Suicide in high security hospital patients.
OBJECTIVE
People with mental disorder and people who are violent are separately recognised as being at high risk of suicide. People detained in high security hospitals are recognised for their violence to others, but perhaps less so for their suicide potential. We aimed to investigate suicide rates among such patients during and after their high security hospital residency, and to establish risk factors for suicide.


METHODS
We extracted data from the Special Hospitals' Case Register on each person resident at any time between 1 January 1972 and 31 December 2000. Suicide rates were calculated for the whole period. We compared rates to the general population using standardised mortality ratios (SMRs). We used poisson regression to estimate the effects of gender, legal category of detention, offending history and length of admission on the suicide rate.


RESULTS
Of the 5,955 individuals, 218 completed suicide. The suicide rate was nearly 7 times higher among resident men (SMR 662, 95% CI 478-845) and over 40 times higher in resident women (SMR 4,012, 95% CI 2,526-5,498) than in the general population; it was 23 times higher (SMR 2,325, 95% CI 1,901-2,751) and 45 times higher (SMR 4,486, 95% CI 2,727-6,245) among post-discharge men and women, respectively. The suicide rate was significantly higher among women than men inside high security but not after discharge.


CONCLUSIONS
The suicide rate among high security hospital patients was significantly higher than in the general population. Women were especially at risk while resident, whereas for men, the risk was higher after discharge.
Jones
Roland M
RM
Department of Psychological Medicine and Neurology, Cardiff University, Cardiff, CF14 4XN, UK. jonesrm6@cf.ac.uk
Hales
Heidi
H
Butwell
Martin
M
Ferriter
Mike
M
Taylor
Pamela J
PJ
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003134:Commitment of Persons with Psychiatric Disorders; D057237:Criminals / Q000523:psychology; D004739:England; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000401:mortality*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D012307:Risk Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D014852:Wales; D055815:Young Adult