Clinical Correlates of Inpatient Suicide
J Clin Psychiatry 2003;64:14-19
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Previous suicide assessment research
has led to standard predictors of risk. Despite this, there are
approximately 30,000 suicides per year in the United States, 5%
to 6% of which occur in hospitals. The primary purpose of this
study is to improve our ability to assess risk and intervene
Method: Charts from 76 patients who committed
suicide while in the hospital, or immediately after discharge,
were reviewed. The week before suicide was rated for both
standard risk predictors and, using items from the Schedule for
Affective Disorders and Schizophrenia (SADS), for presence and
severity of symptoms found to be correlated with acute risk in
Results: Regarding standard predictors, only 49%
(N=37) had any prior suicide attempt and 25% (N=19) were admitted
for this reason. Thirty-nine percent (30/76) were admitted for
suicidal ideation, but 78% denied suicidal ideation at their last
communication about this; 46% (N=35) showed no evidence of
psychosis; of those on precautions (N=45), 51% (N=23) were on q
15 minute suicide checks or 1:1 observation; and 28% (N=21) had a
no-suicide contract in effect. On SADS ratings, 79% (N=60) met
criteria for severe or extreme anxiety and/or agitation.
Conclusion: Standard risk assessments and
standard precautions used were of limited value in protecting
this group from suicide. Adding severity of anxiety and agitation
to our current assessments may help identify patients at acute
risk and suggest effective treatment interventions. The
importance of a matched comparison group to ascertain if this
sample can be blindly discriminated from inpatients who do not
commit suicide is clear.