Suicide following psychiatric hospitalization.

The hypothesis was tested that following psychiatric hospitalization, those subjects who subsequently completed suicide would be distinguished from those who did not by the interaction of two circumstances: a state of defenselessness at the time of hospitalization, and experience of adverse life events following release from hospital. Subjects were 40 male VA psychiatric inpatients: 20 who completed suicide following release, and 20 controls matched on age, race, and time at risk in the community. Defenselessness (the incapacity to defend against distressful negative self-feelings) was defined in terms of scores derived from the extended Brief Psychiatric Rating Scale administered shortly after the patient's hospitalization. Adverse life events were eight events characterized simultaneously as undesirable, unlikely to have been initiated by the subject, and having a score of 30 or above on the Social Readjustment Rating Scale. In confirmation of the hypothesis, it was found that completed suicide subjects were significantly and appreciably more likely both to have had high defenselessness scores at the time of hospitalization and to have experienced adverse life events during the posthospitalization period, whereas neither circumstance in the absence of the other was predictive. The findings support the position that suicide is a response to experiences with self-threatening implications, in the face of personal incapacity to defend against, adapt to, or cope with such experiences.     

Suicide attempters in the emergency department before hospitalization in a psychiatric ward

PURPOSE. The study aims to compare the current suicidal risk of mood disorder patients who had just attempted suicide, as compared with those who had not attempted suicide, admitted to an emergency department (ED), and then hospitalized in a psychiatric unit. METHOD. One hundred sixty‐one mood disorder patients admitted to the ED were studied. A total of 22.4% of the participants were admitted for a suicide attempt. Patients were assessed for psychopathology and diagnosis. FINDINGS. Suicide attempters were nearly 12 times more likely to report ongoing suicidal ideation during the psychiatric evaluation in the ED than nonattempters. Men and women did not differ for current and previous suicide attempts or for ongoing suicidal ideation. PRACTICAL IMPLICATIONS. It is important to conduct a suicide risk assessment when individuals are admitted to an ED.     

Around-the-clock mobile psychiatric crisis intervention: Another effective alternative to psychiatric hospitalization

This retrospective study evaluates the effect of the addition of a mobile psychiatrist to a 24-hour crisis intervention team, on the number of admissions, to the local state and private hospitals, of residents of the team's catchment area. During the Program period, the psychiatrist was available at the site of the crisis to provide immediate psychiatric treatment. The number of admissions to the hospitals during the Program period was then compared to those of the corresponding periods of the two previous years and of the year after, by means of a time series statistical analysis. When the onsite services of a psychiatrist were added to the mobile crisis intervention program a sharp decrease in state hospital admissions took place, without any increase in private hospital admissions. This decrease was followed by a definite rebound, after the on-site services of the psychiatrist were terminated, and throughout the following year.     

Alternatives to psychiatric hospitalization for children

The impetus for the dramatic increase in the number of treatment alternatives for children has come from changes in the theoretical conceptualization of treatment, social and political pressures, and financial considerations. This article reviews the literature on alternatives to hospitalization, appraising the available data on the effectiveness of psychiatric hospitalization and its alternatives and considers future research needs and the development of services in this area.     

Vascular risk to late-life depression: evidence from a longitudinal community study

OBJECTIVE: To determine prospectively relationships between minor cerebrovascular episodes and depressive symptoms in a community cohort of older persons. METHOD: In 1988-1989, baseline measurements of vascular risk factors and depressive symptoms were obtained in older community residents (mean age = 67). At 10-year follow-up, three subgroups of subjects still residing in the community were re-assessed: those who had suffered a transient ischaemic attack (TIA) (n = 16) in the intervening period; those with hypertension but no TIAs (n = 38); and, those with neither TIAs nor hypertension (n = 40). RESULTS: Of the 16 persons with depressive symptoms at 10-year follow-up, only three had reported depressive symptoms initially. Subjects who had experienced TIAs during the longitudinal phase had higher rates of depressive symptoms than the subjects from the other two groups (38%vs 13%, p < 0.05). CONCLUSIONS: This study supports the notion that cerebrovascular incidents predispose to late-onset depression in older persons residing in the community. Intrinsically, this provides epidemiological support for the validity of the concept of 'vascular depression'.     

Trends in adolescent psychiatric hospitalization

This article explores the recent increase in adolescent psychiatric inpatient admissions. Factors fueling the tendency to hospitalize are discussed, and the concept of medicalization of adolescent behavior problems is related to this trend. Reflecting the medicalization concept, several questions and hypotheses regarding parental decision-making as it is related to adolescent hospitalization are presented. Through further investigation, a better understanding of the factors influencing or determining need for adolescent psychiatric hospitalization can be gained.     

Suicide in the psychiatric hospital

Society's attitudes toward and treatment of the suicider are examined. The emotional and clinical impact suicide has on everyone, and its consequences to the hospital are detailed. Our unfortunate emphasis on “prevention” as against treating the disease process which causes the death is stressed. Also stressed is the psychiatrist's misplaced role in contrast to that of other physicians involved in a patient's death. Only in psychiatry does it seem that the role assigned the physician is that he prevent a specific patient's death as much as that he treat the patient's underlying fatal disease. An address at the 44th Annual Meeting of the Association of Psychiatric Services for Children, New Orleans, Louisiana, March, 1993.     

Suicide in psychiatric patients: A comparative study

Summary Many factors held to be associated with suicide also apply to mental illness in general. An important question is whether psychiatric patients who commit suicide are distinguishable from other psychiatric patients. — In this study, a comparison was made between suicide psychiatric patients and randomly selected psychiatric patients from the same original patient group. The patients were compared concerning factors that on the basis of earlier knowledge about causes of suicide could be expected to differentiate the two groups. The variables chosen for comparison were mainly objective social and medical data. Information was collected from the psychiatric hospital records. The analysed sample consisted of 45 suicide patients and 276 controls. — The major difference in the comparison of suicide patients versus control psychiatric patients was a high frequency of previously attempted suicide in both sexes in the suicide group. In this study, 56% of all suicides had a history of previous attempt. Other factors found to be of special importance in psychiatric suicide patients were recent object loss by death in men, and living alone in women. Less prominent findings with slight significance were: more patients with affective disorder in the male suicide group and more divorced patients among the female suicides compared to controls. — The suicide patients had in many respects received similar psychiatric services to the control patients. The most interesting difference was a higher occurrence of no treatment in the male suicide group. Female suicide patients were more often hospitalised.Causative findings of possible significance were 3 female suicides in the small diagnostic group of conversion hysteria and 2 female suicides precipitated by reports to the police for shop-lifting.The evaluation of suicide risk by the examining doctor was also studied and only a minority of the suicide patients were recorded as suicidal at the last contact with the department.

---

Zusammenfassung Viele Faktoren, die man mit Suicid verbunden hält, stehen auch mit psychischer Krankheit im allgemeinen in Beziehung. Es ist eine wichtige Frage, ob psychiatrische Patienten, die einen Suicid begehen, von anderen psychiatrischen Patienten unterscheidbar sind. — In dieser Arbeit wurde ein Vergleich zwischen psychiatrischen Suicidpatienten und zufällig ausgewählten psychiatrischen Patienten aus ursprünglich derselben Patientengruppe angestellt. Die Patienten wurden in Bezug auf Faktoren verglichen, von denen man aufgrund des früher gewonnenen Wissens über Suicidursachen erwarten konnte, daß sie zwischen den beiden Gruppen differenzierten. Für den Vergleich wurden hauptsächlich objektive soziale und medizinische Daten als Variablen gewählt. Die Information wurde aus den psychiatrischen Krankenberichten entnommen. Die untersuchte Stichprobe bestand aus 45 Suicidpatienten und 276 Kontrollfällen. — Als Hauptunterschied im Vergleich der Suicidpatienten mit den psychiatrischen Kontrollfällen ergab sich in der Suicidgruppe bei beiden Geschlechtern eine große Häufung vorausgegangener Suicidversuche. 56% aller Suicidpatienten aus dieser Untersuchungsgruppe hatten früher einmal Selbstmordversuche begangen. Weitere besonders wichtige Faktoren unter den psychiatrischen Suicidpatienten waren: Bei den Männern ein vorausgegangener Objektverlust durch den Tod, bei den Frauen das Alleinleben. Als weniger hervorstechende Ergebnisse mit geringerer Bedeutung erwiesen sich im Vergleich mit den Kontrollfällen: in der männlichen Suicidgruppe waren mehr Patienten mit affektiven Störungen, in der weiblichen Suicidgruppe mehr geschiedene Patientinnen. — Die Suicidpatienten hatten in vielfacher Hinsicht ähnliche psychiatrische Behandlungen erhalten wie die Kontrollfälle. Der interessanteste Unterschied bestand darin, daß bei der männlichen Suicidgruppe häufiger keine Behandlung vorausgegangen war. Weibliche Suicidpatienten waren häufiger hospitalisiert. Möglicherweise bedeutsam waren unter den gefundenen Ursachen drei weibliche Suicidfälle in der diagnostisch seltenen Gruppe der Konversionshysterie und Suicide bei zwei Frauen, denen eine Meldung bei der Polizei wegen Ladendiebstahls vorausgegangen war. Die Einschätzung des Suicidrisikos durch den untersuchenden Arzt wurde auch geprüft, nur eine Minderheit der Suicidpatienten wurde beim letzten Kontakt mit der Abteilung als suicidal verzeichnet.

---

Résumé Bien des facteurs considérés comme étant associés au suicide s'appliquent également à la maladie mentale en général. Il est important de savoir si les patients psychiatriques qui se suicident peuvent être distingués des autres patients psychiatriques. Dans cette étude, on a comparé des cas psychiatriques de suicide à des patients psychiatriques choisis au hasard dans le même groupe original de patients. Les patients ont été comparés à propos de facteurs dont on pouvait attendre, sur la base des connaissances antérieures sur les causes de suicide, qu'ils différencient les deux groupes. Les variables choisies pour la comparaison étaient principalement des données sociales et médicales objectives. Les renseignements ont été tirés des dossiers de l'hôpital psychiatrique. L'échantillon analysé comprenait 45 cas de suicide et 276 cas de contrôle. La principale différence, dans la comparaison des cas de suicide par rapport aux cas psychiatriques de contrôle, résidait dans la fréquence élevée, au sein du groupe des cas de suicide et pour les deux sexes, des tentatives de suicide antérieures (ici, dans 56% des cas). D'autres facteurs se sont avérés particulièrement importants dans les cas psychiatriques de suicide: une perte objectale récente par décès pour les hommes, et le fait de vivre seul pour les femmes. Parmi les résultats moins évidents et faiblement significatifs, on a noté davantage de patients présentant un trouble affectif parmi les hommes du groupe des cas de suicide et davantage de patients divorcés parmi les femmes de ce groupe que dans les cas de contrôle. Les patients du groupe des suicides avaient, à bien des égards, bénéficié des mêmes services psychiatriques que les cas de contrôle. La différence la plus intéressante résidait dans le fait qu'il est arrivé plus souvent que les hommes du groupe des suicides n'aient pas repu de traitement. Les femmes de ce groupe avaient été plus souvent hospitalisées. Il est possible que les résultats suivants soient significatifs: 3 cas de suicide femmes dans le petit groupe diagnostique des hystéries de conversion et 2 cas de suicide femmes précipités par une dénonciation à la police pour vol à la tire. L'évaluation du risque de suicide par le médecin traitant a également été étudiée, et seule une minorité des cas de suicide avaient été déclarés suicidaires lors du dernier contact avec le service.

     

Changes in social network diversity and perceived social support after psychiatric hospitalization: results from a longitudinal study

BACKGROUND: There is a large empirical basis for the importance of social networks and support for people with a mental illness. However, only a few studies have examined the predictors, changes and correlations of these constructs within a longitudinal framework. AIM: To analyze changes in social network diversity as measured by the number of social roles and perceived social support over the course of three years after a psychiatric hospitalization while controlling for sociodemographic and clinical variables. A further aim was to inquire whether some social roles are perceived as being more supportive than others. METHOD: Random coefficient models were applied to the data of a longitudinal study on the life circumstances of people with affective disorders or schizophrenia (N = 183). RESULTS: The majority of participants had relatives, friends and co-workers, while a markedly smaller proportion had a spouse/partner or children. Social network diversity increased during the time period observed while the perception of social support did not change. Being male, without a job (competitive or sheltered), or having a low income predicted less diverse networks. Partners and friends were perceived as most supportive. Persons without a close friendship perceived less overall support, but only at baseline (hospitalization), while persons with a job on the competitive labor market felt better supported. CONCLUSIONS: Social disintegration in the course of mental illness that is found in some studies has no equivalent in our study in what concerns network diversity and perceived support. According to our results, characteristics of vocational and economic integration are of much greater relevance, as they enhance or hinder access to social participation.     

Alcohol consumption and later risk of hospitalization with psychiatric disorders: prospective cohort study

The potential effects of alcohol intake upon the risk of psychiatric disorders have not often been investigated. The purpose of this study was to investigate, in a population sample, the association between self-reported amount of alcohol intake and the later risk of being registered in a Danish hospital with a psychiatric disorder. The prospective cohort study, the Copenhagen City Heart Study (n=18,146), was used, containing three updated sets of alcohol intake and lifestyle covariates and up to 26 years follow-up. Alcohol intake was measured by self-report while psychiatric disorders were measured through registers. For women, the overall pattern showed that drinking above the sensible limits increased the risk of psychiatric disorders in general, especially for anxiety disorders where women drinking above the sensible drinking limits had a risk of 2.00 (confidence interval: 1.31-3.04) compared to women drinking below the sensible drinking limits. For men, the risk functions were slightly U-shaped; thus, a weekly low or moderate alcohol intake seemed to have a protective effect towards developing psychiatric disorders. The findings suggest sex differences in the association between alcohol consumption and risk of psychiatric disorders.     

Suicide risk in relation to socioeconomic,demographic, psychiatric,and familial factors: a national register-based study of all suicides in Denmark, 1981-1997

OBJECTIVE: Suicide risk was addressed in relation to the joint effect of factors regarding family structure, socioeconomics, demographics, mental illness, and family history of suicide and mental illness, as well as gender differences in risk factors. METHOD: Data were drawn from four national Danish longitudinal registers. Subjects were all 21,169 persons who committed suicide in 1981-1997 and 423,128 live comparison subjects matched for age, gender, and calendar time of suicide by using a nested case-control design. The effect of risk factors was estimated through conditional logistic regression. The interaction of gender with the risk factors was examined by using the log likelihood ratio test. The population attributable risk was calculated. RESULTS: Of the risk factors examined in the study, a history of hospitalization for psychiatric disorder was associated with the highest odds ratio and the highest attributable risk for suicide. Cohabiting or single marital status, unemployment, low income, retirement, disability, sickness-related absence from work, and a family history of suicide and/or psychiatric disorders were also significant risk factors for suicide. Moreover, these factors had different effects in male and female subjects. A psychiatric disorder was more likely to increase suicide risk in female than in male subjects. Being single was associated with higher suicide risk in male subjects, and having a young child with lower suicide risk in female subjects. Unemployment and low income had stronger effects on suicide in male subjects. Living in an urban area was associated with higher suicide risk in female subjects and a lower risk in male subjects. A family history of suicide raised suicide risk slightly more in female than in male subjects. CONCLUSIONS: Suicide risk is strongly associated with mental illness, unemployment, low income, marital status, and family history of suicide. The effect of most risk factors differs significantly by gender.