Clinical aspects of inpatient suicides: A retrospective analysis of suicides from 2008 to 2019 in 9 hospitals in North Rhine-Westphalia

BACKGROUND: Suicides represent a serious public health problem worldwide. An increase in suicide rates was observed among psychiatric inpatients. OBJECTIVES: The aim of this study was to examine differences in inpatient suicides across age groups and to derive clinical implications from special features of inpatient suicide. MATERIAL AND METHODS: A total of 229 (partially) inpatient suicides were retrospectively analyzed based on standardized report protocols. Data included information on sociodemographic background, medication, diagnoses, duration of hospitalization, suicide method, location, weekday, and potential stressors. Suicide rates per admission were calculated by sex and age group. Age-related differences in categorical variables were analyzed using χ2 tests. RESULTS: From 2008 to 2019, the overall suicide rate ranged from 0.06% to 0.03% suicides/admission. Suicide rates per admission, stratified by age group, showed a significant increase for both women and men aged 60-69 years. Age stratification (χ2 tests including post hoc tests with Bonferroni correction) showed differences in diagnoses, stressors, and medication. Hanging was the most common suicide method, followed by railway suicide. More than half of the suicides occurred outside the hospital environment, during hospital leave approved by staff. CONCLUSIONS: The suicide rate per duration of hospitalization increased after the first month of treatment, which may highlight the severity of the underlying mental illness, resulting in a longer hospitalization period and potential therapy resistance, so approved periods of leave should be considered carefully. Awareness of somatic comorbidities and chronic pain during the therapeutic process is important, especially for older patients. Hanging is the most common method of suicide, whereas railway suicide is the most common method in younger age groups. These findings emphasize the importance of preventive construction measures.