Risk of suicide attempts and self-harm after 1.4 million general medical hospitalizations of men with mental illness
Year: 2022
Type: article
Study design: Observational Study
Abstract: BACKGROUND: 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.
Source: Journal of Psychiatric Research
Institutions: Weill Cornell Medicine, University of California, Los Angeles
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $3,170
Awards: ALACRITY for Late- and Mid-Life Mood Disorders, 4/4: Leveraging EHR-linked biobanks for deep phenotyping, polygenic risk score modeling, and outcomes analysis in psychiatric disorders, G562934659, Linking VA and non-VA data to study the risk of suicide in chronic pain patients., Predicting Self-Harm, Suicide Attempt, and Suicidal Death using Longitudinal EHR, Claims and Mortality Data, Training the Science of Child Mental Health Treatment, UCLA Clinical and Translational Science Institute
OpenAlex ID: W4308945114