title: Short-term Suicide Risk After Psychiatric Hospital Discharge.
abstract: OBJECTIVE
  Although psychiatric inpatients are recognized to be at increased risk for suicide immediately after hospital discharge, little is known about the extent to which their short-term suicide risk varies across groups with major psychiatric disorders.
  
  
  OBJECTIVE
  To describe the risk for suicide during the 90 days after hospital discharge for adults with first-listed diagnoses of depressive disorder, bipolar disorder, schizophrenia, substance use disorder, and other mental disorders in relation to inpatients with diagnoses of nonmental disorders and the general population.
  
  
  METHODS
  This national retrospective longitudinal cohort included inpatients aged 18 to 64 years in the Medicaid program who were discharged with a first-listed diagnosis of a mental disorder (depressive disorder, bipolar disorder, schizophrenia, substance use disorder, and other mental disorder) and a 10% random sample of inpatients with diagnoses of nonmental disorders. The cohort included 770 643 adults in the mental disorder cohort, 1 090 551 adults in the nonmental disorder cohort, and 370 deaths from suicide from January 1, 2001, to December 31, 2007. Data were analyzed from March 5, 2015, to June 6, 2016.
  
  
  METHODS
  Suicide rates per 100 000 person-years were determined for each study group during the 90 days after hospital discharge and the demographically matched US general population. Adjusted hazard ratios (ARHs) of short-term suicide after hospital discharge were also estimated by Cox proportional hazards regression models. Information on suicide as a cause of death was obtained from the National Death Index.
  
  
  RESULTS
  In the overall population of 1 861 194 adults (27% men; 73% women; mean [SD] age, 35.4 [13.1] years), suicide rates for the cohorts with depressive disorder (235.1 per 100 000 person-years), bipolar disorder (216.0 per 100 000 person-years), schizophrenia (168.3 per 100 000 person-years), substance use disorder (116.5 per 100 000 person-years), and other mental disorders (160.4 per 100 000 person-years) were substantially higher than corresponding rates for the cohort with nonmental disorders (11.6 per 100 000 person-years) or the US general population (14.2 per 100 000 person-years). Among the cohort with mental disorders, AHRs of suicide were associated with inpatient diagnosis of depressive disorder (AHR, 2.0; 95% CI, 1.4-2.8; reference cohort, substance use disorder), an outpatient diagnosis of schizophrenia (AHR, 1.6; 95% CI, 1.1-2.2), an outpatient diagnosis of bipolar disorder (AHR, 1.6; 95% CI, 1.2-2.1), and an absence of any outpatient health care in the 6 months preceding hospital admission (AHR, 1.7; 95% CI, 1.2-2.5).
  
  
  CONCLUSIONS
  After psychiatric hospital discharge, adults with complex psychopathologic disorders with prominent depressive features, especially patients who are not tied into a system of health care, appear to have a particularly high short-term risk for suicide.
authors.affiliation: New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.affiliation: New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York.
authors.forename: Melanie
authors.initials: M
authors.lastname: Wall
authors.affiliation: New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York.
authors.forename: Shuai
authors.initials: S
authors.lastname: Wang
authors.affiliation: Center for Health Services Research on Pharmacotherapy, Chronic Disease Management and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick.
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.affiliation: New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York.
authors.forename: Shang-Min
authors.initials: SM
authors.lastname: Liu
authors.affiliation: Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gerhard
authors.affiliation: Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland.
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D003866:Depressive Disorder / Q000401:mortality; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000401:mortality* / Q000523:psychology; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D012559:Schizophrenia / Q000401:mortality; D019966:Substance-Related Disorders / Q000401:mortality; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D014481:United States; D000092864:Suicide Prevention