Systematic review and meta‐analysis of the clinical factors associated with the suicide of psychiatric in‐patients

Abstract

Large M, Smith G, Sharma S, Nielssen O, Singh SP. Systematic review and meta‐analysis of the clinical factors associated with the suicide of psychiatric in‐patients. Objective: To estimate the strength of the associations between the suicide of psychiatric in‐patients and demographic, historical, symptomatic, diagnostic and treatment factors. Method: A systematic review and meta‐analysis of controlled studies of the suicide of psychiatric in‐patients including suicides while on approved or unapproved leave. Results: Factors that were significantly associated with in‐patient suicide included a history of deliberate self‐harm, hopelessness, feelings of guilt or inadequacy, depressed mood, suicidal ideas and a family history of suicide. Patients suffering from both schizophrenia and depressed mood appeared to be at particular risk. The association between suicidal ideas and in‐patient suicide was weak and did not reach statistical significance after a quantitative correction for publication bias. A high‐risk categorization as defined by a combination of retrospectively determined individual risk factors was strongly statistically associated with in‐patient suicide (OR = 10.9), with a sensitivity of 64% and a specificity of 85%. Conclusion: Despite the apparently strong association between high‐risk categorization and subsequent suicide, the low base rate of in‐patient suicide means that predictive value of a high‐risk categorization is below 2%. The development of safer hospital environments and improved systems of care are more likely to reduce the suicide of psychiatric in‐patients than risk assessment.