Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric in-patients.
OBJECTIVE
To estimate the strength of the associations between the suicide of psychiatric in-patients and demographic, historical, symptomatic, diagnostic and treatment factors.


METHODS
A systematic review and meta-analysis of controlled studies of the suicide of psychiatric in-patients including suicides while on approved or unapproved leave.


RESULTS
Factors that were significantly associated with in-patient suicide included a history of deliberate self-harm, hopelessness, feelings of guilt or inadequacy, depressed mood, suicidal ideas and a family history of suicide. Patients suffering from both schizophrenia and depressed mood appeared to be at particular risk. The association between suicidal ideas and in-patient suicide was weak and did not reach statistical significance after a quantitative correction for publication bias. A high-risk categorization as defined by a combination of retrospectively determined individual risk factors was strongly statistically associated with in-patient suicide (OR=10.9), with a sensitivity of 64% and a specificity of 85%.


CONCLUSIONS
Despite the apparently strong association between high-risk categorization and subsequent suicide, the low base rate of in-patient suicide means that predictive value of a high-risk categorization is below 2%. The development of safer hospital environments and improved systems of care are more likely to reduce the suicide of psychiatric in-patients than risk assessment.
The Euroa Centre, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW 2031, Australia. mmbl@bigpond.com
M
M
Large
G
G
Smith
S
S
Sharma
O
O
Nielssen
S P
SP
Singh
D000367:Age Factors; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D017533:Marital Status; D001523:Mental Disorders / Q000523:psychology*; D012307:Risk Factors; D012737:Sex Factors; D013405:Suicide / Q000523:psychology*