J Korean Neuropsychiatr Assoc.  2019 Aug;58(3):202-208. 10.4306/jknpa.2019.58.3.202.

Factors Associated with Suicidal Behavior of Psychiatric Inpatients

• Kim H
• Kim JW
• Kang HJ
• Kim SY
• Lee JY
• Kim JM
• Shin IS
• Yoon JS
• Kim SW

• KMID: 2456600
• DOI: http://doi.org/10.4306/jknpa.2019.58.3.202

Abstract

OBJECTIVES
This study examined the factors associated with suicidal behavior in psychiatric inpatients.
METHODS
The medical records of 208 psychiatric inpatients were reviewed retrospectively. The factors related to suicide attempts and ideation at the time of admission, and during outpatient follow-up, were investigated.
RESULTS
In total, 120 patients (57.7%) with a history of at least one suicide attempt, and 163 patients (78.4%) who reported active suicide ideation (e.g., a suicide plan or intention to commit suicide) at the time of admission were reviewed. Being unmarried or divorced, substance abuse, impulsivity, and a poor social support system were associated with a history of suicide attempts. The suicidal ideation group had significantly higher rates of coexisting depression, severe depressive symptoms, hopelessness, and impulsivity, as well as a lower incidence of moral objection to suicide and high religiosity. In total, 15 out of 193 patients (7.8%) who were followed-up at outpatient clinics attempted suicide after discharge. Patients who attempted suicide or reported suicidal ideation at the outpatient clinic after discharge were significantly more likely to have a history of previous suicide attempts, or have had active suicide ideation at the time of admission. Good social support and high responsibility to family were inversely associated with suicidal ideation as an outpatient.
CONCLUSION
A history of suicide attempts and ideation at the time of hospital admission were the risk factors for future outpatient suicidal behavior. Further study is warranted to develop a checklist and assessment measures of the various risk and protective factors associated with suicidal behavior.

Keyword

Suicide; Suicidal ideation; Risk factor; Protective factor; Inpatients

MeSH Terms

Ambulatory Care Facilities
Checklist
Depression
Divorce
Follow-Up Studies
Humans
Impulsive Behavior
Incidence
Inpatients*
Intention
Medical Records
Outpatients
Protective Factors
Retrospective Studies
Risk Factors
Single Person
Substance-Related Disorders
Suicidal Ideation
Suicide
Suicide, Attempted

Reference

1.OECD.org [homepage on the Internet]. OECD Health Statistics 2019. Paris: OECD [updated 2019 Jul 2;cited 2019 Aug 13]. Available from:. http://stats.oecd.org/wbos/fileview2.aspx?IDFile=9dc6e690-fa1d-40fa-a279-b726e2616433.

2.ncmh.go.kr [homepage on the Internet]. Sejong: Ministry of Health & Welfare;2016 [updated 2016 Apr 5; cited 2019 Aug 13]. Available from:. http://www.ncmh.go.kr/kor/notice/snmhNoticeView.jsp?no=8062&fno=37&gubun_no=0&pg=16&search_item=0&search_content=&menu_cd=K_02_01_00_00_00.

3.Mościcki EK. Identification of suicide risk factors using epidemiologic studies. Psychiatr Clin North Am. 1997. 20:499–517.

4.Kim SW., Kim JM., Shin IS., Yoon JS. Suicide and crisis intervention. J Korean Med Assoc. 2012. 55:341–348.

5.Park CM., Lim JS., Choi YM., Park JH., Joe SH. The effect of depression, stress, coping strategies on the suicidal ideation in healthy controls and psychiatric patients. J Korean Neuropsychiatr Assoc. 2017. 56:68–77.

6.Wasserman D., Rihmer Z., Rujescu D., Sarchiapone M., Sokolowski M., Titelman D, et al. The European Psychiatric Association (EPA) guidance on suicide treatment and prevention. Eur Psychiatry. 2012. 27:129–141.

7.Dervic K., Oquendo MA., Grunebaum MF., Ellis S., Burke AK., Mann JJ. Religious affiliation and suicide attempt. Am J Psychiatry. 2004. 161:2303–2308.

8.Dervic K., Grunebaum MF., Burke AK., Mann JJ., Oquendo MA. Protective factors against suicidal behavior in depressed adults reporting childhood abuse. J Nerv Ment Dis. 2006. 194:971–974.

9.Dervic K., Carballo JJ., Baca-Garcia E., Galfalvy HC., Mann JJ., Brent DA, et al. Moral or religious objections to suicide may protect against suicidal behavior in bipolar disorder. J Clin Psychiatry. 2011. 72:1390–1396.

10.Popovic D., Benabarre A., Crespo JM., Goikolea JM., González-Pinto A., Gutiérrez-Rojas L, et al. Risk factors for suicide in schizophrenia: systematic review and clinical recommendations. Acta Psychiatr Scand. 2014. 130:418–426.

11.Walter F., Carr MJ., Mok PLH., Antonsen S., Pedersen CB., Shaw J, et al. Suicide methods and apecific types of accidental death and fatal poisoning among discharged psychiatric patients: a national cohort study. J Clin Psychiatry. 2018. 79:17m11809.

12.Britton PC., Duberstein PR., Conner KR., Heisel MJ., Hirsch JK., Con-well Y. Reasons for living, hopelessness, and suicide ideation among depressed adults 50 years or older. Am J Geriatr Psychiatry. 2008. 16:736–741.

13.Sohn SY., Kang JI., Namkoong K., Kim SJ. The relationship between risk taking, impulsivity and intolerance of uncertainty. Korean J Biol Psychiatry. 2014. 21:87–92.

14.Cook CC. Suicide and religion. Br J Psychiatry. 2014. 204:254–255.

15.American Psychiatric Association. The diagnostic and statistical manual of mental disorders. 5th ed.Washington, DC: Amercican Psychiatric Association Publishing;2013.

16.Lobo Prabhu S., Molinari V., Bowers T., Lomax J. Role of the family in suicide prevention: an attachment and family systems perspective. Bull Menninger Clin. 2010. 74:301–327.

17.Barrero SA. Preventing suicide: a resource for the family. Ann Gen Psychiatry. 2008. 7:1.

18.Frey LM., Cerel J. Risk for suicide and the role of family: a narrative review. J Fam Issues. 2015. 36:716–736.

19.Koller G., Preuss UW., Bottlender M., Wenzel K., Soyka M. Impulsivity and aggression as predictors of suicide attempts in alcoholics. Eur Arch Psychiatry Clin Neurosci. 2002. 252:155–160.

20.Cheng AT., Chen TH., Chen CC., Jenkins R. Psychosocial and psychiatric risk factors for suicide. Case-control psychological autopsy study. Br J Psychiatry. 2000. 177:360–365.

21.Dumais A., Lesage AD., Alda M., Rouleau G., Dumont M., Chawky N, et al. Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors in men. Am J Psychiatry. 2005. 162:2116–2124.

22.Chang HB., Munroe S., Gray K., Porta G., Douaihy A., Marsland A, et al. The role of substance use, smoking, and inflammation in risk for suicidal behavior. J Affect Disord. 2019. 243:33–41.

23.Darvishi N., Farhadi M., Haghtalab T., Poorolajal J. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. PLoS One. 2015. 10:e0126870.

24.McManama O'Brien KH., Sellers CM., Battalen AW., Ryan CA., Ma-neta EK., Aguinaldo LD, et al. Feasibility, acceptability, and preliminary effects of a brief alcohol intervention for suicidal adolescents in inpatient psychiatric treatment. J Subst Abuse Treat. 2018. 94:105–112.

25.Wojnar M., Ilgen MA., Czyz E., Strobbe S., Klimkiewicz A., Jakubczyk A, et al. Impulsive and non-impulsive suicide attempts in patients treated for alcohol dependence. J Affect Disord. 2009. 115:131–139.

26.Dick DM., Smith G., Olausson P., Mitchell SH., Leeman RF., O'Malley SS, et al. Understanding the construct of impulsivity and its relationship to alcohol use disorders. Addict Biol. 2010. 15:217–226.

27.Kessler RC., Berglund P., Borges G., Nock M., Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. JAMA. 2005. 293:2487–2495.

28.Sun L., Zhang J. Suicide acceptability and suicide attempt: a case-control study with medically serious suicide attempters aged 15 to 54 years in rural China. J Nerv Ment Dis. 2018. 206:694–698.

29.Kleiman EM., Liu RT. Prospective prediction of suicide in a nationally representative sample: religious service attendance as a protective factor. Br J Psychiatry. 2014. 204:262–266.

30.Fegg M., Kraus S., Graw M., Bausewein C. Physical compared to mental diseases as reasons for committing suicide: a retrospective study. BMC Palliat Care. 2016. 15:14.

31.Singhal A., Ross J., Seminog O., Hawton K., Goldacre MJ. Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage. J R Soc Med. 2014. 107:194–204.

32.Zhang J. Marriage and suicide among Chinese rural young women. Soc Forces. 2010. 89:311–326.

33.Wilson KG., Stelzer J., Bergman JN., Kral MJ., Inayatullah M., Elliott CA. Problem solving, stress, and coping in adolescent suicide attempts. Suicide Life Threat Behav. 1995. 25:241–252.

34.Zhang X., Wang H., Xia Y., Liu X., Jung E. Stress, coping and suicide ideation in Chinese college students. J Adolesc. 2012. 35:683–690.

35.Bazrafshan MR., Jahangir F., Mansouri A., Kashfi SH. Coping strategies in people attempting suicide. Int J High Risk Behav Addict. 2014. 3:e16265.

36.Cleary A. Suicidal action, emotional expression, and the performance of masculinities. Soc Sci Med. 2012. 74:498–505.

37.Vogel DL., Wade NG., Hackler AH. Perceived public stigma and the willingness to seek counseling: the mediating roles of self-stigma and attitudes toward counseling. J Couns Psychol. 2007. 54:40–50.

38.Vaiva G., Vaiva G., Ducrocq F., Meyer P., Mathieu D., Philippe A, et al. Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study. BMJ. 2006. 332:1241–1245.

39.Thompson MP., Kingree JB., Lamis D. Associations of adverse childhood experiences and suicidal behaviors in adulthood in a U.S. nationally representative sample. Child Care Health Dev. 2019. 45:121–128.

40.Raleva M. Early life stress: a key link between childhood adversity and risk of attempting suicide. Psychiatr Danub. 2018. 30(Suppl 6):341–347.