TY  - JOUR
PY  - 2014//
TI  - Determinants of completed railway suicides by psychiatric in-patients: case-control study
JO  - British journal of psychiatry
A1  - Lukaschek, Karoline
A1  - Baumert, Jens
A1  - Krawitz, Marion
A1  - Erazo, Natalia
A1  - Förstl, Hans
A1  - Ladwig, Karl-Heinz
SP  - 398
EP  - 406
VL  - 205
IS  - 5
N2  - Background Suicide prediction during psychiatric in-patient treatment remains an unresolved challenge. Aims To identify determinants of railway suicides in individuals receiving in-patient psychiatric treatment. <br><br>METHOD The study population was drawn from patients admitted to six psychiatric hospitals in Germany during a 10-year period (1997-2006). Data from 101 railway suicide cases were compared with a control group of 101 discharged patients matched for age, gender and diagnosis. <br><br>RESULTS Predictors of suicide were change of therapist (OR = 22.86, P = 0.004), suicidal ideation (OR = 7.92, P<0.001), negative or unchanged therapeutic course (OR = 7.73, P<0.001), need of polypharmaceutical treatment (OR = 2.81, P = 0.04) and unemployment (OR = 2.72, P = 0.04). Neither restlessness nor impulsivity predicted in-patient suicide. <br><br>CONCLUSIONS Suicidal ideation, unfavourable clinical course and the use of multiple psychotropic substances (reflecting the severity of illness) were strong determinants of railway suicides. The most salient finding was the vital impact of a change of therapist. These findings deserve integration into the clinical management of patients with serious mental disease.<p />  <p>Language: en</p>
LA  - en
SN  - 0007-1250
UR  - http://dx.doi.org/10.1192/bjp.bp.113.139352
ID  - ref1
ER  -