The results of a study published in the February issue of APA's Journal of Psychiatric Services indicate that psychiatric hospitalization is more effective in reducing adults' short-term risk of suicide than the long-term risk.

The short-term risk of suicide decreased from 42 percent at admission to 21 percent at discharge in 241 psychiatric patients hospitalized for an average of 17 days. In contrast, the long-term clinical risk of suicide decreased from 40 percent at admission to 30 percent at discharge.

Short term was defined as within one week and long term as within one year.

"This difference may reflect the fact that acute psychiatric symptoms, which are a strong predictor of suicidal ratings of short-term risk, decreased during hospitalization, whereas relevant factors outside the hospital did not change much," note the authors.

Seventy-one physicians estimated the short- and long-term risk of suicide in adult patients upon admission to and discharge from a psychiatric inpatient unit in the early 1990's. Measures included the Longitudinal Inventory of Function and Encounters for a history of suicide and the Overt Aggression Scale for self-destructive behavior in the hospital. Psychiatric symptoms were measured with the Brief Psychiatric Rating Scale (BPRS).

The mean age of the patients was 42; 50 percent of the patients were men, 18 percent were married, and 50 percent lived alone. The primary psychiatric diagnoses were schizophrenia (19 percent) and depressive disorders (16 percent).

Fifty-two percent of patients had a history of suicidal behavior, and 49 percent had a history of drug or alcohol abuse. Only 2 percent exhibited suicidal behavior in the hospital. Fifteen percent had either been physically abused as children or witnessed family violence.

The researchers found short-term risk factors for suicide at admission included a history of suicidal behavior and high levels of anxiety and depression.

At discharge, the short-term risk of suicide was associated with severe psychosocial stressors, a history of violent behavior before admission, and higher ratings of short-term risk at admission.

The researchers found that 10 percent of patients had physically attacked someone recently, and 24 percent had fear-inducing behaviors such as physical attacks on objects, threats to attack persons, or verbal attacks during the two weeks prior to admission, notes the report.

Long-term risk factors for suicide at admission included a history of suicide and high scores on the BPRS for motor retardation, emotional withdrawal, and blunted affect.

At discharge, the long-term risk of suicide was associated with more severe psychosocial stressors, substance abuse, younger age, being married, and higher ratings of long-term risk at admission.

The authors comment, "In contrast to the admission ratings, discharge ratings of suicide were substantially influenced by variables such as severity of psychosocial stressors, substance abuse history, and whether the patient would be living alone."

Previous research has shown these factors to be related to outpatient suicide. Moreover, past research on actual risks of suicide found similar significant variables, including a history of suicidal behavior, an anxious and depressed mood state, and emotional withdrawal.

The authors suggest that community-based interventions are needed to reduce long-term suicide risk. "Such interventions could address medication compliance, follow-up with aftercare, substance abuse, social supports, and other relevant issues."

Further research is needed on the utility of widely used interventions to improve the risk of long-term suicide such as extended partial hospitalization, long-term psychotherapy, and frequent contact with case managers, say the authors.

(Psychiatric News, May 16, 1997)