Impact of four integrated self-management interventions on psychiatric readmissions in patients at suicide risk: An interrupted time series analysis in Switzerland

BACKGROUND: Frequent psychiatric readmissions can burden patients, families, and the healthcare system. This study aimed to assess the impact of four integrated self-management interventions on psychiatric readmissions among patients at increased suicide risk. METHODS: We conducted an interrupted time series analysis of inpatient data from the largest psychiatric hospital in Central Switzerland, covering the period from January 2018 to December 2023. The intervention package, including collaborative suicide risk assessment, personal safety planning, mental health first aid courses for relatives, and a self-management mobile application, was gradually introduced between September 2021 and December 2022. Mixed-effects logistic regression models were used to estimate changes in the odds of readmission within 30 days, 3 months, and 6 months post-discharge, adjusting for age, seasonality, length of hospital stay, and primary diagnosis group. RESULTS: The study included 6690 patients with a mean age of 40.6 years (SD = 13.8), 44.8 % of whom were women. Among patients at increased suicide risk, the intervention package was associated with reduced odds of 30-day readmission during the introduction period (OR = 0.68, 95 % CI = 0.53-0.87) and after full implementation (OR = 0.65, 95 % CI = 0.50-0.85). Similar reductions were observed for readmissions within 3 and 6 months post-discharge. The effects were, on average, larger among men than women. No statistically significant changes were found in patients at no or low suicide risk. CONCLUSION: The self-management intervention package was associated with significant reductions in psychiatric readmissions among patients at increased suicide risk. Strengthening post-discharge support is critical to bridging gaps between inpatient and outpatient care, particularly for vulnerable populations.