Why you should care
Because when it comes to mental health, hospitalization is not enough
When you’re discharged from a hospital, it usually means that you’re healed and well. But when it comes to mental health, that might not be the case. People who are discharged from psychiatric hospitals are usually considered more likely to harm themselves. Now, a new meta-analysis in JAMA Psychiatry that attempted to quantify that vulnerability shows that the risk is much higher than we thought.
Former psychiatric inpatients are 44 times more likely to die by suicide when compared to the worldwide suicide rate.
The risk is highest immediately after discharge and gradually decreases as the years go by. In the 3 months post-discharge period, suicide risk is roughly 100 times that of the global risk.
This trend has interested researchers for a long time, especially given that the suicide rate in the United States has been rising since 1999. Globally, suicide is the second leading cause of death among 15 to 29-year-olds.
The authors of the meta-analysis studied 100 unique studies on this topic from all over the world that had been published over a span of 50 years. One of the key findings was that suicide risk remains elevated many years after discharge. People who had been out of psychiatric hospitals for as long as 10 years still had a suicide rate 25 to 30 times the global rate.
“Everyone knew it was high but people didn’t know that it was this high,” says Dr. Christopher Ryan, an Australian psychiatrist and professor at the University of Sydney who is one of the authors of the analysis.
One common explanation for the heightened rate is that people are often admitted to psychiatric hospitals because they show acute signs of harming themselves. And therefore, these people would naturally be at a higher risk of committing suicide after they’ve been discharged. In most cases, hospitalization doesn’t influence suicide risk per se.
But that may not always be the case. “A distinct possibility is that a percentage of those [deaths] are caused by the hospitalization itself,” Dr. Ryan tells OZY. Perhaps some people, especially if they’ve been hospitalized against their wishes, wouldn’t have committed suicide if they hadn’t been hospitalized in the first place, he says.
“They might think, for example, my God, what has it come to if I’m now here in this hospital and I’m surrounded by all these people who look troubled,” says Dr. Ryan. However, he adds that it doesn’t mean that psychiatric hospitalization is all bad.
But psychiatric hospitalization must always be looked at with a grain of salt. “If you think that this is a free pass and everything will be fine, that might be overly optimistic,” he says.
Another worrying revelation from the analysis is that the risk seems to have increased in the last two decades. Studies between 1995 and 2016 showed a higher overall rate of suicide risk–greater than 600 deaths per person-year–compared to earlier studies–close to 400 deaths per person-year or lower. “This is a disturbing finding considering the increase in community psychiatry and the availability of a range of new treatments during this period,” the authors write.
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Dr. Mark Olfson, a professor of Psychiatry at Columbia University Medical Center who wrote an editorial about the meta-analysis told OZY in an email that more support needs to be provided to these individuals during this high-risk period. “One relatively low-cost option to help smooth these transitions involves mobile health technologies with text messaging functions,” he said.