title: Suicide within two weeks of discharge from psychiatric inpatient care: a case-control study.
abstract: OBJECTIVE
  Suicide risk after discharge from psychiatric inpatient care is high, particularly in the first few weeks. The aim of the study was to identify risk factors and protective factors (that is, factors associated with a reduced risk of suicide), including variation in health care received, for suicide among patients in the two-week postdischarge period.
  
  
  METHODS
  This was a national population-based retrospective case-control study of 100 psychiatric patients in England (2004-2006), age 18-65, who died by suicide within two weeks of hospital discharge. These patients were matched on discharge date with 100 living control group patients.
  
  
  RESULTS
  Fifty-five percent of suicides occurred within a week of discharge, 49% of whom died before their first follow-up appointment. Conditional logistic regression analyses indicated that recent adverse life events and a short (less than one week) final admission were independently associated with postdischarge suicide, as were older age and comorbid psychiatric disorders. Receiving enhanced aftercare (under the Care Programme Approach) was protective of suicide.
  
  
  CONCLUSIONS
  Discharged patients viewed as being at high risk of suicide require immediate community follow-up. Mental health services should be mindful of discharging patients after a short admission. The potential role of detrimental life experiences indicates that mental health clinicians need to be aware of the circumstances into which patients are being discharged. Use of enhanced levels of care, such as that offered by the Care Programme Approach, may play a strong role in preventing suicide within two weeks of discharge.
authors.affiliation: Centre for Mental Health and Risk, Jean McFarlane Building, University of Manchester, Manchester M13 9PL, United Kingdom.
authors.forename: Harriet
authors.initials: H
authors.lastname: Bickley
authors.forename: Isabelle M
authors.initials: IM
authors.lastname: Hunt
authors.forename: Kirsten
authors.initials: K
authors.lastname: Windfuhr
authors.forename: Jenny
authors.initials: J
authors.lastname: Shaw
authors.forename: Louis
authors.initials: L
authors.lastname: Appleby
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000379:methods*; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D010347:Patient Care Planning / Q000592:standards; D010351:Patient Discharge; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult; D000092864:Suicide Prevention