Post-hospitalization course and predictive signs of suicidal behavior of suicidal patients admitted to a psychiatric hospital: a 2-year prospective follow-up study

BMC Psychiatry

Yuji Okazaki⁵  Hidetoki Ishii⁸  Makoto Nozu²  Naoki Kumagai³  Yoshitaka Tatebayashi⁶  Hirohiko Harima⁷  Kayo Ishimoto⁷  Taro Tokunaga⁷  Yoichi Ishikawa¹  Kaori Utsumi¹  Yuka Yoshizawa¹  Atsushi Imai⁷  Miyabi Igarashi⁷  Naoki Hayashi⁴ 

[1] Osaka Prefectural Tondabayashi Health Center, Osaka, Japan;Tokyo Metropolitan Tama Comprehensive Center for Mental Health and Welfare, Tokyo, Japan;Disabled Persons Programs Division, Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government, Tokyo, Japan;Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan;Schizophrenia Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan;Affective Disorders Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan;Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan;Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan

关键词: Mental disorders;    Psychiatric hospitals;    Follow-up studies;    Self-injurious behavior;    Suicide attempt;   

Others  :  1124246
DOI  :  10.1186/1471-244X-12-186

 received in 2012-05-19, accepted in 2012-10-25,  发布年份 2012

【 摘 要 】

Background

Suicidal patients admitted to a psychiatric hospital are considered to be at risk of suicidal behavior (SB) and suicide. The present study aimed to seek predictors of SB recurrence of the high-risk patients by examining their post-hospitalization course.

Method

The design was 2-year prospective follow-up study of patients consecutively admitted with SB to a psychiatric center in Tokyo. The DSM-IV diagnoses and SB-related features of subjects were determined in structured interviews. Subsequently, the subjects underwent a series of follow-up assessments at 6-month intervals. The assessment included inquiries into SB recurrence, its accompanying suicidal intent (SI) and SF-8 health survey. Analyses of serial change over time in the follow-up data and Cox proportional hazards regression analyses of SB recurrence were performed.

Results

106 patients participated in this study. The dropout rate during the follow-up was 9%. Within 2 years, incidences of SB as a whole, SB with certain SI (suicide attempt) and suicide were 67% (95% CI 58 - 75%), 38% (95% CI 29 - 47%) and 6% (95% CI 3 - 12%), respectively. Younger age, number of lifetime SBs and maltreatment in the developmental period were predictive of SB as a whole, and younger age and hopelessness prior to index admission were predictive of suicide attempt. Regarding diagnostic variables, anxiety disorders and personality disorders appeared to have predictive value for SB. Additionally, poor physical health assessed during the follow-up was indicated as a possible short-term predictor of SB recurrence.

Conclusions

This study demonstrated a high incidence of SB and suicide and possible predictors of SB recurrence in the post-hospitalization period of psychiatric suicidal patients. Specialized interventions should be developed to reduce the suicide risk of this patient population.

【 授权许可】

   
2012 Hayashi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Harris EC, Barraclough B: Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 1997, 170:205-228.
• [2]Isometsä ET, Lönnqvist JK: Suicide attempts preceding completed suicide. Br J Psychiatry 1998, 173:531-535.
• [3]Nordentoft M, Mortensen PB, Pedersen CB: Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry 2011, 68:1058-1064.
• [4]Troister T, Links PS, Cutcliffe J: Review of predictors of suicide within 1 year of discharge from a psychiatric hospital. Curr Psychiatry Rep 2008, 10:60-65.
• [5]Large M, Sharma S, Cannon E, Ryan C, Nielssen O: Risk factors for suicide within a year of discharge from psychiatric hospital: a systematic meta-analysis. Aust N Z J Psychiatry 2011, 45:619-628.
• [6]Haukka J, Suominen K, Partonen T, Lonnqvist J: Determinants and outcomes of serious attempted suicide: a nationwide study in Finland, 1996–2003. Am J Epidemiol 2008, 167:1155-1163.
• [7]Tidemalm D, Langstrom N, Lichtenstein P, Runeson B: Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. BMJ 2008, 337:a2205.
• [8]Qin P, Nordentoft M: Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry 2005, 62:427-432.
• [9]Owens D, Horrocks J, House A: Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry 2002, 181:193-199.
• [10]Suominen K, Isometsa E, Ostamo A, Lonnqvist J: Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study. BMC Psychiatry 2004, 4:11. BioMed Central Full Text
• [11]Wenzel A, Berchick ER, Tenhave T, Halberstadt S, Brown GK, Beck AT: Predictors of suicide relative to other deaths in patients with suicide attempts and suicide ideation: a 30-year prospective study. J Affect Disord 2011, 132:375-382.
• [12]Zahl DL, Hawton K: Repetition of deliberate self-harm and subsequent suicide risk: long-term follow-up study of 11,583 patients. Br J Psychiatry 2004, 185:70-75.
• [13]Maris R, Berman A, Silverman MM: The theoretical component in suicidology. In Comprehensive textbook of suicidology. Edited by Maris R, Berman A, Silverman MM. Guilford Press, New York; 2000:26-61.
• [14]Wasserman D: A stress-vulnerability model and the development of the suicidal process. In Suicide: An unnecessary death. Edited by Wasserman D. artin Dunitz, London; 2001:13-28.
• [15]Joiner T: Why people die by suicide. Harvard University Press, Cambridge, MA; 2005.
• [16]Links P, Nisenbaum R, Ambreen M, Balderson K, Bergmans Y, Eynan R, Harder H, Cutcliffe J: Prospective study of risk factors for increased suicide ideation and behavior following recent discharge. Gen Hosp Psychiatry 2012, 34:88-97.
• [17]Bille-Brahe U, Jessen G: Repeated suicidal behavior: a two-year follow-up. Crisis 1994, 15:77-82.
• [18]Morton MJ: Prediction of repetition of parasuicide: with special reference to unemployment. Int J Soc Psychiatry 1993, 39:87-99.
• [19]Tejedor MC, Diaz A, Castillon JJ, Pericay JM: Attempted suicide: repetition and survival–findings of a follow-up study. Acta Psychiatr Scand 1999, 100:205-211.
• [20]Sidley GL, Calam R, Wells A, Hughes T, Whitaker K: The prediction of parasuicide repetition in a high-risk group. Br J Clin Psychol 1999, 38(Pt 4):375-386.
• [21]Greenfield B, Henry M, Weiss M, Tse SM, Guile JM, Dougherty G, Zhang X, Fombonne E, Lis E, Lapalme-Remis S, Harnden B: Previously suicidal adolescents: predictors of six-month outcome. J Can Acad Child Adolesc Psychiatry 2008, 17:197-201.
• [22]Brent DA, Greenhill LL, Compton S, Emslie G, Wells K, Walkup JT, Vitiello B, Bukstein O, Stanley B, Posner K, et al.: The Treatment of Adolescent Suicide Attempters study (TASA): predictors of suicidal events in an open treatment trial. J Am Acad Child Adolesc Psychiatry 2009, 48:987-996.
• [23]Holma KM, Melartin TK, Haukka J, Holma IA, Sokero TP, Isometsa ET: Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: a five-year prospective study. Am J Psychiatry 2010, 167:801-808.
• [24]Colman I, Newman SC, Schopflocher D, Bland RC, Dyck RJ: A multivariate study of predictors of repeat parasuicide. Acta Psychiatr Scand 2004, 109:306-312.
• [25]Forman EM, Berk MS, Henriques GR, Brown GK, Beck AT: History of multiple suicide attempts as a behavioral marker of severe psychopathology. Am J Psychiatry 2004, 161:437-443.
• [26]Dirks BL: Repetition of parasuicide–ICD-10 personality disorders and adversity. Acta Psychiatr Scand 1998, 98:208-213.
• [27]Johnsson Fridell E, Ojehagen A, Traskman-Bendz L: A 5-year follow-up study of suicide attempts. Acta Psychiatr Scand 1996, 93:151-157.
• [28]Hjelmeland H: Repetition of parasuicide: a predictive study. Suicide Life Threat Behav 1996, 26:395-404.
• [29]Brittlebank AD, Cole A, Hassanyeh F, Kenny M, Simpson D, Scott J: Hostility, hopelessness and deliberate self-harm: a prospective follow-up study. Acta Psychiatr Scand 1990, 81:280-283.
• [30]van Egmond M, Garnefski N, Jonker D, Kerkhof A: The relationship between sexual abuse and female suicidal behavior. Crisis 1993, 14:129-139.
• [31]Söderberg S, Kullgren G, Salander Renberg E: Childhood sexual abuse predicts poor outcome seven years after parasuicide. Soc Psychiatry Psychiatr Epidemiol 2004, 39:916-920.
• [32]Hayashi N, Igarashi M, Imai A, Osawa Y, Utsumi K, Ishikawa Y, Tokunaga T, Ishimoto K, Harima H, Tatebayashi Y, et al.: Psychiatric disorders and clinical correlates of suicidal patients admitted to a psychiatric hospital in Tokyo. BMC Psychiatry 2010, 10:109. BioMed Central Full Text
• [33]Silverman MM, Berman AL, Sanddal ND, O'Carroll PW, Joiner TE: Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide Life Threat Behav 2007, 37:248-263.
• [34]Silverman MM, Berman AL, Sanddal ND, O'Carroll PW, Joiner TE: Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav 2007, 37:264-277.
• [35]De Leo DBS, Bertolote JM, Kerkhof A, Bille-Brahe U: Definitions of suicidal behaviour. In Suicidal behavior. Edited by Leo D, Bille-Brahe U, Kerkhof A, Schmidke A. Hogrefe & Huber, Massachusetts; 2004:11-40.
• [36]Muehlenkamp JJ: Self-injurious behavior as a separate clinical syndrome. Am J Orthopsychiatry 2005, 75:324-333.
• [37]First MB, Spitzer RL, Gibbon M, Williams JBW, Benjamine LS: Structured Clinical Interview for DSM-IV Axis I Disorders: SCID-I: Clinician Version: Administration Booklet. American Psychiatric Publishing, Washington D.C; 1997.
• [38]First MB, Gibbon M, Spitzer RL, Williams JBW: User's Guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders: SCID-II. American Psychiatric Publishing, Washington D.C; 1997.
• [39]Beck AT, Schuyler D, Herman I: Development of suicidal intent scales. In The prediction of suicide. Edited by Beck AT, Resnik HRLP, Lettieri DJ. Charles Press, Maryland; 1974:45-56.
• [40]Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961, 4:561-571.
• [41]Beck AT, Weissman A, Lester D, Trexler L: The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol 1974, 42:861-865.
• [42]Ware J, Kosinski M, Dewey J, Gandek B: How to Score and Interpret Single-Item Health Status Measures: A Manual for Users of the SF-8 Health Survey. QualyMetric, Boston; 2001.
• [43]Fukuhara S, Suzukamo Y: Manual of the SF-8, Japanese version. Institute for Health Outcomes & Process Evaluation Research, Kyoto; 2004.
• [44]Aish AM, Wasserman D, Renberg ES: Does Beck's Hopelessness Scale really measure several components? Psychol Med 2001, 31:367-372.
• [45]Sareen J, Cox BJ, Afifi TO, de Graaf R, Asmundson GJ, ten Have M, Stein MB: Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Arch Gen Psychiatry 2005, 62:1249-1257.
• [46]Bolton JM, Pagura J, Enns MW, Grant B, Sareen J: A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder. J Psychiatr Res 2010, 44:817-826.
• [47]Linehan MM, Shireen LR, Welch SS: Psychiatric aspects of suicidal behavior: Personality disorders. In The international handbook of suicide and attempted suicide. Edited by Hawton K, Heeringen K. John Wiley & Sons, Chichester; 2005:147-178.
• [48]Johnson JG, Cohen P, Skodol AE, Oldham JM, Kasen S, Brook JS: Personality disorders in adolescence and risk of major mental disorders and suicidality during adulthood. Arch Gen Psychiatry 1999, 56:805-811.
• [49]Suominen K, Haukka J, Valtonen HM, Lonnqvist J: Outcome of patients with major depressive disorder after serious suicide attempt. J Clin Psychiatry 2009, 70:1372-1378.
• [50]Brodsky BS, Stanley B: Adverse childhood experiences and suicidal behavior. Psychiatr Clin North Am 2008, 31:223-235.
• [51]Johnson JG, Cohen P, Gould MS, Kasen S, Brown J, Brook JS: Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood. Arch Gen Psychiatry 2002, 59:741-749.
• [52]Welch SS: A review of the literature on the epidemiology of parasuicide in the general population. Psychiatr Serv 2001, 52:368-375.
• [53]Kasen S, Cohen P, Chen H: Developmental course of impulsivity and capability from age 10 to age 25 as related to trajectory of suicide attempt in a community cohort. Suicide Life Threat Behav 2011, 41:180-192.
• [54]Fergusson DM, Boden JM, Horwood LJ: Unemployment and suicidal behavior in a New Zealand birth cohort: a fixed effects regression analysis. Crisis 2007, 28:95-101.
• [55]Nakao M, Yamanaka G, Kuboki T: Suicidal ideation and somatic symptoms of patients with mind/body distress in a Japanese psychosomatic clinic. Suicide Life Threat Behav 2002, 32:80-90.
• [56]Venkoba Rao A: Physical illness, pain, and suicidal behavior. Crisis 1990, 11:48-56.
• [57]Bahk WM, Park S, Jon DI, Yoon BH, Min KJ, Hong JP: Relationship between painful physical symptoms and severity of depressive symptomatology and suicidality. Psychiatry Res 2011, 189:357-361.
• [58]Walsh E, Harvey K, White I, Higgitt A, Fraser J, Murray R: Suicidal behaviour in psychosis: prevalence and predictors from a randomised controlled trial of case management: report from the UK700 trial. Br J Psychiatry 2001, 178:255-260.
• [59]Rudd MD, Dahm PF, Rajab MH: Diagnostic comorbidity in persons with suicidal ideation and behavior. Am J Psychiatry 1993, 150:928-934.
• [60]Corbitt EM, Malone KM, Haas GL, Mann JJ: Suicidal behavior in patients with major depression and comorbid personality disorders. J Affect Disord 1996, 39:61-72.