In-patient suicide: selection of people at risk, failure of protection and the possibility of causation

BJPsych Open
Matthew Michael LargeChristopher James Ryan

Abstract

Being a current psychiatric in-patient is one of the strongest statistical risk factors for suicide. It is usually assumed that this strong association is not causal but is a result of the combination of the selection of high-risk patients for admission and the imperfect protection from suicide afforded by psychiatric wards. Logically, a third factor, which is causal, might play a role in the association. It has recently been suggested that adverse experiences in psychiatric units such as trauma, stigma and loss of social role might precipitate some in-patient suicides. To consider whether there is a causal association between psychiatric hospitalisation and suicide. We used the framework of Austin Bradford Hill's criteria for assessing causality in epidemiology to consider the possibility that psychiatric hospitalisation might causally contribute to the extent and variation in in-patient suicide rates. The association between psychiatric hospitalisation and suicide clearly meets five of the nine Hill's criteria (strength of association, consistency, plausibility, coherence and analogy) and partially meets three of the remaining four criteria (gradient of exposure, temporality and experimental evidence). Admission to hospital i...Continue Reading

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Citations

Jul 30, 2019·Frontiers in Psychiatry·Justine FletcherBridget Hamilton
Apr 25, 2018·Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie·Robert A BruerMatthew Large
Dec 6, 2019·Journal of Diabetes Science and Technology·Katharine D Barnard-KellyEric Renard
Jul 18, 2020·Medicine, Health Care, and Philosophy·Antoinette LundahlNiklas Juth
Jul 11, 2018·International Journal of Environmental Research and Public Health·Silke Bachmann
Jul 31, 2018·The British Journal of Psychiatry : the Journal of Mental Science·Matthew Michael Large, Nav Kapur
Aug 6, 2019·Medicine, Science, and the Law·Nilamadhab Kar, Tulika Prasad
Jan 8, 2021·Frontiers in Psychiatry·Eberhard A DeisenhammerCarl Miller

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