The impact of hospitalization on clinical assessments of suicide risk.
OBJECTIVE
Clinicians' assessments of patients' suicide risk at admission to and discharge from a psychiatric hospital were examined to learn how clinical estimates of risk changed over the course of hospitalization and to identify which demographic and clinical characteristics were associated with higher estimates of risk at admission and discharge.


METHODS
Seventy-one treating physicians evaluated risk of self-harm of 241 patients at admission to and discharge from a short-term inpatient unit. Risk within the next week (short-term risk) and within the next year (long-term risk) was estimated. At discharge and admission, the physicians also rated patients' symptoms using the Brief Psychiatric Rating Scale. Nurses rated self-directed aggression during hospitalization with the Overt Aggression Scale.


RESULTS
Ratings of short-term risk were lower at discharge than at admission, whereas ratings of long-term risk showed relatively little change. At both discharge and admission, the estimated risk of self-harm was associated with a history of suicidal behavior and with acute symptoms, such as depression, anxiety, and emotional withdrawal. At discharge, the estimated risk was also associated with substance abuse, severity of psychosocial stressors, and living alone.


CONCLUSIONS
Clinicians appeared to view their hospital-based interventions as influencing variables relevant to short-term risk of suicide but as having little impact on long-term risk. Implications are discussed for management of suicide risk and for medicolegal assertions regarding prevailing community practices that are made in litigation alleging negligent release of patients from hospitals.
McNiel
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Department of Psychiatry, School of Medicine, University of California, San Francisco 94143, USA.
Binder
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D010351:Patient Discharge; D010555:Personality Inventory; D018570:Risk Assessment; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D000092864:Suicide Prevention