Short-term Suicide Risk After Psychiatric Hospital Discharge

Abstract

Importance: Although psychiatric inpatients are recognized to be at increased risk for suicide immediately after hospital discharge, little is known about the extent to which their short-term suicide risk varies across groups with major psychiatric disorders.

Objective: To describe the risk for suicide during the 90 days after hospital discharge for adults with first-listed diagnoses of depressive disorder, bipolar disorder, schizophrenia, substance use disorder, and other mental disorders in relation to inpatients with diagnoses of nonmental disorders and the general population.

Design, setting, and participants: This national retrospective longitudinal cohort included inpatients aged 18 to 64 years in the Medicaid program who were discharged with a first-listed diagnosis of a mental disorder (depressive disorder, bipolar disorder, schizophrenia, substance use disorder, and other mental disorder) and a 10% random sample of inpatients with diagnoses of nonmental disorders. The cohort included 770 643 adults in the mental disorder cohort, 1 090 551 adults in the nonmental disorder cohort, and 370 deaths from suicide from January 1, 2001, to December 31, 2007. Data were analyzed from March 5, 2015, to June 6, 2016.

Main outcomes and measures: Suicide rates per 100 000 person-years were determined for each study group during the 90 days after hospital discharge and the demographically matched US general population. Adjusted hazard ratios (ARHs) of short-term suicide after hospital discharge were also estimated by Cox proportional hazards regression models. Information on suicide as a cause of death was obtained from the National Death Index.

Results: In the overall population of 1 861 194 adults (27% men; 73% women; mean [SD] age, 35.4 [13.1] years), suicide rates for the cohorts with depressive disorder (235.1 per 100 000 person-years), bipolar disorder (216.0 per 100 000 person-years), schizophrenia (168.3 per 100 000 person-years), substance use disorder (116.5 per 100 000 person-years), and other mental disorders (160.4 per 100 000 person-years) were substantially higher than corresponding rates for the cohort with nonmental disorders (11.6 per 100 000 person-years) or the US general population (14.2 per 100 000 person-years). Among the cohort with mental disorders, AHRs of suicide were associated with inpatient diagnosis of depressive disorder (AHR, 2.0; 95% CI, 1.4-2.8; reference cohort, substance use disorder), an outpatient diagnosis of schizophrenia (AHR, 1.6; 95% CI, 1.1-2.2), an outpatient diagnosis of bipolar disorder (AHR, 1.6; 95% CI, 1.2-2.1), and an absence of any outpatient health care in the 6 months preceding hospital admission (AHR, 1.7; 95% CI, 1.2-2.5).

Conclusions and relevance: After psychiatric hospital discharge, adults with complex psychopathologic disorders with prominent depressive features, especially patients who are not tied into a system of health care, appear to have a particularly high short-term risk for suicide.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.. Comparison of Suicide Rates of Adult Inpatients With Mental Disorders and the General Population

Inpatient data are derived from the primary discharge diagnosis in the Medicaid program and followed up for the first 90 days after discharge. Suicide rates in the general population are derived from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research and matched to the mental disorder cohorts by age, sex, and race or ethnicity.

Figure 2.. Cumulative Probability of Suicide During the First 90 Days After Hospital Discharge

Includes inpatients in the mental and nonmental disorder cohorts. All comparisons are with the nonmental disorder cohort using log-rank tests.

Figure 3.. Cumulative Probability of Suicide of Male and Female Inpatients With Any Mental Disorder During the First 90 Days After Hospital Discharge

Comparison uses the log-rank test.