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Suicidal Risk Following Hospital Discharge

A Review

Forte, Alberto MD; Buscajoni, Andrea MD; Fiorillo, Andrea MD, PhD; Pompili, Maurizio MD, PhD; Baldessarini, Ross J. MD

doi: 10.1097/HRP.0000000000000222

Learning objectives After participating in this activity, learners should be better able to:

• Evaluate risk of suicide and suicide attempts following psychiatric hospitalization

• Assess the relationship between suicide attempts and completed suicides

Background Suicidal risks among psychiatric patients appear to be especially high soon after hospitalization. Given the importance of such outcomes, and the lack of recent reviews of post-discharge suicide attempt risks, we evaluated reported findings on the risk of suicide and attempts following psychiatric hospitalization.

Methods With systematic, computerized searching, we identified 48 studies (1964–2017) involving 1,700,785 subjects. Follow-up was limited to ≥12 months after discharge from psychiatric hospitalization to avoid inflation of annualized rates due to shorter exposure times.

Results The overall observed pooled, annualized rate of completed suicide was 241 (confidence interval, 238–243) per 100,000 person-exposure years in 41 studies, and for attempts, 722 (698–746) in 13 studies. In six studies (64,848 subjects) reporting on both suicides and attempts, the ratio of annualized rates for attempts/completed suicides was 8.79 (6.63–12.0). Among all 48 studies, cumulative distribution of suicidal events included 26.4% (25.9–26.9) within the initial month, 40.8% (40.2–41.4) within 3 months, and 73.2% (72.7–73.7) within 12 months of discharge.

Conclusions Among patients recently discharged from psychiatric hospitalization, rates of suicide deaths and attempts were far higher than in the general population or even in unselected clinical samples of comparable patients, with a strong inverse association with time post-discharge. Improved monitoring and care of patients discharged from psychiatric hospitalization are needed, ideally with detailed planning and implementation of aftercare prior to discharge.

From the International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA (Drs. Forte, Pompili, and Baldessarini); Department of Neurosciences, Mental Health & Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, Italy (Drs. Forte, Buscajoni, and Pompili); Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy (Dr. Fiorillo); Harvard Medical School (Dr. Baldessarini).

Supported, in part, by a grant from the Bruce J. Anderson Foundation and the McLean Private Donors Psychiatric Research Fund (Dr. Baldessarini).

Original manuscript received 25 August 2018; revised manuscript received 24 October 2018, accepted for publication subject to revision 18 November 2018; revised manuscript received 20 November 2018.

Correspondence: Dr. Alberto Forte, Department of Neurosciences, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1037, 00189 Rome, Italy. Email:

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© 2019 President and Fellows of Harvard College
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