Suicide in a large population of former psychiatric inpatients

• Published in: Psychiatry and clinical neurosciences Vol. 65; no. 3; pp. 286 - 295
• Main Authors: Sani, Gabriele, Tondo, Leonardo, Koukopoulos, Athanasios, Reginaldi, Daniela, Kotzalidis, Giorgio D., Koukopoulos, Alexia E., Manfredi, Giovanni, Mazzarini, Lorenzo, Pacchiarotti, Isabella, Simonetti, Alessio, Ambrosi, Elisa, Angeletti, Gloria, Girardi, Paolo, Tatarelli, Roberto
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.04.2011; Wiley-Blackwell
• Subjects: Adult; Adult and adolescent clinical studies; Aggressive behavior; Agitation; Anticonvulsants; antidepressant drugs; Antidepressants; Anxiety; Biological and medical sciences; Bipolar disorder; Bipolar disorders; Data processing; Depression; Female; Hallucinations; Hospitals; Humans; Inpatients - psychology; Lithium; Male; Medical sciences; Mental disorders; Mental Disorders - complications; Mental Disorders - diagnosis; Mental Disorders - drug therapy; Mental Disorders - psychology; Mood; Mood disorders; Neuropharmacology; Personality; Pharmacology. Drug treatments; Psychiatric Status Rating Scales; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Psychoses; Psychosis; Psychotropic Drugs - therapeutic use; Retrospective Studies; Risk Factors; Schizophrenia; Sex Characteristics; Sex differences; Suicide; Suicide - psychology; Suicide - statistics & numerical data; Psychosis; Mood disorder; Agitation; Psychotropic; antidepressant drugs; Schizophrenia; Mental disorder; Antidepressant agent; Bipolar disorder; Suicide
• ISSN: 1323-1316; 1440-1819
• DOI: 10.1111/j.1440-1819.2011.02205.x

Aims:  The aim of this study was to identify predictors of completed suicide in a wide sample of psychiatric inpatients receiving retrospective and prospective DSM‐IV diagnoses. Methods:  We followed up 4441 severe psychiatric patients who were hospitalized for some time during a 35‐year period in a private hospital setting. We collected sociodemographic, clinical and temperamental data. Results:  Ninety‐six patients from the sample committed suicide. There were no sex differences in suicide completion and no differences between major psychiatric disorders, but people who had been hospitalized for anxiety disorders did not commit suicide and people with bipolar disorders were more likely to commit suicide than people with unipolar major depression. Shorter‐term treatment with lithium and anticonvulsants, longer‐term treatment with antidepressants, history of suicide attempts, suicidal thinking, and single status positively predicted completed suicide. Suicide tended to occur after a mean period of about 14 years of duration of disease. Patients' symptoms during the period preceding suicide were assessed through interviewing patients' physicians or family members. Symptoms occurring in >10% of cases were, in decreasing order, inner tension, racing/crowded thoughts, aggressive behavior, guilt, psychomotor agitation, persecutory ideation, anxiety, and hallucinations. Surprisingly, cyclothymic temperament was less associated with completed suicide as compared to other temperaments. Conclusions:  Suicide is likely to occur in a milieu of agitation, mixed anxiety and depression, and psychosis. Longer‐term mood stabilizer treatment may reduce the rate of completed suicide.