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Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric in-patients
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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. doi:10.1111/j.1600-0447.2010.01672.x ISSN 0001690X.
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Official URL: http://dx.doi.org/10.1111/j.1600-0447.2010.01672.x
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 | ||||
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| Subjects: | R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| 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 | ||||
| Official Date: | July 2011 | ||||
| Dates: |
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| Volume: | Vol.124 | ||||
| Number: | No.1 | ||||
| Page Range: | pp. 18-19 | ||||
| DOI: | 10.1111/j.1600-0447.2010.01672.x | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
Data sourced from Thomson Reuters' Web of Knowledge
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