Risk of suicide attempts and self-harm after 1.4 million general medical hospitalizations of men with mental illness

ElsevierVolume 157, January 2023, Pages 50-56Journal of Psychiatric ResearchAuthor links open overlay panelHighlights•

A classification model stratified risk of suicidal behavior after general medical hospitalization of men with mental illness.

Key predictors of risk were medical and psychiatric comorbidity, age, previous self-harm, and prior medical hospitalization.

EHRs may be leveraged to discriminate risk of suicidal behavior among men with co-occurring medical and psychiatric illness.

AbstractBackground

The short-term risk of suicide after medical hospital discharge is four times higher among men compared with women. As previous work has identified female-specific antecedents of suicide-related behavior after medical hospitalization of women with serious mental illness, we examined predictors among a similar population of men with multimorbidity.

Methods

Classification and regression tree (CART) models were developed and validated using electronic health records (EHRs) from 1,423,161 medical (non-psychiatric) hospitalizations of men ≥ 18-years-old with an existing diagnosis of a depressive disorder, bipolar disorder, or chronic psychosis. Hospitalizations occurred between 2009 and 2017. Risk groups were evaluated using an independent testing set. The primary outcome was readmission within one year associated with ICD-9 or -10 code for self-harm or attempt.

Results

The 1-year readmission rate for intentional self-harm and suicide attempt was 3.9% (55,337/1,423,161 hospitalizations). The classification model discriminated risk with area under the curve (AUC) 0.73 (Confidence Interval [95%CI] 0.68–0.74), accuracy 0.82 (95%CI 0.71–0.83), sensitivity 82.6% (95%CI 81.2–84), and specificity 83.1% (95%CI 81.7–84.5). Strongest predictors were medical comorbidity, prior self-harm, age, and prior hospitalization. Men with greater medical comorbidity burden and prior self-harm were at highest risk (Odds Ratio [OR] 3.10, 95%CI 3.02–3.18), as were men < 62-years-old with few medical comorbidities (OR 1.11 95%CI 1.08–1.13).

Limitations

The study focused on medical hospitalizations for suicide attempt and thus captured only severe attempts resulting in hospitalization.

Conclusions

After medical hospitalization, men with serious mental illness experienced a high risk of self-harm (1:25 hospitalizations). Risk was particularly elevated among younger patients without prior medical conditions and older patients with medical comorbidity and prior self-harm.

Keywords

Suicide attempt

Self-harm

Medical hospitalization

Serious mental illness

Risk prediction

Multimorbidity

© 2022 The Authors. Published by Elsevier Ltd.

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