title: Meta-analysis of suicide rates among psychiatric in-patients.
abstract: OBJECTIVE
  To examine factors associated with the number of psychiatric admissions per in-patient suicide and the suicide rate per 100,000 in-patient years in psychiatric hospitals.
  
  
  METHODS
  Random-effects meta-analysis was used to calculate pooled estimates, and meta-regression was used to examine between-sample heterogeneity.
  
  
  RESULTS
  Forty-four studies published between 1945 and 2013 reported a total of 7552 in-patient suicides. The pooled estimate of the number of admissions per suicide calculated using 39 studies reporting 150 independent samples was 676 (95% CI: 604-755). Recent studies tended to report higher numbers of admissions per suicide than earlier studies. The pooled estimate of suicide rates per 100,000 in-patient years calculated using 27 studies reporting 95 independent samples was 147 (95% CI: 138-156). Rates of suicide per 100,000 in-patient years tended to be higher in more recent samples, in samples from regions with a higher whole of population suicide rate, in samples from settings with a shorter average length of hospital stay and in studies using coronial records to define suicide.
  
  
  CONCLUSIONS
  Rates of in-patient suicide in psychiatric hospitals vary remarkably and are disturbingly high. Further research might clarify the extent to which patient factors and the characteristics of in-patient facilities contribute to the unacceptable mortality in psychiatric hospitals.
authors.affiliation: Mental Health Services, The Prince of Wales Hospital, Sydney, NSW, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Walsh
authors.forename: G
authors.initials: G
authors.lastname: Sara
authors.forename: C J
authors.initials: CJ
authors.lastname: Ryan
authors.forename: M
authors.initials: M
authors.lastname: Large
mesh_terms: D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D012044:Regression Analysis; D012307:Risk Factors; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*
keywords: in-patients; psychiatric hospitals; suicide