National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, University of Manchester, Manchester M13 9PL, UK.
J Affect Disord. 2013 Jan 10;144(1-2):123-8. doi: 10.1016/j.jad.2012.06.019. Epub 2012 Aug 4.
Around a quarter of in-patient suicides occur within the first week of admission to psychiatric in-patient care. Little is known on the factors associated with suicide during this critical time. We aimed to identify risk factors for suicide among in-patients within the first week of admission.
A national population-based case-control study of 107 current psychiatric in-patients in England who died by suicide within a week of admission, matched on admission date with 107 living controls.
Forty-two (40%) suicide cases died within the first 3 day of admission. A fifth of all suicides were on authorised leave at the time of death, but 34% were off the ward without staff agreement compared to only 1% of controls. Independent risk factors for suicide included previous self-harm, recent adverse life events, and a short (<12 months) duration of illness.
This is a retrospective study, using clinical data mainly collected from case records. Clinicians were not blind to case/control status.
The first few days of admission should be recognised as the period of highest risk. Careful risk evaluation is needed at this time, particularly in those with recent illness onset or previous suicide attempts. Knowledge of life events experienced before admission should be incorporated into risk assessments. Improvements to the ward environment to lessen the distress of an admission may be an important preventative measure. Protocols may require adapting to improve the safety of those on agreed leave, and prevent absconding through increased vigilance and closer observation of ward exits.
大约四分之一的住院自杀发生在精神科住院治疗的第一周内。在这段关键时期，与自杀相关的因素知之甚少。我们旨在确定入院第一周内住院患者自杀的风险因素。
这是一项针对英格兰 107 名在入院后一周内自杀的当前精神科住院患者的全国性基于人群的病例对照研究，按入院日期与 107 名存活对照匹配。
42 例（40%）自杀病例在入院后的前 3 天内死亡。所有自杀事件中，有五分之一的人在死亡时获得了授权休假，但 34%的人未经工作人员同意离开病房，而对照组只有 1%。自杀的独立风险因素包括以前的自残行为、最近的生活事件和较短的（<12 个月）疾病持续时间。
这是一项回顾性研究，使用的临床数据主要来自病例记录。临床医生无法对病例/对照状态保持盲态。
入院后的最初几天应被视为风险最高的时期。此时需要进行仔细的风险评估，特别是在近期发病或以前有自杀企图的患者中。应将入院前经历的生活事件的知识纳入风险评估中。改善病房环境以减轻入院时的痛苦可能是一项重要的预防措施。可能需要调整协议以提高获准休假者的安全性，并通过加强病房出口的警戒和更密切的观察来防止擅自离开。
