Suicide Risk Post-Hospital: A Word of Warning on the Final Day of Mental Health Month
When we, or the people we love, are at real risk for suicide, we often consider hospitalization. We know hospitalization (whether inpatient or outpatient) is one of the best methods for keeping them (or us) safe in the short-term. It's exceptionally difficult to obtain the means to self-harm in a hospital setting, which helps. Additionally, regular and focused access to treatment in a healthcare setting has been shown to decrease suicide risk in general. This also helps. It is any wonder then that many of us believe the threat of imminent self-harm has been eliminated upon release? If it hadn't been, we think, why would the hospital have issued the release?
A study released today in JAMA, indicates that our assumption, that things are better post-hospitalization, is very likely wrong.
A meta-analysis of 100 studies, which captured nearly 5 million person-years and more than 17 thousand suicides from all across the world, confirmed that the suicide risk after hospitalization doesn't decrease. It rises. And "markedly."
In the U.S., for example, the overall suicide death rate was 13.4 per 100,000 in 2014. According to the meta-analysis, the overall suicide rate for patients hospitalized due to risk of suicide was 1089 per 100,000 person-years in the first three months after discharge. That is a significant difference. The risk does seem to decline in the months discharge (571 per 100,000 during the following 9 months), but the risk appears to remain for at least 10 years after discharge (274 per 100,000.)
There are likely some confounding variables here. It is likely that the people hospitalized due to suicide risk are significantly more likely to attempt and commit suicide than their non-hospitalized peers. Hospitalization implies an urgency and likelihood that may not exist in those who admit to suicidal ideation but aren't at such immediate risk (i.e. those who have no concrete plan). It may also be that current healthcare and insurance systems are pushing release before patients are actually ready to be on their own.
Regardless, this study does indicate one thing clearly: Patients hospitalized due to suicide risk need intensive care in the first few months after discharge. Regular follow-ups. Consistent and frequent therapy. The danger isn't over, yet.
To read the study: http://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2017.1044