Format

Send to

Choose Destination
Br J Psychiatry. 2014 Nov;205(5):398-406. doi: 10.1192/bjp.bp.113.139352. Epub 2014 Sep 25.

Determinants of completed railway suicides by psychiatric in-patients: case-control study.

Author information

1
Karoline Lukaschek, PhD, Jens Baumert, PhD, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg; Marion Krawitz, MD, Natalia Erazo, PhD, Department for Psychosomatic Medicine and Psychotherapy, Hans Förstl, MD, Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich; Karl-Heinz Ladwig, PhD, MD habil, Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, and Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

Abstract

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.

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.

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.

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.

PMID:
25257065
DOI:
10.1192/bjp.bp.113.139352
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Cambridge University Press
Loading ...
Support Center