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Psychiatr Serv. 2018 Sep 1;69(9):1032-1035. doi: 10.1176/ Epub 2018 Jun 1.

Death by Suicide in the First Year After Irregular Discharge From Inpatient Hospitalization.

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Dr. Riblet and Dr. Shiner are with White River Junction Veterans Affairs (VA) Medical Center, White River Junction, Vermont. Along with Dr. Watts, they are also with the Dartmouth College Geisel School of Medicine, Hanover, New Hampshire. Dr. Watts is also with the VA National Center for Patient Safety, Ann Arbor, Michigan. Dr. Richardson is with the Research Triangle Institute, Research Triangle Park, North Carolina. He completed this work while at the VA Serious Mental Illness Treatment, Research, and Evaluation Center (SMITREC), Ann Arbor, Michigan, where Ms. Peltzman and Dr. McCarthy are affiliated. Dr. McCarthy is also with the Department of Psychiatry, University of Michigan, Ann Arbor.



Single-site studies indicate irregular hospital discharges are associated with elevated suicide risk. As part of ongoing analytics in the Veterans Affairs (VA) health system, the authors evaluated associations between irregular discharge and suicide over a 15-year period.


All inpatient discharges and discharge types from 2001 through 2014 were identified using VA administrative data. Mortality and cause-of-death data were drawn from comprehensive VA searches of the Centers for Disease Control and Prevention National Death Index. Suicide risk following regular versus irregular discharge was compared by using survival analysis and adjusting for age, gender, and VA facility.


Among 5,051,051 discharges, 2.1% (103,995) were irregular. Adjusted suicide risk was higher following irregular discharge compared with regular discharge (hazard ratio [HR]=2.02, 95% confidence interval [CI]=1.78-2.29). Stratified analyses by unit type showed that the association was nonsignificant for psychiatric discharges but significant for general medical discharges (HR=3.01, CI=2.54-3.57).


Patients were at increased suicide risk after irregular hospital discharges.


Suicide & self-destructive behavior, Discharge against medical advice, Hospitalization


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