Factors associated with risk of death by suicide after psychiatric hospitalization by the Unified Health System in Brazil (2002-2015)

Abstract

Objective: To investigate overall and sex-related characteristics associated with the risk of death by suicide within 365 days of discharge in patients admitted to psychiatric hospitals in the Brazilian Unified Health System (SUS).

Method: A non-concurrent prospective cohort of adult patients admitted to psychiatric hospitals in the SUS, from 2002 to 2015. Patients were stratified according to sociodemographic and clinical variables. Adjusted hazard ratios (aHRs) of suicide within 365 days of discharge were estimated using Cox proportional hazard regression models.

Results: This sample comprised 1,228,784 adult patients admitted to psychiatric hospitals. Of these, 3201 died by suicide within 365 days of discharge. The risk of suicide was positively associated with male sex, age between 18 and 29 years, living in the South region, and living in rural or intermediate municipalities. The highest risk of suicide was among patients with depressive disorders (aHR, 3.87; 95%CI, 3.41-4.38) follow by opioid-related disorders (aHR, 2.71; 95%CI, 2.00-3.67), particularly among female patients.

Conclusion: Patients with a psychiatric hospital admission should have access to mental health care services immediately after discharge and in the long term. Findings of this study may support suicide prevention policies and have implications for clinical decisions related to patient discharge and follow-up.

Keywords: Hospital discharge; Mental health; Postdischarge suicide; Psychiatric hospitalization; Suicide; Unified Health System.