Suicide in psychiatric in-patients

Approximately 25‐ 40% of suicide victims are in contact with psychiatric services in the year before death. 1 Fourteen per cent receive in-patient care during this year, and around one-fifth of these (3‐ 4% of all suicides) die while in hospital. 2 Suicide rates (based on deaths per admissions per year) among psychiatric in-patients may have increased over the last 50 years. 3 The causes of this possible increase have not been determined, but some explanations include structural changes in psychiatric hospitals; differences in the patient groups admitted to hospital; and increased patient liberty on the ward. 3 It is notoriously difficult to predict suicide risk in psychiatric patients accurately, as factors associated with suicide are also associated with mental illness. Relatively few factors specific to in-patient suicide have been identified, and they have limited predictive value. 4 This paper summarizes previous work on the features of in-patients that kill themselves, examines the clinical value of recent research findings derived from case-control studies, and concludes with an account of recent recommendations on the prevention of in-patient suicide.