Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan; Department of Psychiatry, National Taiwan University College of Medicine, Taipei 10051, Taiwan; Department of Nursing, Oriental Institute of Technology, New Taipei City 22061, Taiwan.
Department of Medical Research, National Taiwan University Hospital, Taipei 10055, Taiwan.
J Affect Disord. 2020 Apr 1;266:528-533. doi: 10.1016/j.jad.2020.02.014. Epub 2020 Feb 3.
This study aimed to compare the predictors of suicides among psychiatric inpatients and recently discharged patients and to examine the association between the length of stay and suicides.
Data from psychiatric inpatients were extracted from the National Health Insurance databank and merged with information from the Cause of Death data using unique identification numbers. Poisson regression analyses were used to estimate the incidence rate ratio for inpatient and post-discharge suicides, which included the variables of sex, age, psychiatric diagnosis, and number of admissions in the preceding year. The associations between length of stay and inpatient and post-discharge suicide were examined using multivariate Poisson regression analyses that were adjusted for these variables.
A diagnosis of affective disorders and a higher number of previous admissions increased both inpatient and post-discharge suicides. Patients older than 15-24 years had a significantly lower inpatient suicide risk but were more likely to die by suicide post-discharge. The risk of suicide both during the inpatient stay and post-discharge statistically significantly decreased when the length of stay was longer.
As there were variations in societal, environmental, and facility-level factors that might have influenced the association between length of stay and suicide, the generalization of our findings to different settings may be impeded.
This study provides additional evidence that hospitalization helps to reduce the suicide risk. It suggests that medical professionals should be alert to inpatient suicide and that they should determine the optimal length of stay considering post-discharge suicide.
本研究旨在比较精神科住院患者和近期出院患者自杀的预测因素，并探讨住院时间与自杀之间的关系。
从国家健康保险数据库中提取精神科住院患者的数据，并使用唯一识别号码与死因数据中的信息合并。使用泊松回归分析估计住院和出院后自杀的发病率比，其中包括性别、年龄、精神科诊断和前一年的住院次数等变量。使用多元泊松回归分析调整这些变量后，检验住院时间与住院和出院后自杀之间的关系。
诊断为情感障碍和前一年住院次数增加会增加住院和出院后自杀的风险。15-24 岁以上的患者住院自杀风险显著降低，但出院后自杀的可能性更高。随着住院时间的延长，自杀的风险在住院期间和出院后都有统计学意义地下降。
由于社会、环境和医疗机构水平等因素的变化可能影响住院时间与自杀之间的关联，因此我们的研究结果可能难以推广到不同的环境。
本研究提供了额外的证据表明住院有助于降低自杀风险。这表明医疗专业人员应该警惕住院期间的自杀风险，并应考虑到出院后的自杀风险，确定最佳的住院时间。
