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Psychiatric hospital bed availability may not influence suicide rates

Availability of psychiatric hospital beds was not causally related to suicide rates, according to recent findings. Researchers suggested future research focus on how beds are being used rather than the absolute number of beds.

“In the past 15 years, there has been a 22% increase in the national suicide rate in the United States, while the total number of psychiatric hospital beds in the United States decreased from 34 to 22 beds per 100,000 residents,” Robert D. Gibbons, PhD, of University of Chicago, and colleagues wrote. “Bastiampillai et al suggest that the availability of psychiatric hospital beds may be a risk factor in a complex network of suicide risk factors.”

To assess associations between suicide rates and psychiatric hospital bed capacity in the United States, researchers analyzed state-level data from the Area Health Resource File on psychiatric hospital bed counts, the number of substance use beds, suicide rates, and per capita mental health spending from 1999 to 2013.

Researchers found a simple inverse association between suicide rates and declining psychiatric hospital bed capacity when considering only a parallel time series.

However, the overall association was produced by between state differences in availability of psychiatric hospital beds (RR = 0.987; 95% CI, 0.981-0.993), accounting for a 1.32% increase in the annual suicide rate per 1 fewer psychiatric hospital bed per 100,000 residents.

There was no within-state association between changes in psychiatric hospital bed capacity and changes in suicide rates (RR = 1; 95% CI, 0.998-1.004), despite notable within-state variability in psychiatric hospital bed availability.

There was a small but significant inverse effect of mental health spending on suicide rates between states (RR = 0.999; 95% CI, 0.998-0.999), that indicated a 0.01% decrease in suicide rates per every dollar of mental health spending.

Analysis did not indicate a significant within-state association.

“Our findings indicate that attention should focus on determining how existing psychiatric beds are used rather than their absolute number. What are the proportions of high-risk patients being treated as outpatients vs. inpatients, and how do their suicide rates compare after adjusting for risk profiles? Suicide risk is linked to rates of the diagnosis of major depression and how effectively it is treated at the outpatient level,” the researchers wrote. “By focusing on hospital bed capacity, we may miss more fundamental deficits in detecting and treating patients at risk for suicide.” – by Amanda Oldt

Disclosure: Gibbons reports serving as an expert witness on statistical issues related to suicide for Pfizer, GSK, and Wyeth and as a founder of Adaptive Testing Technologies, which distributes computerized adaptive tests for mental health assessment. Please see the study for a full list of relevant financial disclosures.