Suicide Risk and Acute Psychiatric Readmissions: A Prospective Cohort Study

OBJECTIVE: The objective was to improve knowledge of the role and functioning of psychiatric acute wards with respect to admissions because of suicide risk and factors associated with readmission. METHODS: Over one year, 1,245 consecutive psychiatric patients from a Norwegian catchment area were included at index admission and reassessed in cases of readmission. After a mean follow-up period of 562 days, a total of 1,234 readmissions were assessed. Time from discharge to readmission was analyzed with univariate and multivariate Cox regression analyses. Outcome variables included acute readmissions and readmissions for suicide risk. RESULTS: Fifty-four percent of the index admissions and 62% of the readmissions were related to suicide risk. Substance use disorders, personality disorders, prior psychiatric hospitalization, unemployment, and receipt of social benefits were significant predictors of any readmissions and readmissions because of suicide risk. At index admission suicidal ideation or suicide plans significantly predicted readmission because of suicide risk. A small subgroup of patients contributed disproportionately to the number of readmissions. A higher number of readmissions per individual patient was associated with greater tendency of admission because of suicide risk. CONCLUSIONS: The acute ward played an important role for patients with suicidal behavior. Care providers and clinicians should focus on staff training and supervision with regard to assessment and management of suicidal patients. Collaboration with referring physicians and aftercare providers is also important to help patients gain constructive coping strategies and break patterns of suicidal behavior and readmission.