title: Postdischarge suicide: A psychodynamic understanding of subjective experience and its importance in suicide prevention.
abstract: Recent discharge from a psychiatric inpatient facility is associated with a high risk of suicide. There are multiple factors that may contribute to this increase in risk. Psychodynamic considerations about the patient's subjective experience of suicidality, hospitalization, and discharge are often overlooked but are critical to understanding this phenomenon. Qualitative research has begun to provide empirical support for the importance of the psychological aspects of discharge, and the heightened state of vulnerability that patients experience during this time. Review of the literature and careful consideration of clinical experience is helpful in elucidating this experience in a way that can inform effective treatment. This article integrates a psychodynamic understanding of suicidality in the postdischarge period with a review of empirical research and formulates clinical recommendations for suicide prevention.
authors.affiliation: North Shore Medical Center and Harvard Medical School.
authors.forename: Mark
authors.initials: M
authors.lastname: Schechter
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Goldblatt
authors.affiliation: McLean Hospital and Harvard Medical School.
authors.forename: Elsa
authors.initials: E
authors.lastname: Ronningstam
authors.affiliation: McLean Hospital and Harvard Medical School.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Herbstman
authors.affiliation: McLean Hospital and Harvard Medical School.
authors.forename: John T
authors.initials: JT
authors.lastname: Maltsberger
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D006778:Hospitals, Psychiatric; D006801:Humans; D007398:Interpersonal Relations; D007902:Length of Stay; D055118:Medication Adherence; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D010351:Patient Discharge; D012307:Risk Factors; D012944:Social Support; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D000092864:Suicide Prevention
chemical_list: D000928:Antidepressive Agents