Many patients with schizophrenia who attempt suicide after hospital discharge missed out on a pre-discharge suicide risk assessment, shows a study from Denmark.
And those missing out included high-risk groups, such as men and patients with a new schizophrenia diagnosis.
“Additional efforts appear warranted in order to ensure that all patients receive systematic suicide risk assessment before being discharged and that appropriate measures are taken to lower the risk of suicidal behavior,” say lead researcher Charlotte Gjørup Pedersen (Aalborg Psychiatric Hospital, Denmark) and colleagues.
The team found that adherence to systematic suicide risk assessment had increased significantly during the study period, with 72% of patients being assessed by a psychiatrist in 2005, rising to 89% in 2009.
However, 1% of the 7107 patients studied committed suicide within 1 year of discharge and 8% attempted to do so. In all, 66% of patients who committed suicide had a documented risk assessment, as had 73% of those who attempted suicide.
Men comprised three-quarters of the completed suicides, but were 22% less likely than women to have received a risk assessment, after adjusting for a range of patient- and treatment-related variables.
Also, patients who abused alcohol or drugs had a reduced likelihood for receiving a suicide risk assessment, as did those with a Global Assessment of Functioning score below 30.
Patients with new schizophrenia diagnoses accounted for 19% of all participants. In total, 64% received a risk assessment, and 23% had missing information on suicide risk assessment; the others were not assessed. Among these patients, having their psychopathology assessment via an interview test and undergoing a cognitive test significantly increased the likelihood that they would undergo a pre-discharge suicide risk assessment.
“Despite the recommendations for the use of systematic suicide risk assessment, the predictive value of the risk assessment is modest due to the high prevalence of the assessment of risk factors and the low rate of suicidal behavior,” the researchers write in Psychiatric Services.
“Systematic suicide risk assessment should therefore be used with caution to guide clinicians and patients but should not stand alone.”
They conclude: “Attention to overall improvements in the care provided both before and after discharge is therefore warranted.”
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