More attention needs to be paid to suicide prevention in general hospitals, according to a new study.
Researchers from the University of Stirling found that people who took their own lives were three times more likely to have been last discharged from a general hospital than a psychiatric one.
The research team, led by Nadine Dougall, studied all deaths by suicide in Scotland in people aged 15 and over between 1981 and 2010. Of the 16,411 suicides, 66% had linkable hospital records.
Researchers found that of those people who died by suicide 8,263 had last been in a general hospital, compared to only 2,644 who had been in a psychiatric hospital. Overall, a quarter of deaths (2,575) occurred within three months of people being discharged from hospital – and 58% among those people discharged from a general hospital.
Despite having died by suicide, only 14% of those who were discharged from a general hospital had a psychiatric diagnosis recorded in their notes at their last visit. But analysis of the records found that a further 19% had a previous history of mental illness that had not been recorded.
Less than half of all those who died after being discharged from a general hospital had been given a diagnosis of ‘injury or poisoning’, which includes accidents and self-injury. Young men aged 15-45 accounted for 60% of these deaths. Among all those who had been diagnosed with ‘injury or poisoning’ before discharge, 22% took their lives within three months of discharge, and 68% within a year.
The researchers believe that there is potential for staff in general hospitals to identity an ‘at-risk’ group of people who are not being admitted for ‘injury or poisoning’, but who do have a previous history of self-injury or a psychiatric disorder, or both.
“Contact with healthcare services offers opportunities for health professionals to engage in suicide prevention,” Dougall said. “To do this, we need to be able to assess which people are most at risk.
“Our study found that substantially more people who died by suicide were last discharged from general hospitals, rather than psychiatric hospitals, with many of these deaths having occurred relatively soon after a discharge. This suggests that more opportunities for intervention may exist.
“Targeted follow-up of people admitted to general hospital having self-harmed – in particular young men – and screening for psychological problems in those who have had a previous history of self-harming or of mental illness, could be beneficial. To do this, hospitals will need to make better use of historical and electronic health records. Hospitals would also need to ensure that all hospital staff are able to engage in basic mental health screening of ‘at risk’ patients.”
The full study is published in the British Journal of Psychiatry. Reference: Dougall N, Lambert P, Maxwell M, Dawson A, Sinnott R, McCafferty S, Morris C, Clark D and Springbett A. Deaths by suicide and their relationship with general and psychiatric hospital discharge: 30-year record linkage study. British Journal of Psychiatry, ePub ahead of print, bjp.bp.112.122374, 30 January 2014