Large, Matthew M., Smith, G. (Glen), Sharma, Swapnil, Nielssen, Olav B. and Singh, Swaran P.. (2011) Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric in-patients. Acta Psychiatrica Scandinavica, Vol.124 (No.1). pp. 18-19. ISSN 0001690X

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Abstract

Objective: To estimate the strength of the associations between the suicide of psychiatric in-patients and demographic, historical, symptomatic, diagnostic and treatment factors. Method: A systematic review and meta-analysis of controlled studies of the suicide of psychiatric in-patients including suicides while on approved or unapproved leave. Results: Factors that were significantly associated with in-patient suicide included a history of deliberate self-harm, hopelessness, feelings of guilt or inadequacy, depressed mood, suicidal ideas and a family history of suicide. Patients suffering from both schizophrenia and depressed mood appeared to be at particular risk. The association between suicidal ideas and in-patient suicide was weak and did not reach statistical significance after a quantitative correction for publication bias. A high-risk categorization as defined by a combination of retrospectively determined individual risk factors was strongly statistically associated with in-patient suicide (OR = 10.9), with a sensitivity of 64% and a specificity of 85%. Conclusion: Despite the apparently strong association between high-risk categorization and subsequent suicide, the low base rate of inpatient suicide means that predictive value of a high-risk categorization is below 2%. The development of safer hospital environments and improved systems of care are more likely to reduce the suicide of psychiatric in-patients than risk assessment.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Divisions:	Faculty of Medicine > Warwick Medical School > Mental Health and Wellbeing Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Systematic reviews (Medical research), Meta-analysis, Suicide -- Risk factors, Psychotherapy patients -- Health risk assessment
Journal or Publication Title:	Acta Psychiatrica Scandinavica
Publisher:	Wiley-Blackwell Publishing, Inc.
ISSN:	0001690X
Date:	July 2011
Volume:	Vol.124
Number:	No.1
Page Range:	pp. 18-19
Identification Number:	10.1111/j.1600-0447.2010.01672.x
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
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URI:	http://wrap.warwick.ac.uk/id/eprint/39085

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