Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, Austria.
J Clin Psychiatry. 2019 Sep 17;80(5):18m12702. doi: 10.4088/JCP.18m12702.
The first weeks after discharge from a psychiatric hospital constitute a period of considerably increased risk for suicide. Most studies on risk factors have investigated a relatively long time frame after discharge or have identified unmodifiable factors. This case-control study focused on factors describing the interaction between patient and hospital and studied variables during the entire course of the hospital stay.
Suicide cases were identified by linking the Tyrol Suicide Register (all suicides occurring in the Austrian state of Tyrol) with the registers of the 3 psychiatric hospitals in the state. Postdischarge suicide cases were defined as suicides occurring within 12 weeks after discharge. Control subjects were patients who had also been inpatients in the respective psychiatric unit but had not committed suicide. Matching variables included sex, age, hospital, diagnosis, and date of discharge. The study period comprised 7 years (February 1, 2004-January 31, 2011).
A total of 89 suicide cases and 144 controls were included. Factors differentiating cases from controls included a history of suicidal behavior or threats (odds ratio [OR] = 4.65; P < .001), depressive symptoms (OR = 3.63; P = .004) and disordered thought content (OR = 2.68; P = .001) at admission, admission mode (patient self-referral less often [OR = 0.28; P = .009]), a change from one ward to another (OR = 1.87; P = .035), discharge initiated by the patient (OR = 10.34; P = .013), depressive symptoms at this point in time (OR = 4.42; P < .001), discharge mode (less often into institutional care [OR = 0.17; P = .002]), and linkage with postdischarge care (fixed appointment with a general practitioner less often [OR = 0.53; P = .024]).
The results of this study point to suicide preventive measures that may be implemented during and after hospitalization, including clear information transfer in case of unavoidable ward change and optimization of follow-up care organization.
从精神病院出院后的最初几周是自杀风险显著增加的时期。大多数关于危险因素的研究都调查了出院后相对较长的时间框架，或者确定了不可改变的因素。本病例对照研究侧重于描述患者与医院之间相互作用的因素，并在整个住院期间研究变量。
通过将蒂罗尔自杀登记处（所有在奥地利蒂罗尔州发生的自杀事件）与该州 3 家精神病院的登记处联系起来，确定自杀病例。出院后自杀病例被定义为出院后 12 周内发生的自杀。对照病例为也在各自精神病单元住院但未自杀的患者。匹配变量包括性别、年龄、医院、诊断和出院日期。研究期为 7 年（2004 年 2 月 1 日-2011 年 1 月 31 日）。
共纳入 89 例自杀病例和 144 例对照病例。区分病例与对照的因素包括自杀行为或威胁史（比值比[OR] = 4.65；P <.001）、入院时的抑郁症状（OR = 3.63；P =.004）和思维内容障碍（OR = 2.68；P =.001）、入院方式（患者自我转诊较少[OR = 0.28；P =.009]）、从一个病房转到另一个病房（OR = 1.87；P =.035）、患者发起出院（OR = 10.34；P =.013）、此时的抑郁症状（OR = 4.42；P <.001）、出院方式（较少进入机构护理[OR = 0.17；P =.002]）和与出院后护理的联系（与全科医生的固定预约较少[OR = 0.53；P =.024]）。
本研究结果表明，可以在住院期间和出院后实施预防自杀的措施，包括在不可避免的病房变更时进行明确的信息转移和优化随访护理组织。
