%0 Journal Article
%T Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric in-patients
%J Acta psychiatrica Scandinavica
%D 2011
%A Large, M.
%A Smith, G.
%A Sharma, S.
%A Nielssen, O.
%A Singh, S. P.
%V 124
%N 1
%P 18-29
%X Large M, Smith G, Sharma S, Nielssen O, Singh SP. Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric in-patients. Objective:  To estimate the strength of the associations between the suicide of psychiatric in-patients and demographic, historical, symptomatic, diagnostic and treatment factors. Method:  A systematic review and meta-analysis of controlled studies of the suicide of psychiatric in-patients including suicides while on approved or unapproved leave. Results:  Factors that were significantly associated with in-patient suicide included a history of deliberate self-harm, hopelessness, feelings of guilt or inadequacy, depressed mood, suicidal ideas and a family history of suicide. Patients suffering from both schizophrenia and depressed mood appeared to be at particular risk. The association between suicidal ideas and in-patient suicide was weak and did not reach statistical significance after a quantitative correction for publication bias. A high-risk categorization as defined by a combination of retrospectively determined individual risk factors was strongly statistically associated with in-patient suicide (OR = 10.9), with a sensitivity of 64% and a specificity of 85%. Conclusion:  Despite the apparently strong association between high-risk categorization and subsequent suicide, the low base rate of in-patient suicide means that predictive value of a high-risk categorization is below 2%. The development of safer hospital environments and improved systems of care are more likely to reduce the suicide of psychiatric in-patients than risk assessment.<p /> <p>Language: en</p>
%G en
%I John Wiley and Sons
%@ 0001-690X
%U http://dx.doi.org/10.1111/j.1600-0447.2010.01672.x