title: Suicide attempts by psychiatric patients in acute inpatient, long-stay inpatient and community care.
abstract: BACKGROUND
  This study examined rates of and risk factors associated with suicide attempts by psychiatric patients under active care. It was especially focussed on the relative rates across three standard treatment settings: acute inpatient care, long-stay inpatient care and community-based care.
  
  
  METHODS
  A total of 12,229 patients in 13,632 episodes of care were rated on the Health of the Nation Outcome Scales (HoNOS) Item 2. For the purposes of the current investigation, a score of 4 was deemed to indicate a suicide attempt.
  
  
  RESULTS
  Incidence densities per 1000 episode days were 5.4 (95% CI = 4.8-6.1) for patients under care in acute inpatient settings, 0.6 (95% CI = 0.5-0.8) for patients under care in long-stay inpatient settings, and 0.5 (95% CI = 0.5-0.6) for patients under care in community-based arrangements. Predictors varied by treatment setting. Risk was elevated for personality disorders across all settings: 22.7 attempts per 1000 episode days (95% CI = 17.2-30.0) in acute inpatient care; 2.1 (95% CI = 1.0-4.5) in long-stay inpatient care; and 2.3 (95% CI = 1.7-3.0) in community-based care. This effect remained after adjustment for demographics.
  
  
  CONCLUSIONS
  Rates of suicide attempts among psychiatric patients are a major issue facing contemporary mental health care systems, and risk factors vary across different treatment settings.
authors.affiliation: Department of General Practice and Public Health, University of Melbourne, West Heidelberg, Victoria, Australia. j.pirkis@gpph.unimelb.edu.au
authors.forename: J
authors.initials: J
authors.lastname: Pirkis
authors.forename: P
authors.initials: P
authors.lastname: Burgess
authors.forename: D
authors.initials: D
authors.lastname: Jolley
mesh_terms: D000208:Acute Disease; D000328:Adult; D003156:Community Mental Health Services; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000534:rehabilitation*; D008875:Middle Aged; D010554:Personality Disorders / Q000150:complications; D012189:Retrospective Studies; D013406:Suicide, Attempted / Q000706:statistics & numerical data*