Clinical correlates of inpatient suicide.
BACKGROUND
Previous suicide assessment research has led to standard predictors of risk. Despite this, there are approximately 30,000 suicides per year in the United States, 5% to 6% of which occur in hospitals. The primary purpose of this study is to improve our ability to assess risk and intervene successfully.


METHODS
Charts from 76 patients who committed suicide while in the hospital, or immediately after discharge, were reviewed. The week before suicide was rated for both standard risk predictors and, using items from the Schedule for Affective Disorders and Schizophrenia (SADS), for presence and severity of symptoms found to be correlated with acute risk in recent studies.


RESULTS
Regarding standard predictors, only 49% (N = 37) had any prior suicide attempt and 25% (N = 19) were admitted for this reason. Thirty-nine percent (30/76) were admitted for suicidal ideation, but 78% denied suicidal ideation at their last communication about this; 46% (N = 35) showed no evidence of psychosis; of those on precautions (N = 45), 51% (N = 23) were on q 15 minute suicide checks or 1:1 observation; and 28% (N = 21) had a no-suicide contract in effect. On SADS ratings, 79% (N = 60) met criteria for severe or extreme anxiety and/or agitation.


CONCLUSIONS
Standard risk assessments and standard precautions used were of limited value in protecting this group from suicide. Adding severity of anxiety and agitation to our current assessments may help identify patients at acute risk and suggest effective treatment interventions. The importance of a matched comparison group to ascertain if this sample can be blindly discriminated from inpatients who do not commit suicide is clear.
Busch
Katie A
KA
Department of Psychiatry, Rush Medical College, Chicago, IL, USA.
Fawcett
Jan
J
Jacobs
Douglas G
DG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D004363:Drug Utilization; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000523:psychology; D012107:Research Design; D018570:Risk Assessment; D012720:Severity of Illness Index; D013405:Suicide / Q000523:psychology*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D014150:Antipsychotic Agents