Psychological Medicine



Original Article

Suicide in psychiatric in-patients in England, 1997 to 2003


NAVNEET KAPUR a1c1, ISABELLE M. HUNT a1, ROGER WEBB a2, HARRIET BICKLEY a1, KIRSTEN WINDFUHR a1, JENNY SHAW a1, LOUIS APPLEBY a1 and The National Confidential Inquiry into Suicide and Homicide
a1 National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Williamson Building, University of Manchester, Manchester, UK
a2 Centre for Women's Mental Health Research, Department of Psychiatry and Behavioural Sciences, Williamson Building, University of Manchester, Manchester, UK

Article author query
kapur n   [PubMed][Google Scholar] 
hunt im   [PubMed][Google Scholar] 
webb r   [PubMed][Google Scholar] 
bickley h   [PubMed][Google Scholar] 
windfuhr k   [PubMed][Google Scholar] 
shaw j   [PubMed][Google Scholar] 
appleby l   [PubMed][Google Scholar] 

Abstract

Background. Psychiatric in-patients are at particularly high risk of suicide but few studies have investigated trends in in-patient suicide over time.

Method. We conducted a prospective study of all patients admitted to National Health Service (NHS) in-patient psychiatric care in England (1997–2003). The study was carried out as part of the National Confidential Inquiry into Suicide. The main outcome measure was death by suicide. Suicide rates were determined using Hospital Episode Statistics (HES) as the denominator.

Results. Between the first 2 years of the study (1997 and 1998) and the last 2 years of the study (2002 and 2003) the annual number of in-patient deaths from suicide fell from 187 to 156 (a 17% reduction). The rate of in-patient suicide fell by between 9% and 28% depending on which denominator was used. This fall was observed for both males and females, and was most marked for those aged 15–44 years. Reductions were also observed for the three most common methods of death (hanging, jumping, poisoning), but the trend for hanging did not reach statistical significance. Although the number of post-discharge suicides fell, the risk of post-discharge suicide (using admissions as a denominator) may have increased by as much as 10% during the study period.

Conclusion. The rate of suicide among psychiatric in-patients appears to have fallen. The fall may reflect falling general population rates, changes in in-patient case mix, service improvements, or a transfer of risk to the post-discharge period. Services need to be aware of the importance of providing high quality aftercare following discharge from hospital.

(Published Online July 25 2006)


Correspondence:
c1 Centre for Suicide Prevention, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. (Email: nav.kapur@manchester.ac.uk)


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