Lay Summary

Current and recent psychiatric inpatient stay significantly increases suicide risk. National suicide mortality rates and inpatient-related suicide rates from 12 countries were analysed specifically for sex differences in hospital-related suicide rates. We found that suicide risk was significantly higher in female patients for all investigated time intervals, implicating that sex-specific suicide preventions are needed.

Background

Suicide risk in patients is significantly heightened during psychiatric inpatient care, as well as after recent discharge. It is unclear whether, and to what extent, suicide risk varies between the sexes. Thus, the aim of this study was to investigate potential sex differences for suicide during and after psychiatric hospitalization in various countries.

Methods

National suicide mortality rates and inpatient-related suicide rates (three intervals: during psychiatric inpatient treatment, 1 month, and 1 year after discharge) from 12 countries for 2000–2016 were analysed, and a logistic model was used to quantify the effect of sex.

Results

Patients admitted to or discharged from psychiatric inpatient care were more susceptible to commit suicide compared to the general population. Likelihood for completed suicide during inpatient psychiatric care was significantly higher in females (OR = 1.85; 95% CI [1.46, 2.34]) compared to males. Female patients also showed significantly higher suicide risk within the first month after discharge (OR = 1.94; 95% CI [1.66, 2.27]) and within the first year after discharge (OR = 2.04; 95% CI [1.87, 2.23]) compared to the male population.

Conclusion

Our analysis confirmed significant associations between the time during and after psychiatric inpatient care and increased suicide risk. Further, a significant sex effect was observed, with females in this population being at a proportionally higher risk for suicide during psychiatric inpatient treatment as well as the year following discharge. Our study implicates that more effective suicide-preventive measures during inpatient stay are needed, especially focusing on female patients.