Many schizophrenia patients who attempt suicide after leaving a hospital did not receive a suicide risk assessment before discharge, according to a new study from Denmark. These mostly include high-risk groups, such as men and patients with a new schizophrenia diagnosis.
Three-quarters of the completed suicides were done by men, and they were 22 percent less likely than women to have received a risk assessment, after adjusting for a variety of patient and treatment-related factors.
“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,” said lead researcher Charlotte Gjørup Pedersen, Ph.D., of the Aalborg Psychiatric Hospital, Denmark and colleagues.
The findings showed that the practice of suicide risk assessments had increased significantly during the study period, with 72 percent of patients being evaluated by a psychiatrist in 2005, rising to 89 percent in 2009.
Overall, 1 percent of the 7107 study patients committed suicide within 1 year of discharge and 8 percent attempted it. Furthermore, 66 percent of patients who committed suicide had a documented risk assessment, as had 73 percent of those who attempted suicide.
Schizophrenia patients who abused alcohol or drugs were less likely to receive a suicide risk assessment, as were those with a score below 30 on the Global Assessment of Functioning — a numeric scale (1-100) designed to measure the functioning level of adults with mental health disorders.
Patients with new schizophrenia diagnoses accounted for 19 percent of all participants. Overall, 64 percent received a risk assessment, 23 percent had missing information on suicide risk assessment, and the others were not assessed at all. Among these patients, undergoing an interview test as well as a cognitive test greatly increased the likelihood that they would be given 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 wrote in Psychiatric Services.
“Systematic suicide risk assessment should therefore be used with caution to guide clinicians and patients but should not stand alone.
“Attention to overall improvements in the care provided both before and after discharge is therefore warranted.”
Source: Psychiatric Services