Earlier follow-up lowered suicide risk after psychiatric inpatient discharge

Key takeaways:

• Earlier follow-up was linked to lower suicide risk following psychiatric inpatient discharge.
• “Intensive follow-up” may be needed right after discharge, especially for those at high-risk for admission.

An earlier follow-up visit after psychiatric inpatient discharge was associated with lower risk of suicide in a population-based study from South Korea.

Earlier follow-up lowered suicide risk for patients with substance use disorder, schizophrenia, bipolar disorder and depression, suggesting that “more intensive follow-up” is needed immediately after discharge, particularly for the prevention of suicide in those deemed high-risk at admission, Song E. Che, MPH, and colleagues wrote in JAMA Network Open.

The retrospective cohort study included 76,462 adults who, between Jan. 17, 2017, and Dec. 31, 2018, were newly admitted to hospitals with a psychiatric illness other than dementia.

Che and colleagues tracked the group’s post-discharge suicide rate through 2021 and, using a Cox proportional hazards model, explored its association to how early patients had received follow-up care in the first 30 days after discharge.

The cohort was 52.6% male with a mean age of 46.4 years. Data came from the National Health Claim Database in South Korea, which contained all patients’ demographic characteristics, prescriptions, examinations and other health care services.

Among the 49,319 patients who received follow-up care within 30 days of being discharged, the mean follow-up period was 30.8 months (standard deviation = 20.2).

Compared with patients who received no follow-up care, those who had follow-up within 7 days had a hazard ratio for suicide risk of 0.82 (94% CI, 0.8-0.83).

Risk increased as follow-up time lengthened, the researchers wrote. The hazard ratio was 0.83 (95% CI, 0.82-0.85) for patients who had follow-up within 8 to 14 days and 0.86 (95% CI, 0.84-0.89) for those who had follow-up between 15 and 30 days.

A total of 1,536 patients died of suicide during the study.

Che and colleagues concluded that “more intensive follow-up” may be needed immediately after discharge to prevent suicide in patients with psychiatric illness, especially those deemed high risk at admission.

The study’s limitations included data being unavailable for some important suicide risk factors, including suicide attempt history, socioeconomic status and social support. Also, “the timing of outpatient care is inevitably different depending on cost efficiency, institutional priorities and patient-centeredness,” the researchers wrote.