Suicide inside hospitals

Systematic and methodologically verified research of clinical characteristics and methods of suicide in patients who commit suicide in hospital settings is long overdue. Such events are rare, but have extremely negative consequences for both families and institutions. The aim of the review is to summarize information on completed suicides in departments of general and psychiatric hospitals for the diagnosis and prevention of in-hospital suicides. Material and methods. A search was conducted for publications with comprehensive clinical data on suicide in hospitals, which are important for creating a better and safer care environment. Cross-institutional data analysis improves the accuracy of identifying patients at risk for suicide and also provides the opportunity to capture more complete profiles of suicide risk factors. Results. In-hospital suicides include suicides that occur during hospitalization, whether inside or outside the facility, and for psychiatric patients, suicides that occur within 24 hours of discharge. The rate of suicide in hospitals is high and exceeds that in the general population. It is 250 per 100,000 admissions to psychiatric hospitals and 1.8 per 100,000 admissions to general hospitals, which is four to five times higher than in the general population. Up to 5.5% of suicides occur in hospitals, of them from 3 to 5.5% take place in psychiatric hospitals and about 2% happen in general hospitals. Risk factors for suicide are presented. The availability of one or more means of suicide, such as: water, fences with sharp peaks, high floors – third floor and higher, sharp instruments – knives and glass fragments, the possibility of hanging – are a recognized factor in psychiatric institutions. In the psychiatric environment, length of hospitalization also determines the risk of suicide. It is highest during the first week of hospitalization and two weeks after discharge. Insufficient monitoring, underestimation of suicide risk by staff, poor communication within duty teams and lack of an intensive care unit contribute to suicide risk. Risk factors include a history of suicidality with suicide attempts shortly before admission, diagnoses of schizophrenia and mood disorders, co-occurring alcohol and drug dependence, hospitalization without consent, living alone and previous absence from duty. Risk factors in the period immediately after hospitalization include a history of suicide and suicidal thoughts or suicide attempts shortly before hospitalization, as well as during hospitalization, existing difficulties in interpersonal relationships, stress and loss of work, loneliness, the decision to unplanned discharge from the hospital, absence contact with staff in the period closest to discharge. In general hospitals, suicidal factors are chronic illness and the severity of the physical condition, the patient’s personality characteristics and the presence of concomitant psychiatric pathology. Some countries have established national suicide prevention programs and have made the issue of inpatient suicide a priority. Conclusion. To prevent suicide and suicide attempts before and after discharge in general and psychiatric hospitals, there is an urgent need to educate staff about suicidal behavior and improve the identification of suicidal patients. The assessment of suicidal individuals should include recommendations regarding patient safety, treatment of the underlying condition, and specific treatment approaches. Consultation with a psychiatrist. Prevention measures include close monitoring, constant surveillance, restriction of access to means of suicide, referral to a psychiatric clinic and treatment with sedatives. Mental disorders are treated according to clinical guidelines and after discharge. Specific psychological and reflexology therapy for suicidal behavior reduces the risk of probable suicide. Reducing suicide mortality rates among general hospital inpatients is achieved through increased staff awareness, improved care, and increased attention to patients' social, family, and financial concerns.