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Risk factors for suicide in the immediate post-discharge period

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Abstract

Background

Suicide risk is highest in the first few months following psychiatric in-patient care. Most data on post-discharge suicides have come from Western countries. Many studies collected cases of suicide over a long post-discharge period and did not focus on this high-risk period. This study aims to describe the characteristics and examine the risk factors of suicides occurring in the immediate post-discharge period in Hong Kong.

Methods

A case-control study based on discharged patients from all psychiatric hospitals/units in Hong Kong in 1997–1999. Suicides occurring within 60 days of discharge from psychiatric hospitals (N = 97) were ascertained by record linkage with Coroner’s court data. Controls were matched for age, gender, diagnoses, discharge hospitals, and dates of discharge. Possible risk factors were extracted from in- and out-patient records, and were identified by conditional logistic regression.

Results

The commonest diagnosis and suicide method were schizophrenia and falling from a height, respectively. There were no significant case-control differences in the drug treatment received. Risk factors for suicides were: previous deliberate self-harm (OR = 2.3, 95% CI = 1.07–5.05), admission for deliberate self-harm (OR = 3.2, 95% CI = 1.3–7.8), compulsory admission (OR = 3.1, 95% CI = 1.1–8.7), living alone (OR = 5.8, 95% CI = 1.4–23), work stresses (OR = 5.4, 95% CI = 1.5–18) and being out of contact (OR = 7.9, 95% CI = 1.87–33). The overall number of risk factors had greater screening efficacy for suicide than any single factor.

Conclusions

Vulnerable (previous suicidality) and uncooperative (compulsory admission and out of contact) patients who live alone and are exposed to work stresses are prone to immediate post-discharge suicide. Thorough treatment of the circumstances leading to the index admissions, management of work stresses, improved engagement in follow-up care and systematic assessment of suicide risk are indicated.

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Acknowledgements

The authors would like to thank the Quality Assurance Subcommittee (Psychiatry) for support of the project, Information Technology Section for identification of cases and controls, chief-of-service for approval of access to medical records and Dr. Elizabeth King for allowing revision of her instrument.

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Authors and Affiliations

  1. Dept. of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China

    Chui-Kwan Kan FHKCPsych & Eva L. W. Dunn MRCPsych

  2. Dept. of Psychiatry, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China

    Ting-Pong Ho MD

  3. Dept. of Psychiatry, Tuen Mun Hospital, Hong Kong, China

    Jimmy Y. S. Dong FHKCPsych

Authors
  1. Chui-Kwan Kan FHKCPsych
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  2. Ting-Pong Ho MD
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  3. Jimmy Y. S. Dong FHKCPsych
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  4. Eva L. W. Dunn MRCPsych
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Corresponding author

Correspondence to Ting-Pong Ho MD.

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Kan, CK., Ho, TP., Dong, J.Y.S. et al. Risk factors for suicide in the immediate post-discharge period. Soc Psychiat Epidemiol 42, 208–214 (2007). https://doi.org/10.1007/s00127-006-0153-0

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  • DOI: https://doi.org/10.1007/s00127-006-0153-0

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