The first 12 weeks after psychiatric hospitalization are the highest risk period for suicide, and health systems with limited resources should focus their suicide prevention efforts there.
The online health information resource Modern Medicine briefly describes the study:
Marcia Valenstein, M.D., of the Department of Veterans Affairs Medical Center in Ann Arbor, Mich., and colleagues conducted a study of 887,859 Veteran Affairs patients who were treated for depression from April 1999 to September 2004 … Within the first 12 weeks of psychiatric hospitalization, there were 568 suicides per 100,000 person-years, versus 210/100,000 after new antidepressants treatment, 193/100,000 after other starts and 154/100,000 after changes to dosage …
“Health systems with limited resources may need to first focus on the highest-risk treatment periods which follow psychiatric hospitalization,” the authors write. “If resources permit, health systems might also consider providing closer monitoring in the first 12 weeks immediately following antidepressant starts, across all adult age-groups.”
UPDATE 01/12/09: Today’s Washington Post includes the entire background article on the study, by HealthDay reporter Steven Reinberg, which quotes Simon Rego, associate director of psychology training at Montefiore Medical Center and an assistant professor at Albert Einstein College of Medicine in New York City:
The study highlights the importance of moving some of the responsibility traditionally placed on clinicians to the entire mental health care system in order to shift the focus of prevention efforts from individual patients to entire at-risk populations, [Rego said].
“In terms of suicide prevention, the results indicate that there are readily identifiable high-risk periods following specific events, such as being discharged from an inpatient psychiatric stay or starting a new antidepressant medication, and contrary to previously held notions, that these risk periods are not just for younger patients,” Rego said … “the best use of our mental health resources would be to target efforts at frequent reassessment of suicide risk, offering of support, and establishing a connection to outpatient services during the entire 12-week period after discharge from a psychiatric hospitalization.”
[The abridged URL for this post is http://tinyurl.com/PostHospitalization .]