title: Suicide in hospitalized early psychosis patients at the time of discharge from hospital: An exploratory study of attempters and nonattempters.
abstract: BACKGROUND
  Early intervention programs for psychosis are gateways for suicide prevention. These programs offer an excellent opportunity for prevention due to easy access, early identification, and provisions for continuity of care. These programs have been found effective in reducing rates of suicide after discharge to communities. The objective of this study was to examine suicide risk level among early psychosis patients admitted with and without previous suicide attempts. We hypothesized that all patients admitted with early psychosis would be at high risk of suicide, regardless of a previous suicide attempt.
  
  
  METHODS
  Suicide risk was compared between patients admitted with a suicide attempt (n = 30) and patients admitted without a suicide attempt (n = 30). The primary outcome measure of interest was suicide risk which was measured with the Scale for Impact of Suicidality-Management, Assessment and Planning of Care clinical interview. All patients met DSM-IV TR criteria for schizophrenia. Psychopathology was assessed using the Brief Psychiatric Rating Scale and level of depression was assessed using the Hamilton Depression Rating Scale. The data were statistically analyzed.
  
  
  RESULTS
  Patients admitted with a previous attempt (mean = 29.5, standard deviation [SD] =12.0) did not differ significantly in suicide risk from those admitted without a previous attempt (mean = 27.5, SD = 12.5), (t[58] =0.63, P = 0.53). Patients admitted without a suicide attempt scored higher in depressive symptoms (t[58] =10.62, P < 0.001) than that of admitted with a suicide attempt. There were no significant differences between patients admitted with and without suicide attempts on any comorbidity, other than a trend toward a higher prevalence of personality disorder in patients with no suicide attempt. Attempters and nonattempters did not differ on any demographic variables either.
  
  
  CONCLUSIONS
  Of those admitted without a previous suicide attempt, our findings suggest that it is critical that all patients discharged from an acute psychiatric unit must receive comprehensive community care. The identification of risk, and subsequent intervention for suicidal and self-harm behaviors, should be a central part of treatment for all mental disorders.
authors.affiliation: Consultant Psychiatrist, Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: Amresh
authors.initials: A
authors.lastname: Shrivastava
authors.affiliation: Medical Social Worker, Forensic Program, Regional Mental Health Care, St. Thomas, London, Ontario, Canada.
authors.forename: Coralee
authors.initials: C
authors.lastname: Berlemont
authors.affiliation: Department of Psychiatry, The Western University and Chief, Assessment and Mood and Anxiety Program, Regional Mental Health Care, London, Ontario, Canada.
authors.forename: Robbie
authors.initials: R
authors.lastname: Campbell
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Megan
authors.initials: M
authors.lastname: Johnston
authors.affiliation: Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharastra, India.
authors.forename: Avinash
authors.initials: A
authors.lastname: De Sousa
authors.affiliation: Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharastra, India.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Shah
keywords: Early psychosis; hospitalization; psychosis; schizophrenia; suicide