one year after hospital discharge. Outpatient follow-up is an effective prevention strategy.

Keywords: Outpatient follow-up; Psychiatric disorders; Suicide.