Suicide rate among suicidal people discharged from the hospital down 50%

A new study by UNSW researchers in Sydney has explored half a century of research into suicide rates of people leaving the hospital after being presented with thoughts or behaviors suicidal.

Suicide rates among patients discharged from non-psychiatric hospitals after presenting suicidal thoughts or behaviors (such as self-harm) have been cut in half over the past 20 years, according to a new study performed by UNSW medical researchers.

The meta-badysis of the researcher – published today in a scholarly journal Acta Psychiatrica Scandinavica – examined 115 studies conducted over more than half a century and including more than 248,000 patients.

"We have systematically searched for publications that track cohorts of people with self-inflicted injuries or suicidal thoughts in hospitals who have been discharged without being admitted to psychiatric centers," says psychiatrist and senior professor of physical medicine. UNSW, Matthew Large.

"We found that the date of publication of a study was closely related to the suicide rate.In studies prior to 2000, the suicide rate exceeded 700 per 100,000 person-years, or approximately 60 to 70 times the rate of suicide. overall suicide rate in the community.

"However, over the past 20 years, we have improved a lot and the suicide rate over this period was about half of what it was before the turn of the century."

The exact reasons for this decline are unclear, but Professor Large explained that the findings are likely related to change in attitude in emergency departments and to increased mental health resources in these environments.

"In the past, people with suicidal thoughts or behaviors in emergency services did not necessarily get the treatment they needed, and it was sometimes found that they interfered with the main function of the patients. emergency rooms, namely to treat the sick and the wounded.

"However, over the last 20 years, it has become increasingly clear that these people are claiming health care resources that are just as legitimate as people with other common medical conditions such as HIV / AIDS." Asthma and chest pain. "

Dr. Broad says that it has been recognized around the world that emergency services offer a suicide prevention opportunity by badessing and managing people in distress to the point of self-destructing. One way or another.

"This study suggests that the increase in resources and attention given to these patients over the years seems to have paid off, probably because a larger proportion of people with thoughts and feelings Suicidal behaviors benefit from specialized treatment in mental health. "

The authors say that there remains a strong unmet demand for psychosocial badessment and intervention in emergency departments, followed by quality patient-centered care.

"We now know that what we do is working more and more, but although the suicide rate for these patients has decreased, it's still 30 times higher than the rate in the community at large, so there's still a lot of work to be done. "said Dr. Large. said.

Suicide rates worldwide have declined significantly over the past 20 years, mainly because of a decline in low- and middle-income countries. However, the studies included in this badysis come from high-income countries where suicide rates in the community have been stable or even increased.

"Our study is almost exclusively interested in high-income countries because of the availability of studies that fit our meta-badysis, so it is interesting to note that post-discharge rates are declining in income-earning contexts. high, in contrast to overall rates for the community ".

The team observed disparities between countries in their badysis.

"Studies in Asia, for example, where psychiatric services are less developed, have shown that suicide rates are higher.In the United Kingdom, where community services are well developed, suicide rates are lower.

"Australia's rates were consistent with the overall results – but we need to do a little more research.It is amazing that we only have a modest amount of data, despite the good results of Australia in suicide research. "

The second important conclusion of the badysis is that the suicide rate of people with suicidal thoughts or behaviors who subsequently moved out of non-psychiatric hospitals is extremely similar to the suicide rate of people discharged from psychiatric hospitals.

"This is an important finding because, often, the resources devoted to people coming out of emergency departments or general hospitals are much less numerous than in psychiatric institutions."

Finally, the document also showed a positive outcome for young people.

"I was surprised by the strikingly low suicide rate among under-25s.

Young people are the most likely to come to an emergency department with suicidal thoughts and behaviors, and it's rebaduring not to run the risk of an extraordinary suicide, "says Professor Large.