Article Title: Suicide Rates After Discharge From Psychiatric Facilities: A Systematic Review and Meta-analysis

Journal Title: The Journal of the American Medical Association

Publication Year: 2017

Author(s): Chung, D., et al

 

Study Description:

Many published studies have identified high rates of suicide after psychiatric hospitalization. This study aims to quantify the rates of suicide post discharge from psychiatric facilities. This systematic review and meta-analysis includes a total of 100 studies which examines different patient samples such as females vs. males vs. “mixed sex” and adults vs. adolescents vs. older adults. This includes a total of 17,857 suicides during 4,725,445 person-years.

 

Outcomes:

The primary outcome studied was the suicide rate after discharge from psychiatric facilities.

 

Results:

The pooled rate of suicide after discharge was found to be 484 per 100,000 person years. The period of follow up was analyzed to determine the effect of follow up duration on suicide after discharge. The suicide rate in the samples with a follow up period of 3 months or less was 1,132 per 100,000 person years. For a follow up period of 3-12 months it was 654 per 100,000 person years; for 1-5 years it was 494 per 100,000 person years; for 5-10 years it was 366 per 100,000 person years; and for greater than 10 years it was 277 per 100,000 person years. In addition, the suicide rate was lower for adolescent groups (158 per 100,000 person years) compared to adults (555 per 100,000 person years) and older patients (496 per 100,000 person years). Samples that included individuals discharged after an admission for suicidality (2078 per 100,000 person years) has 4 times the suicide rate compared to other samples.

 

Conclusion:

The immediate (3 month or less) post discharge period is of increased risk (100 times the global suicide risk). Suicide rates remain high for many years after discharge. Patients who were admitted due to suicidal ideations or behaviors are of higher risk for suicide after discharge.

 

Limitations:

1. Most studies came from high income economies, results may not be representative of post-discharge suicide in low and middle income countries
2. Study didn’t estimate suicide rates in the days immediately after discharge.

 

Clinical Applicability:

This study can help guide clinical practice by placing an emphasis on suicide prevention on the period shortly following discharge. Suicide prevention should begin while patients are still hospitalized and should be closely followed, especially in the 3 month post discharge period. Also, previously admitted patients who exhibited prior suicidality should be a focus of the community efforts because these individuals remain at a higher risk of suicide for many years. This study emphasizes the need for close and rapid outpatient follow up following psychiatric hospitalization.