In honor of Veteran’s day, our post today is about suicide after discharge from a psychiatric hospitalization. Post-hospital suicide is a rarely studied event but does occur among all military and civilians. The rate of suicide for soldiers in the US Army has historically been lower than the rate of civilian suicides, however since 2004 it’s been on the rise. It has risen to the point where the suicide rate for US Army soldiers is now higher than for civilians, even though the Army has been trying to address the problem. One group that would be important to target for intervention would be soldiers who have recently been discharged from inpatient psychiatric care. It has been long known that these patients are at high risk of taking their lives.
The U.S. Military has data that shows there is an eight-fold rise in the risk of suicide during the 3-month period after being hospitalized for a psychiatric condition. This data shows a five-fold rise in the risk of suicide during the next 9 months. A report showing a similar rise among civilians calls for expanding the suicide prevention programs after hospital discharge and interventions. In the United Kingdom they practice these kinds of interventions and there have been a significant decrease in post-hospital suicides, so it seems there is an association between the two.
Suicide is a very rare event, even among those who have recently been discharged from inpatient psychiatric care; therefore, the benefits of giving all inpatients who have been recently discharged in-depth comprehensive post-hospital suicide prevention instructions sounds a bit too extreme as the risks for everyone in this category are low. A more sensible approach would be to combine fairly inexpensive widely accepted interventions with more precisely targeted interventions for those patients deemed high-risk. However, this type of tiered approach means that a reliable risk assessment would need to be developed.
The most accurate predictors of suicide can be found in socio-demographics. These would include the gender being male, the age they enlisted in the service, any criminal history, possessing a weapon, being verbally violent, prior suicidality as well as particular aspects of their inpatient and outpatient psychiatric care. These would include number of prescriptions for antidepressants filled in the previous year and which psychiatric disorders had been diagnosed while they were hospitalized.
Nearly 53% of suicide after discharge happened among the 5% of those hospitalized who had the highest predictable suicide risk, which comes to 3,824.1 suicides per every 100,000 people per year. These hospitalizations of the patients at most risk also accounted for a significant rise in the proportions of a number of other negative post-hospitalization outcomes. These include deaths by unintentional injury, attempted suicide, and additional hospitalizations.
The risk factors involved in suicide are known far and wide, however incorporating all this information in a way that it can be used to predict suicide is not so easy. This research study approached this problem by coming up with an actuarial algorithm for suicide risk from data derived from the U.S. Army and the Department of Defense. This is how they determined that 52.9% of suicides happened post-hospitalization of the 5% at most predictable risk.
It might be that intervening in this high-risk category of patients would not entirely solve the problem of suicide among those in the U.S. Army since suicide after discharge only account for 12% of all suicides among U.S. Army soldiers. The algorithm could help target those most in need of preventive programs and interventions.
Because of the large concentration of those most at risk of committing suicide and of having other negative outcomes, there may be a justification for targeting more extensive post-hospital suicide programs and interventions towards soldiers that have been categorized among those with the greatest risk for suicide after discharge. Before making a final decision a lot of factors would need to be considered, such as the cost of these programs and interventions, their effectiveness as compared to other forms of treatment, and any possible negative effects.