title: Has deinstitutionalization affected inpatient suicide? Psychiatric inpatient suicide rates between 1990 and 2013 in Israel.
abstract: OBJECTIVE
  To examine variations in rates of inpatient suicide and clinical risk factors for this phenomenon.
  
  
  METHODS
  The National Israeli Psychiatric Hospitalization Case Registry was used to study inpatient suicide. Clinical risk factors for inpatient suicide were examined in a nested case control design.
  
  
  RESULTS
  Between 1990 and 2013 there were 326 inpatient suicides, at an average of one inpatient suicide per 1614 admissions. A significant decline in rates of suicide per admission over time (p<0.001) was associated with a reduced number of beds (p<0.001) and a decline in nationwide suicide rates (p=0.001). Clinical risk factors for inpatient suicide were: affective disorders (OR=5.95), schizoaffective disorder (OR=5.27), schizophrenia (OR=3.82), previous suicide attempts (OR=2.59), involuntary hospitalization (OR=1.67), and more previous hospitalizations (OR=1.16,). A multivariate model with sensitivity of 27.3% and specificity of 95.3% for inpatient suicide, showed a positive predictive value of 0.4%.
  
  
  CONCLUSIONS
  The absolute number and rates of inpatient suicide per admission have decreased over time, probably due to the decreased number of beds lowering total time at risk. Patients with affective and psychotic disorders and with previous suicide attempts have the greatest risk of inpatient suicide. However, clinical characteristics do not enable identification of patients who are at risk for suicide.
authors.affiliation: Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel. Electronic address: lindalevi90@gmail.com.
authors.forename: Linda
authors.initials: L
authors.lastname: Levi
authors.affiliation: Division of Psychiatry, University College London, England, United Kingdom.
authors.forename: Nomi
authors.initials: N
authors.lastname: Werbeloff
authors.affiliation: Ministry of Health, Jerusalem, Israel.
authors.forename: Inna
authors.initials: I
authors.lastname: Pugachova
authors.affiliation: Ministry of Health, Jerusalem, Israel.
authors.forename: Rinat
authors.initials: R
authors.lastname: Yoffe
authors.affiliation: University of New South Wales, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Large
authors.affiliation: Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Davidson
authors.affiliation: Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Mark
authors.initials: M
authors.lastname: Weiser
mesh_terms: D000328:Adult; D003688:Deinstitutionalization / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients / Q000523:psychology; D007557:Israel / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D012189:Retrospective Studies; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Clinical; In-patients; Psychiatric hospitals; Suicide