Key Points
Rationale
The risk of suicide is particularly high in the period immediately following discharge from psychiatric hospitalization (Chung et al., 2019).
However, most previous studies on suicide risk factors have focused on long-term follow-up periods and modeled risk as constant over time (Franklin et al., 2017).
There is a critical need to examine suicide risk and risk factors in the short-term period after discharge, particularly for patients hospitalized for depression.
Additionally, it is important to investigate whether the relative importance of different risk factors changes over time following discharge.
Method
This was a population-basedcohort studyusing Finnish national registers, including hospital discharge, population, and cause of death registers.
Procedure
The study identified all psychiatric hospitalizations for patients 18 years and older with depression as the principal diagnosis from 1996 to 2017.
Patients were followed for up to 2 years from their last discharge, with each discharge marking the beginning of a new follow-up period.
Sample
The study included 193,197 hospitalizations among 91,161 individuals. Of these individuals, 56.2% were female, and the mean age was 44.0 years (SD= 17.3).
Measures
Data were collected from national registers on:
Statistical measures
The study used:
Results
Incidence of suicide after discharge:
Short-term risk factors (0-3 days after discharge):
Temporal patterns of relative risk over 2 years:
Insight
This study provides crucial insights into the dynamic nature of suicide risk following psychiatric hospitalization for depression.
The extremely high risk in the immediate post-discharge period underscores the critical importance of intensive follow-up care and support during this time.
The identification of specific short-term risk factors, such as severe depression, current suicide attempts, and older age, can help clinicians prioritize resources and interventions for the most vulnerable patients.
The varying temporal patterns of risk factors over the 2-year follow-up period is a novel and important finding. It suggests that the relative importance of different risk factors changes over time, which has significant implications for ongoing risk assessment and management.
For example, while clinical factors like depression severity and current suicide attempts have the strongest association with risk immediately after discharge, their relative importance decreases over time. In contrast, factors like alcohol and substance use disorders become increasingly important predictors of suicide risk in the longer term.
They highlight the need for dynamic risk assessment models that account for changes in the relative importance of different factors over time.
Further research could focus on:
Strengths
Limitations
Clinical Implications
The results of this study have significant implications for clinical practice and suicide prevention efforts:
The significance of these results is substantial, as they provide a more nuanced understanding of suicide risk that can inform more effective prevention strategies.
By recognizing the dynamic nature of risk factors, clinicians and health systems can develop more personalized and adaptive approaches to suicide prevention for patients with depression.
References
Primary reference
Aaltonen, K., Sund, R., Hakulinen, C., Pirkola, S., & Isometsä, E. (2024). Variations in suicide risk and risk factors after hospitalization for depression in Finland, 1996-2017.JAMA psychiatry,81(5), 506-515.
Other references
Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis.JAMA Psychiatry, 74(7), 694-702.
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., … & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.Psychological Bulletin, 143(2), 187-232.
Nordentoft, M., Mortensen, P. B., & Pedersen, C. B. (2011). Absolute risk of suicide after first hospital contact in mental disorder.Archives of General Psychiatry, 68(10), 1058-1064.
Turecki, G., & Brent, D. A. (2016). Suicide and suicidal behaviour. The Lancet, 387(10024), 1227-1239.
van Heeringen, K., & Mann, J. J. (2014). The neurobiology of suicide.The Lancet Psychiatry,1(1), 63-72.
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
