Abstract
Factors contributing to patients killing themselves while admitted to general hospital medical/surgical (med/surg) units have not been well described. These rare yet devastating suicides appear to have characteristics distinguishing them from suicides in psychiatric inpatients. This article emphasizes the importance of both agitation and readily available lethal means in suicides that are almost invariably impulsive. It also emphasizes how traditional risk factors such as past history of psychiatric illness, substance abuse, or suicidality typically are absent in this population, as are present depression and known suicidality. Caregivers seeking to prevent suicide in the med/surg environment therefore must appreciate the potential lethality of acute psychic and motoric agitation. Close surveillance of agitated patients, with interventions to calm them and secure their surroundings, will assure safety and save lives.
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References and Recommended Reading
Wolfersdorf M: Suicide among psychiatric inpatients. In The International Handbook of Suicide and Attempted Suicide. Edited by Hawton K, van Heeringen K. New York: John Wiley & Sons; 2000:457–466.
Busch KA, Fawcett J, Jacobs DG: Clinical correlates of inpatient suicide. J Clin Psychiatry 2003, 64:14–19.
Fawcett J, Scheftner WA, Clark DC, et al.: Clinical predictors of suicide in patients with major affective disorder: a controlled prospective study. Am J Psychiatry 1987, 144:35–40.
Fawcett J: Predictors of early suicide: identification and appropriate intervention. J Clin Psychiatry 1988, 49(Suppl):7–8.
Fawcett J, Sheftner WA, Fogg L, et al.: Time-related predictors of suicide in major affective disorder. Am J Psychiatry 1990, 147:1189–1194.
Hall RC, Platt DE, Hall RC: Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts. Evaluation of suicide risk in a time of managed care. Psychosomatics 1999, 40:18–27.
Druss B, Pincus H: Suicidal ideation and suicide attempts in general medical illnesses. Arch Intern Med 2000, 160:1522–1526.
Stenager EN, Stenager E, Jensen K: Attempted suicide, depression, and physical diseases: a 1-year follow-up study. Psychother Psychosom 1994, 61:65–73.
Hung CI, Liu CY, Liao MN, et al.: Self-destructive acts occurring during medical general hospitalization. Gen Hosp Psychiatry 2000, 22:115–121.
Proulx F, Lesage AD, Grunberg F: One hundred in-patient suicides. Br J Psychiatry 1997, 171:247–250.
Litman RE, Farberow NL: Suicide prevention in hospitals [in German]. Z Praventivmed 1965, 10:488–498.
Reich P, Kelly MJ: Suicide attempts by hospitalized medical and surgical patients. N Engl J Med 1976, 294:298–301.
Dhossche DM, Ulusurac A, Syed W: A retrospective study of general hospital patients who commit suicide shortly after being discharged from the hospital. Arch Intern Med 2001, 161:991–994.
Ho TP, Tay MS: Suicides in general hospitals in Hong Kong: retrospective study. Hong Kong Med J 2004, 10:319–324.
Suominen K, Isometa I, Heila H, et al.: General hospital suicides—a psychological autopsy study in Finland. Gen Hosp Psychiatry 2002, 24:412–416.
Meehan J, Kapur N, Hunt IM, et al.: Suicide in mental health in-patients and within 3 months of discharge. Br J Psychiatry 2006, 188:129–134.
Bostwick JM, Levenson JL. Suicidality. In The American Psychiatry Publishing Textbook of Psychosomatic Medicine. Edited by Levenson J. Washington, DC: American Psychiatric Publishing; 2005:219–234.
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Bostwick, J.M., Rackley, S.J. Completed suicide in medical/surgical patients: Who is at risk?. Curr Psychiatry Rep 9, 242–246 (2007). https://doi.org/10.1007/s11920-007-0026-6
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DOI: https://doi.org/10.1007/s11920-007-0026-6