Prevention of Inpatient Suicides: An Attempt to Portray an Approach

  • Tony Thomas General Hospital, Pala, Kerala, India.

Abstract

Inpatient Suicide (IPS) is the second most common sentinel event reported to the Joint Commission. Psychiatric inpatient suicide rates in the USA, China, New Zealand, Australia, and the UK range from 0.1% to 0.4% for all psychiatric admissions. Population-based mortality studies in psychiatric care show a 16-fold risk for suicide among psychiatric inpatients and a 2-3-fold greater risk for outpatients compared to the risk for outpatients treated in primary care. The risk factors for suicides in inpatient setting and general population differ. Moreover, the identified risk factors for IPS have relatively low degree of association. Nevertheless, psychiatric inpatients are at a higher risk for suicide. This article discusses the spectrum Model of interventions for mental health protection proposed by Mrazek & Haggarty, B-SAFE strategy, and SAFE-T strategy. The above models portray a stepwise approach for inpatients who are “at risk” for suicide. Prevention strategies are to be specifically tailored for each individual, after carefully assessing the risk of suicide. Early diagnosis and proper treatment of psychiatric illness and modification of hospital environmental factors are the cornerstones in preventing inpatient suicides. The role of nursing and paramedical staff is also discussed.

References

Dong JY, Ho TP, Kan CK. A case-control study of 92 cases of inpatient suicides. J Affect Disord. 2005;87(1):91-99.

Coomb et al; Psychiatric Inpatient Suicide: A Literature Review; Primary Psychiatry; 2007

Deisenhammer EA, DeCol C, Honeder M, Hinterhuber H, Fleischhacker WW. Inpatient suicide in psychiatric hospitals. Acta Psychiatr Scand. 2000;102(4):290-294.

Elizabeth A. King, David S. Baldwin, Julia M. A. Sinclair, Michael J. Campbell The Wessex Recent In-Patient Suicide Study, 2; Case—control study of 59 in-patient suicides; The British Journal of Psychiatry Jun 2001, 178 (6) 537-542

Harris, E. C., & Barraclough, B. (1997). Suicide as an outcome for mental disorders: A meta-analysis. The British Journal of Psychiatry, 170, 250–228.

Busch KA, Fawcett J, Jacobs DG. Clinical correlates of inpatient suicide. J Clin Psychiatry. 2003; 64(1):14-19.

Proulx F, Lesage AD, Grunberg F. One hundred inpatient suicides. Br J Psychiatry. 1997;171:247-250.

Powell J, Geddes J, Deeks J, Goldacre M, Hawton K. Suicide in psychiatric hospital inpatients. Risk factors and their predictive power. Br J Psychiatry. 2000; 176:266-272.

Brecić P1, Ostojić D, Vidović D, Jukić V, Bagarić D, Vilibić M, Celić I, Krizaj A, Bilić P; Characteristics of patients who committed suicide during hospitalization in Psychiatric Hospital "Vrapce" in the period 1996-2006; Coll Antropol. 2009 Mar; 33(1):233-6.

Roy et al; Suicide among psychiatric hospital in-patients; Psychol Med. 1995 Jan;25(1):199-202

Chavan BS, Singh GP, Kaur J. Psychological autopsy of 101 suicide cases from northwest region of India. Indian J Psychiatry 2008; 50:34-8.

Gajalakshmi V, Peto R. Suicide Rates in Tamil Nadu, South India: Verbal autopsy of 39,000 deaths in 1997-98. Int J Epidemiol 2007.

Lieb M, Palm U, Meyer S., Risk Factors for inpatient suicide; Psychiat Prax; 41:4 2014 May, 195-9

Sharma V, Persad E, Kueneman K; A closer look at inpatient suicide; J Affect Disord. 1998 Jan; 47(1-3):123-9.

Shah A, Ganesvaran T. Suicide among psychiatric inpatients with schizophrenia in an Australian mental hospital. Med Sci Law. 1999;39(3):251-259.

Dong JY, Ho TP, Kan CK. A case-control study of 92 cases of inpatient suicides. J Affect Disord. 2005; 87(1):91-99.

Jill M. Harkavy-Friedman, David Kimhy, Elizabeth A. Nelson, David F. Venarde, Dolores Malaspina, and J. John Mann; Suicide Attempts in Schizophrenia: The Role of Command Auditory Hallucinations for Suicide; J Clin Psychiatry 2003;64:871–874

Roy et al; Suicide among psychiatric hospital in-patients; Psychol Med. 1995 Jan;25(1):199-202

Deisenhammer EA, Huber M, Kemmler G, Weiss EM, Hinterhuber H. Psychiatric hospitalizations during the last 12 months before suicide. Gen Hosp Psychiatry. 2007;29(1):63-65.

Brent DA, Perper JA, Goldstein CE, et al. Risk factors for adolescent suicide: a comparison of adolescent suicide victims with suicidal inpatients. Arch Gen Psychiatry. 1988;45:581–588.

Bolton JM, Cox BJ, Afifi TO, Enns MW, Bienvenu OJ, Sareen J. Anxiety disorders and risk for suicide attempts: findings from the Baltimore Epidemiologic Catchment area follow-up study. Depress Anxiety. May 31 2007

Erlangsen A, Zarit SH, Tu X, Conwell Y. Suicide among older psychiatric inpatients: an evidence-based study of a high-risk group. Am J Geriatr Psychiatry. 2006;14(9):734-741.

Joyce B, Wallbridge H. Effects of suicidal behavior on a psychiatric unit nursing team. J Psychosoc Nurs Ment Health Serv. 2003;41(3):14-23

Bethell, J. & Rhodes, A.E. (2007). Depressed mood in the suicidal population. Canadian Journal of Psychiatry, 52, 744–748

Sakinofsky, I. & Webster, G. (2010) The Epidemiology of Suicide in Canada. In J. Cairney & D.L. Streiner (Eds.), Mental Disorder in Canada: An Epidemiological Perspective (p. 379). Toronto: University of Toronto Press. Sakinofsky, I. (2010). How to assess and manage suicidal patients in hospital practice. Presentation to the CAMH Suicide Risk Assessment Initiative work group, Toronto: CAMH.

Cassells C, Paterson B, Dowding D, Morrison R. Long- and short-term risk factors in the prediction of inpatient suicide: review of the literature. Crisis. 2005;26(2):53-63.

Thase, M.E. (2008). Do antidepressants really work? A clinician’s guide to evaluating the evidence. Current Psychiatry Reports, 10, 487–494.

Flensborg-Madsen, T., Knop, J., Mortensen, E.L., Becker, U., Sher, L. & Grønbaek, M. (2009). Alcohol use disorders increase the risk of completed suicide—irrespective of other psychiatric disorders: A longitudinal cohort study. Psychiatry Research, 167, 123–130.

Rehm, J., Baliunas, D., Brochu, S., Fischer, B., Gnam, W., Patra, J. et al. (2006). The Cost of Substance Abuse in Canada 2002.

Ligen MA, Zivin K, Austin KL, Bohnert AS, Czyz EK, Valenstein M, Kilbourne AM. Severe pain predicts greater likelihood of subsequent suicide. Suicide Life Threat Behav. 2010;40:597–608.

Martin D. Cheatle, PhD; Depression, Chronic Pain, and Suicide by Overdose: On the Edge; Pain Med. 2011 June ; 12(Suppl 2): S43–S48.

Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003; 163(20):2433–2445.

Elizabeth H. B. Lin, Susan R. Heckbert, Carolyn M. Rutter, Wayne J. Katon, Paul Ciechanowski, Evette J. Ludman; Depression and Increased Mortality in Diabetes: Unexpected Causes of Death; Ann Fam Med September 1, 2009 vol. 7 no. 5 414-421

Stewart D, Bowers L, Warburton F. Constant special observation and self-harm on acute psychiatric wards: a longitudinal analysis. Gen Hosp Psychiatry. 2009;31(6):523–530.

Len Bowers, Charlotte Dack, Noreen Gul, Ben Thomas, Karen James; Learning from prevented suicide in psychiatric inpatient care: An analysis of data from the National Patient Safety Agency; Int. J. Nurs. Stud. (2011), doi:10.1016/j.ijnurstu 2011.05.008

Coleman JC, Paul GT. Relationship between staffing ratios and effectiveness of inpatient psychiatric units. Psychiatr Serv. 2001;52:1374–1379.

Bassett D, Tsourtos G. Inpatient suicide in a general hospital psychiatric unit. A consequence of inadequate resources? Gen Hosp Psychiatry. 1993;15(5):301–306.

Hunt IM, Windfuhr K, Shaw J, et al. Ligature points and ligature types used by psychiatric inpatients who die by hanging. A national study. Crisis. 2012;33(2):87–94.

Hunt IM, Windfuhr K, Swinson N, et al. Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey. BMC Psychiatry. 2010;10(14).

Benensohn HS, Resnik HL. Guidelines for “suicide-proofing” a psychiatric unit. Am J Psychother. 1973;27(2):204–212.

Cardell R, Bratcher KS, Quinnett P. Revisiting “suicide proofing” an inpatient unit through environmental safeguards: a review. Perspect Psychiatr Care. 2009;45(1):36–44.

Lieberman DZ, Resnik HLP, Holder-Perkins V. Environmental risk factors in hospital suicide. Suicide Life Threat Behav. 2004;34(4):448–453.

Isaac Sakinofsky; Preventing Suicide Among Inpatients; CanJPsychiatry 2014;59(3):131–14

Published
2018-01-07
Section
Review Article