Reflections on suicide in a psychiatric hospital

Taking into consideration topical bibliography suicidal events of the psychiatric clinic of the special county hospital for neurology and psychiatry Ueckermünde are introduced and discussed from the point of view of therapeutical and organizational-structural conditions. Hereby practical procedures in the handling of suicidal patients are described.     

Inpatient suicide in a Chinese psychiatric hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.     

A suicide epidemic in a psychiatric hospital.

The authors report in detail on an epidemic of six inpatient suicides in a psychiatric hospital in Finland. Suggestion and identification had an effect on the timing as well as on the method of four of the suicides. The epidemic is viewed from individual, network, and organizational perspectives. The authors speculate on how such epidemics could be avoided. An increase in inpatient suicide rates has been reported from many countries, and the Werther effect may thus become a topic of considerable importance in psychiatric hospitals in the future.     

Suicide-related behavior after psychiatric hospital discharge: Implications for risk assessment and management

Suicide-related behavior (SRB), including suicide attempts and instrumental SRB, occurs far more often than completed suicide and exacts a toll on patients, their loved ones, and society. Nevertheless, few prospective studies of SRB have been conducted. In this study, 954 patients were interviewed in a psychiatric hospital and then followed for one year after discharge. During this one-year period, nearly one-quarter of patients (23%) engaged in SRB, with the rate of suicide attempts (18%) three times greater than the rate of instrumental SRB (5%). Risk factors for SRB were demographic (White ethnicity, female gender), clinical (past SRB, depression, impaired functioning), and contextual (unemployment, large social networks). In contrast with other studies, there was no "peak" in the risk of SRB shortly after hospital discharge. Instead, patients' rate of SRB was relatively constant over the one-year follow-up. Implications for risk assessment and management in acute inpatient settings are discussed.     

Variations in stress responses following involvement in a railway suicide or attempted suicide

Three train drivers were interviewed one month after their involvement in a railway suicide or suicide attempt. The case studies demonstrate that reactions to these incidents vary from the severe and debilitating (concurrent diagnoses of post-traumatic stress disorder and neurotic depression) to the relatively mild (few reported symptoms). All train drivers reported a significant reduction in symptoms at a follow-up interview six months after the incident. Although the psychological effects of these incidents may be severe they appear to be time-limited.     

Duration of hospitalization and post discharge suicide

A retrospective cohort of discharged patients from all public psychiatric hospitals in Hong Kong (1997-1999) was linked to suicide data from Coroner's court. Patients hospitalized shorter than 15 days had significantly lower suicide rates than longer stay patients. The results were fairly consistent across immediate/late post discharge periods, gender, age, diagnoses, and narrow/wide definitions of suicide. This finding was opposite of what has been reported in the literature. Short hospitalization carried different suicide risks in different service settings.     

A survey of groups within a psychiatric hospital

Summary

The findings of a survey of the involvement of staff in group activities within a large psychiatric hospital are presented. Over two hundred regular group meetings were being held, excluding ward-rounds and business meetings. There was a wide variation in the type and structure of the groups, the purpose and theoretical underpinning of many of which were unclear to the participants. It is suggested that this lack of clarity reflects the fact that the original therapeutic aims have been subverted in the service of institutionalised defences against anxiety. To be therapeutically effective, groups need clear leadership, good supervision and well-defined aims.     

Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients, and admitted nonsuicidal psychiatric patients

The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric inpatients admitted for other reasons were examined. The records of 3,897 patients who were treated at a general hospital in Seoul, Korea, from July 2003 to December 2006 were reviewed. Forty-three of the 3,897 subjects died by suicide during the 2.5-year observation period. Compared to the general Korean population, the suicide mortality rate was 82-fold higher for suicide attempt patients, admitted; 54-fold higher for suicide attempt patients, discharged; 21-fold higher for nonsuicidal patients, admitted; and 11-fold higher for nonsuicidal patients, discharged. In all four groups, diagnosis of a depressive disorder and suicide attempt at presentation were each significant independent risk factors for suicide completion. These results highlight the need for suicide prevention strategies for depressed patients who present to the ER or are admitted to a psychiatric ward after a suicide attempt.     

Environmental risk factors in hospital suicide

Suicide of hospitalized patients is the most common sentinel event reviewed by The Joint Commission on Accreditation of Healthcare Organizations. Shorter lengths of stay, sicker patients, and higher patient to staff ratios challenge the ability of the hospital to maintain safety. Risk factors associated with the physical environment of the inpatient psychiatric unit, cited as the most common root cause of inpatient suicide, may be neglected because evaluation of these factors is generally not included in medical education and training. Minimization of fixtures that can facilitate strangulation and other high risk aspects within the hospital environment is an important element in the prevention of suicide on psychiatric units.     

Parent-child relationships of adopted adolescents in a psychiatric hospital

This study compared the parent-child relationships of 140 adopted and non-adopted adolescents treated in a psychiatric hospital through examination of information contained in the adolescents' medical records. Specifically, comparisons were made of the mention of parental contribution to the problems precipitating hospitalization, psychiatric restriction of parental visits to hospitalized offspring, and referral of parents to an adjunct parents' group. Data were gathered by uninformed research assistants, from the hospital charts of adolescents who had already been discharged from the hospital. Statistical analysis of the data yielded the following results. Adoptive parents were significantly more frequently restricted in their visits to their children. In addition, they were also more likely to have been involved in the precipitants to hospitalization and to have been referred subsequently for adjunctive treatment. It was concluded that parent-child relations may be more problematic among hospitalized adopted, as compared with non-adopted , adolescents. It was also suggested that psychiatric bias concerning "typical" adoptive family dynamics might have contributed to the observed differences.     

Architectural design of a secure forensic state psychiatric hospital

This article describes the architectural design of a secure forensic state psychiatric hospital. The project combined input from staff at all levels of the client organization, outside consultants, and a team of experienced architects. The design team was able to create a design that maximized patient dignity and privacy on one hand, and the ability of staff to observe all patient activity on the other. The design centers around 24-bed units, broken into smaller living wings of eight beds each. Each eight-bed living wing has its own private bathrooms (two) and showers (two), as well as a small living area solely reserved for these eight patients and their guests. An indoor-outdoor dayroom allows patients to go outside whenever they choose, while allowing staff to continue observing them. The heart of the facility is a large treatment mall, designed to foster the acquisition of social, emotional, cognitive, and behavioral skills that will help patients to safely return to their communities.     

The integration of family therapy in a psychiatric day hospital

The clients, who present themselves at our psychiatric day hospital in Amsterdam, often have long-standing problems. These problems are usually of a complex nature, and the age of the clients plays an imporant role in this. Their age varies from seventeen to forty, with an average of twenty-eight.
Efforts were made over a long period to facilitate solutions to the clients' family conflicts. During this time an extensive range of problems within the family were presented of which the symptoms of the client represent just a part.
Working as a family therapist in a psychiatric day hospital, where clients are admitted individually, places the family therapist in a number of dilemmas, especially when many working in the hospital see the problems only as individual ones.     

Symptomatology of adopted and nonadopted adolescents in a psychiatric hospital

This study compared the symptomatology and diagnoses of adopted and nonadopted adolescents in a psychiatric hospital. Data were gathered from the hospital charts of adolescents who already had been discharged from the hospital. Contrary to expectations, adoptees were no more likely than nonadoptees to have received personality disorder diagnoses, nor were they more likely to be hospitalized as the result of antisocial behavior. However, in comparison with nonadopted adolescents, the adopted adolescents were younger upon admission to the hospital, significantly less often diagnosed psychotic, and significantly more often diagnosed adjustment reaction. It was suggested that adopted adolescents may be less likely than nonadopted adolescents to require severe or prolonged pathology in order to be admitted to a psychiatric hospital. It was also suggested that the antisocial symptomatology so frequently observed in adopted children in mental health settings does not account for the hospitalizations of those receiving inpatient treatment.     

Child- versus teacher-administered token programs in a psychiatric hospital school

The purpose of this study was to: (a) compare student-administered token programs with similar programs administered by professional teachers, (b) investigate the contribution of feedback to the success of token systems, (c) compare the effectiveness of peer and teacher feedback, and (d) test a sequence of withdrawal from token programs designed to increase generalization. Results indicated that (a) peers could do just as well as teachers in reducing disruptive behavior through a token program, (b) feedback is not solely responsible for the effectiveness of token reinforcement, (c) peer feedback may be more effective than teacher feedback, and (d) withdrawal from token reinforcement to feedback may be a successful method of retarding the increases in disruptive behavior usually found when backup reinforcers are eliminated.The project was supported by Grant OEG 0-71-2872 (607) from the U.S. Department of Education and Department of Health, Education, and Welfare. The opinions expressed herein, however, do not necessarily reflect the position or policy of the U.S. Office of Education, and no official endorsement by that Office should be inferred. The author would like to thank Drs. L. Krasner, A. O. Ross, and K. Feldman for their assistance throughout the study, and Dr. K. D. O'Leary for his invaluable help. Also gratefully acknowledged is the help of R. Spitalnik, R. Kent, M. Hageman. S. Ransom, W. Kaler, S. Golembeski and E. Howard.     

Self-evaluation by adolescents in a psychiatric hospital school token program

Nine adolescent boys with a history of high rates of disruptive classroom behavior were selected from a psychiatric hospital school and placed in a remedial reading class after school in which various factors in a token reinforcement program involving self-evaluation were investigated. The effects of self-evaluation, in the form of a rating the students gave themselves about the appropriateness of their classroom behavior, were first assessed. While the students' ratings of their own behavior correlated highly with the teacher's ratings and evaluations made by independent observers, the self-evaluations did not lead to a reduction in disruptive behavior. A token reinforcement program, in which the teacher rated the students' level of appropriate behavior and in which the students traded earned rating points for prizes, clearly led to a reduction of disruptive behavior. When the students were given the opportunity to evaluate their own behavior and to receive rewards in exchange for the evaluation, they returned to their former rates of disruptive behavior.