UK study calls for better suicide prevention activity in general hospitals

General hospitals could engage in more mental health screening and better follow-up of at-risk individuals in order to improve suicide prevention, according to research led by Nadine Dougall of the University of Stirling.

The research, published in the British Journal of Psychiatry, studied all deaths by in Scotland in people aged 15 and over between 1981 and 2010. Of the 16,411 suicides, almost two thirds had linkable hospital records.

The researchers found that people who died by suicide were three times more likely to have been last discharged from general hospitals than from psychiatric hospitals. Overall, a quarter of deaths occurred within three months of people being discharged from hospital (and 58% among those people discharged from a general hospital).

Despite having died by suicide, only 14% of those who were discharged from a general hospital had a psychiatric diagnosis recorded in their notes at their last visit. However, analysis of the records found that a further 19% had a previous history of mental illness that had not been recorded.

Less than half of all those who died after being discharged from a general hospital had been given a diagnosis of 'injury or poisoning', which includes accidents and self-injury. Young men aged 15-45 accounted for the majority (60%) of these deaths. Among all those who had been diagnosed with 'injury or poisoning' before discharge, 22% took their lives within three months of discharge, and 68% within a year.

The researchers believe that there is potential for staff in general hospitals to identify an 'at-risk' group of people who are not being admitted for 'injury or poisoning', but who do have a previous history of self-injury or a psychiatric disorder, or both.

Lead researcher Nadine Dougall, of the Nursing, Midwifery and Allied Health Professions Research Unit, which has a base at the University of Stirling, said: "Suicide is a significant public health concern in the UK and worldwide. Contact with healthcare services offers opportunities for health professionals to engage in . To do this, we need to be able to assess which people are most at risk. Our study found that substantially more people who died by suicide were last discharged from general hospitals, rather than psychiatric hospitals, with many of these deaths having occurred relatively soon after a discharge. This suggests that more opportunities for intervention may exist."

"Targeted follow-up of people admitted to general hospital having self-harmed - in particular young men – and screening for psychological problems in those who have had a previous history of self-harming or of mental illness, could be beneficial. To do this, hospitals will need to make better use of historical and electronic health records. Hospitals would also need to ensure that all hospital staff are able to engage in basic mental screening of 'at risk' patients."

More information: Nadine Dougall, Paul Lambert, Margaret Maxwell, Alison Dawson, Richard Sinnott, Susan McCafferty, Carole Morris, David Clark, and Anthea Springbett." Deaths by suicide and their relationship with general and psychiatric hospital discharge: 30-year record linkage study." BJP bjp.bp.112.122374; published ahead of print January 30, 2014, DOI: 10.1192/bjp.bp.112.122374

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