Article Name : Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation.
Method: Meta-analysis of relevant English-language, peer-reviewed papers published in MEDLINE, PsycINFO or Embase between 01 January 1945 and 31 March 2017.
Background: A recent meta-analysis of suicide mortality after discharge from psychiatric facilities revealed alarming figures. The rate of suicide among discharged patients is exceptionally high, with 484 suicides per 100,000 person-years among 100 studies reporting on suicides after any follow-up period and 1132 suicides per 100,000 person-years among 18 studies reporting on suicides within the first 3 months. Indicating that the suicide rate among this vulnerable patient group is up to 100 times the global suicide rate and that being a recently discharged patient confers a higher risk of suicide death than any other risk factor
Many of these studies did not include estimates of periods shorter than 3 months. So this study objective was to compute a combined estimate and statistical spread (including range, median, and quartile values) for suicide rates at both the 1-week and 1-month marks post-discharge. As a secondary goal, the study aimed to investigate potential factors moderating suicide rates during these two follow-up periods based on the attributes of the primary research.
Selection Criteria: Longitudinal studies that reported the number of person years and the number of suicides in the first week and first month post discharge from acute adult psychiatric hospitalisation were included in the study. The article excluded studies of postdischarge suicide after release from child and adolescent psychiatric wards, long-stay mental health wards, forensic psychiatric facilities and patients who were admitted to non-psychiatric settings . The study identified 24 out of 26 papers reporting suicides occurring within the first week or first month post-discharge. An additional eight studies were included after obtaining data from personal communication with authors. Thus, data from a total of 34 papers were analyzed.
Results: Results signify that there is significantly heightened risk of suicide immediately following psychiatric hospitalization(one week post discharge). One week post discharge rates were approximately 3000 suicides per 100,000, one month discharge rates were 2000 per 100,00 and lastly weeks 2-4 showed rates at 1000 per 100,00.
Limitation: The study observed significantvariability throughout the papers included,which can be explained by publication bias towards studies with high suicide rates
Clinical bottom line: With data from the past 3 decades of research, this study highlights that suicide rates in the first week post discharge are nearly 3 times higher when compared to subsequent days. Emphasizing the importance of intensive follow up care during this period via follow up visits, psychoeducation etc.
