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In-patient suicide rate decreased, data showed

The rate of suicide among psychiatric in-patients has fallen significantly in England, according to a recent study. However, the number of suicides rose in patients recently discharged and those enrolled in the care of specialist services such as crisis resolution teams.

Nav Kapur, MD, and researchers from the University of Manchester conducted a prospective study that included all patients admitted to National Health Service (NHS) in-patient psychiatric care from 1997 to 2008 in England. Patients aged at least 15 years who died by suicide while under psychiatric in-patient care were identified from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness database and the NHS’ Hospital Episode Statistics data warehouse.

Results show there were 1,942 suicides in psychiatric in-patients during the entire study period. The average annual number of in-patient suicides fell from 200 in the 1997 to 1998 time period to 105 in 2007 to 2008, a 47.6% drop. The fall in rates was sharper during the earlier years of the study, according to the researchers. The reduction in the suicide rate was significant for suicides occurring on the ward, as well as those at a distance from the ward; however, the drop was more significant for ward deaths (51% vs. 22%).

According to the researchers, the rate of in-patient suicide was higher in males (38.2%) than in females (22.3%), although rates dropped significantly for both populations.

There were statistically significant reductions in deaths by hanging (30.7%), drug poisoning (48.5%), carbon monoxide poisoning (59.6%), drowning (51.2%) and jumping (28.4%). The reduction in deaths by hanging that occurred on the ward was particularly evident, the researchers wrote, with the mean rate falling from 0.60 in 1997 and 1998 to 0.24 in 2007 and 2008. Rates of suicide also fell across most diagnostic groups, but especially in patients diagnosed with schizophrenia (47.1%).

However, results also showed that the rate of suicide after discharge rose from 1.39 to 1.66 per 1,000 discharges per year. There was a significant increase in the number of suicides in patients under the care of specialist services such as crisis resolution and early intervention teams, which would be expected, given the expansion of those types of services, the researchers wrote.

The reduction of in-patient suicide rates could be attributable to a drop in overall suicides, changes to the in-patient case mix or an increased awareness of the problem of in-patient suicide through policy initiatives, according to the researchers.

“There seems to have been a sustained reduction in the rate of suicide among psychiatric in-patients in England at a time of falling bed numbers,” they wrote. “This has been evident across several demographic and clinical subgroups. Changes to in-patient case mix or better quality services are potential explanations, but a transfer of risk cannot be ruled out.”

In particular, the researchers said the potentially high rates of suicide outside of in-patient care warrant further consideration.

Disclosure: The researchers report no relevant financial disclosures.