| BackgroundSuicide is one of the public health issues of global concern.Suicide prevention and intervention are huge challenges faced by mental health professionals and the entire society.According to the World Health Organization,about 800,000 people die by suicide each year worldwide.While the survey shows that from 2012 to 2015,the average annual suicide rate in China was 6.57 per 100,000 people.The risk of suicide is highly correlated with mental illness,and the risk of suicide behavior among patients with mental disorders is higher than that of the general population.Treatment in psychiatric departments for inpatients with high risk is an important means of suicide intervention,because hospital wards provide them with an immediate safe environment,psychological support and medical services.However,there are many post-discharge follow-up studies suggesting that patients with mental illness have an increased risk of suicide behavior after hospitalization,so it will be helpful to monitor dynamic changes of suicide risk among psychiatric inpatients,and in-depth research on factors related to high suicide risk,which is beneficial to formulate the next intervention plan that early identification of inpatients with high risk and reduce the occurrence of suicidal behavior.ObjectiveAt present,researches on suicide risk mainly focus on general population such as adolescents and college students,as well as patients diagnosed with depressive disorder and schizophrenia,but there are few researches on patients with other mental disorders,especially psychiatric inpatients.The purpose of this study was to analyze the factors of recent suicide-related behavior,reduction of suicide risk among psychiatric inpatients and the factors associated with high suicide risk.MethodsA total of 1097 inpatients with mental disorders who met the inclusion criteria were included.Basic demographic and clinical variables were collected,including age,gender,marital status,medical insurance status,work status and other general demographic data,as well as clinical data such as length of stay,main diagnosis,and type of psychiatric prescription drugs at discharge.Data were collected from the Mini International Neuropsychiatric Interview(MINI)Suicide module(simplified version)on the day of admission,and three Assessment time points of the Nurses’ Global Assessment of Suicide Risk(NGASR)(on the day of admission,third day after admission,and 10-30 days during hospitalization).The sample was divided into groups according to the recent occurrence of suicide-related behavior(within 1 week)or classification of suicide risk,and the related factors were compared and analyzed.Results4.1 Recent suicide-related behavior among psychiatric inpatientsA total of 1097 inpatients with mental disorders,with an average age of(37.2±17.2)years,were included in the MINI suicide module(simplified version)assessment on the day of admission,including 614 males(56.0%)and 483 females(44.0%),among whom 85(7.7%)were in the recent occurrence of suicide attempt group.There were 302(27.5%)patients thinking of self-harm and suicide,82(7.5%)patients having a suicide plan recently,and 63(5.7%)having previous suicide attempts.The average score of MINI Suicide module(simplified version)among psychiatric inpatients is 3.3±7.4.Regression analysis showed that younger age,having health insurance,admission by emergency department,having a diagnosis of major depressive disorder and previous suicide attempt(all P<0.05)were associated with the risk of suicide-related behavior recently among hospitalized patients with mental disorders.4.2 Reduction of suicide risk among psychiatric inpatients shortly following hospitalization(3 days)A total of 562 inpatients with mental disorders who underwent NGASR assessment at two time points(i.e.,the day of admission and third day after admission)were included.The mean age was(34.3±26.8)years,with 270 males(48.0%)and 292 females(52.0%).Patients enrolled presented with a medium-high suicide risk(mean score of 9.2±3.3),with 66.0% of patients at high risk at admission.The mean NGASR-5 score(only for the five NGASR items that may change after admission,including Q1,Q4,Q5,Q6,and Q7)decreased from6.3±2.8 on admission to 4.6±3.0 on the third day(P <0.001).Regression analysis showed that patients with high suicide risk on admission day(OR = 85.275,P<0.001)and employed(OR = 0.566,P=0.013)were predicted factors of high suicide risk on the third day.4.3 Reduction of suicide risk among psychiatric inpatients over the course of hospitalization(10～30 days)A total of 191 inpatients with mental disorders who underwent NGASR assessment at three time points(i.e.,the day of admission,third day after admission,and 10～30 days during hospitalization)were included.The mean age was(32.8±16.4)years,with 90 males(47.1%)and 101 females(52.9%).Patients enrolled presented with a medium-high suicide risk(mean score of 9.8±3.2),with73.3% of patients at high risk at admission.The mean NGASR-5 score(only for the five NGASR items that may change after admission,including Q1,Q4,Q5,Q6,and Q7)decreased from 6.7±2.7 on admission to 5.3±2.9 on the third day(P<0.001),and 2.4±2.4 at the last assessment(10～30 days after admission)(P<0.001).Regression analysis showed that patients with high suicide risk on admission day were strongly predicted high suicide risk at the last assessment(13.1%)(OR =5.069,P =0.032).Conclusions5.1 This study suggested that the prevalence of recent suicide-related behavior(within 1 week)in hospitalized patients with mental disorders were surprisingly high,as well as influenced by many factors,among which patients with younger age,no insurance,being admission by emergency department,diagnosed with major depressive disorder and having previous suicide attempts were at a higher risk of suicide-related behavior within one week,which should be paid enough attention in clinical practice.5.2 After only three days of hospital care,there was a substantial reduction in suicidal tendency,and after several weeks of treatment,there was an even greater change.Patients with high suicide risk on the admission day were the strongly predicted high suicide risk on the 3rd day after admission and at the last assessment,while being employed was a protective factor of patients with high suicide risk on the3 rd day after admission.It was significantly beneficial that both initial admission to a safe environment and subsequent aggressive hospitalization.13.61% of patients were still at high risk at the last assessment of hospitalization,and attention should be paid to the post-discharge management and care plan for these patients. |
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