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Among inpatients with affective disorder, clinical improvement and antidepressant treatment is associated with a significantly reduced risk for suicide during hospitalization and after discharge, study results show.
“The risk of suicide in patients with affective disorders is particularly high immediately after admission to, and discharge from a psychiatric hospital,” explain E Høyer, from the University of Aarhus in Denmark, and team.
However, they add that among such patients, “only few risk factors for suicide have been identified” and “little is known about the protective or other effects of treatment.“
To investigate further, the researchers studied data on 282 Danish patients, aged at least 18 years, who were admitted to hospital with affective disorder between 1994 and 1995. Of these, 141 died because of suicide, either during admission or shortly after discharge.
The researchers assessed the patients’ demographic and socioeconomic factors, family history, psychiatric history, treatment, and history of adverse life events, such as bereavement of close relative or friend, separation/divorce, and loss of a job.
Clinical improvement, or no such improvement, during hospitalization was noted if such information was available in the patients’ case files. If no such information was available, the clinical state of the patient at admission and at censoring date was used to make an evaluation.
The team identified four variables that were independent predictors of suicide.
As expected, a previous history of suicide attempts was associated with the greatest risk for death by suicide (incidence-rate ratio [IRR]=4.9). The team also found that loss of a job during the year prior to the index admission was associated with a significant increased risk for suicide, at an IRR of 2.9. This was the only adverse life event associated with an increased risk for suicide, note the researchers
Conversely, clinical improvement during the index admission and treatment with antidepressant drugs were associated with a reduced risk for suicide, both at IRRs of 0.3.
Høyer and team conclude: “Our interpretation of the findings is that clinical improvement of affective disorder and treatment with antidepressant drugs may reduce the risk of suicide. Therefore, and for clinical reasons in general, all efforts should be made to enhance clinical improvement and prevent further episodes of illness.”
They add: “It is important to be aware of the risk of suicide in patients with no or little clinical improvement during inpatient treatment, especially at discharge and during leave from the hospital.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
