Suicide Risk Highest Right After Depression Hospitalization Discharge

Patients hospitalized for depression had a very high risk of suicide in the first few days after discharge, a longitudinal Finnish registry study showed.

An analysis of nearly 200,000 hospitalizations for depression from 1996 to 2017 revealed a suicide incidence rate of 6,062 per 100,000 person-years during days 0-3 following discharge (95% CI 4,963-7,404), according to Erkki Isometsä, MD, PhD, of Helsinki University Central Hospital in Finland, and co-authors.

Suicide incidence remained high but fell to 3,884 per 100,000 person-years in the 4-7 days after discharge (95% CI 3,119-4,835), and continued to fall thereafter, they reported in JAMA Psychiatry.

Several factors were associated with suicide during the first days after discharge, including age, male sex, and clinical risk factors such as severity of the depressive episode, high illness severity and impairment, and current suicide attempt, the researchers found.

They noted that “each factor indicated about 2-fold to 5-fold higher relative risk of suicide in the few days after discharge.”

The researchers also found temporal patterns for suicide risk in the 2 years following discharge. Men and those who’d previously attempted suicide consistently had a higher risk of suicide after leaving the hospital, they reported.

Over time, age and acute clinical risk factors (severe depression, severe illness with impaired function, and current suicide attempt) had a decreasing association with suicide risk, they reported.

Conversely, several factors showed a pattern of increasing risk, including involuntary admission, alcohol use disorder, substance use disorder, and living alone, they found.

Although suicide risk waned over time, “the high-risk postdischarge period still requires intensified attention,” Isometsä and colleagues wrote. “Continuity of care and access to enhanced psychiatric outpatient care within days of discharge should be imperative.”

Jacob Ballon, MD, MPH, of Stanford University in California, who wasn’t involved in the study, told MedPage Today that these results would likely be similar in the U.S., and that they highlight the challenge of treating individuals with depression who need to be hospitalized.

“It’s not like a near-miss in a plane crash, where you re-evaluate everything that possibly could have gone wrong [and] you fix it all, then the day after that you’re at the lowest risk ever for a plane crash,” Ballon noted.

He said the findings emphasize the importance of wrap-around care that extends beyond high-level, acute psychiatric care.

“There has to be a real effort to make sure that there is a solid plan on discharge for the person to be checked in with within that first week after hospitalization,” Ballon said.

To conduct the study, the authors included 91,161 individuals with 193,197 hospitalizations for depression from 1996 to 2017. The patients had a mean age of 44 and 56.2% were female. They used Finnish registers for hospital discharge, population, and cause of death, and included all hospitalizations for depression as the principal diagnosis.

The authors allowed a maximum follow-up time of 2 years per patient and followed up on a total of 226,615 person-years. In total, 1,976 patients died of suicide during the study period, including 1,219 men and 757 women.

The study was limited by a lack of information about the overall course of a patient’s depression, including incomplete data on prior suicide attempts, clinical status at discharge, or whether they voluntarily continued treatment after discharge.

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