The Suicide Risk of Discharged Psychiatric Patients
J Clin Psychiatry 2003;64(6):702-707
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: The suicide risk of psychiatric
patients fluctuated along the course of their illness and was
found to be high in the immediate post-discharge period in some
settings. The epidemiology and psychiatric services for the
suicide population in Hong Kong have differed from those of the
West (i.e., low youth suicide rate, high elderly suicide rate,
high female/male ratio, and heavily government-subsidized
psychiatric service). This study examined the suicide rates
within a year of discharge from psychiatric inpatient care in
Method: Discharges from all psychiatric
hospitals or psychiatric wards in general hospitals in Hong Kong
from 1997 through 1999 were followed up for suicides (ICD-9,
E950-E959) and "undetermined" causes of deaths
(E980-E989) by record linkage with the Coroner's Court until
their deaths or Dec. 31, 2000. The suicide rates (/1000
person-years at risk) and standardized mortality ratios (SMRs;
assigning a value of 1 to the same age- and sex-specific suicide
rates in the general population) were calculated.
Results: 21,921 patients (aged over 15 years)
were discharged from psychiatric hospitals from 1997 through
1999. Two hundred eighty patients committed suicide within 1 year
of discharge; 85 suicides (30%) occurred within 28 days after
discharge. The SMRs for suicide in the first 28 days after
discharge were 178 (95% CI = 132 to 235) for females and 113 (95%
CI = 86 to 147) for males. These rates were 4.0 (95% CI = 2.7 to
5.6) times higher for females and 4.6 (95% CI = 3.2 to 6.3) times
higher for males than the rate in the rest of the year. Young
adults had higher SMRs than the elderly. No specific diagnoses
had higher suicidal risk than others. Calculations including
undetermined causes of deaths (N = 53) gave similar results.
Conclusion: The immediate post-discharge period
carries a high risk of suicide for psychiatric patients. The
high-risk groups are young adults and females. No diagnosis
appears to carry a particularly high risk.