Original Title: Estudio de los factores de riesgo de la conducta suicida. Análisis de la atención sanitaria

Authors' objectives: To assess the association between suicide and different clinical and socio-demographical variables in sample of patients with Mood Disorder diagnosis treated by the Hospital Santiago Apostol (HSA) between 1990-2000.

Authors' results and conclusions: Although the sample of patients from both periods (1990-2000) have similar socio-demographical and clinical characteristics, it is observed that the number of patients with Mood Disorder and attempted suicide tripled in 2000 and the average stay in hospital was shortened to almost six days. In 1990 and 2000, a correlation between previous attempted suicides and shorter stays in hospital was confirmed. During the monitoring period, half of the patients were readmitted over a period of 10 years. The number of patients admitted for Mood Disorder was significantly higher in 2000 than in 1990. During the two years of the study, we observed that there was a very similar distribution according to sex and age in patients with Mood Disorder. The majority employment status in 1990 and 2000 was of active employment, and differences were observed with regard to marital status (1990 married, 2000 unmarried). In 1990 and 2000, the same proportions of emotional patients with histories of previous admissions were maintained, 40% in the immediate family and 50% in close relatives, and the percentage of patients with previous histories of suicidal conduct (30%). About 95% had been admitted to hospital previously at least once. Over the 10-year period monitored, the average number of cases of readmission was almost double in patients with recorded histories of suicidal behaviour. Statistically significant differences were not observed in patients with histories of previous attempted suicides with regard to their age, the presence of family histories of mental disorder, diagnostics and sex. Nevertheless, in the year 2000, we found that the consumption of other drugs (excluding tobacco, cannabis and alcohol) was higher in patients with histories of prior suicide attempts.

Authors' recommendations: Emotional patients with histories of previous suicide attempts are admitted for shorter periods in hospital than those who do not have such histories. In spite of the fact that it is not possible to conclude with certainty that a longer stay in hospital would improve the prognosis of patients with Mood Disorder and with symptoms of suicidality, a systematic assessment should be made of the risk of suicide before and after being admitted to hospital and to appraise the efficiency of the prolongation of the period of admittance or of other measures that might be efficient in the prevention of autolytic risk. For this reason, it would be necessary to establish the programme of specific treatment for these patients immediately after being admitted to hospital. Ideally, these programmes should include psychoeducation and be available in Partial Hospitalisation Units. The impact of these programmes on the prevention of the risk of suicide and improvements in the prognosis of emotional and psychiatric patients in general should be verified. The increase in hospital demand has tripled for these patients over the last decade due to demographic factors. At the same time, there has been a significant reduction in the duration of admissions to hospital. Nevertheless, the seriousness of patients a decade ago is similar to that of patients at this time. In order to offset this situation, resources should be implemented in the community in order to treat Mood Disorder and these should be more specific and sensitive for patients who have attempted suicide. For this reason, we consider that it would be advisable to propose special programmes to integrate both the pharmacological treatment and individual monitoring, and the development of psychological therapies to provide support for patients and their families. It would be appropriate to improve communications between the services of health centres and hospitals in order to monitor patients who are frequently readmitted to hospital. The consumption of certain drugs is a risk factor for the suicidal person. A careful evaluation should be made of patients with Mood Disorder with the accompanying consumption of substances and to create active prevention policies of the consumption of drugs in psychiatric patients and the population as a whole.

Authors' methods: Longitudinal retrospective observational study of all patients admitted to the Psychiatry ward (HSA) during the period 1990-2000, who comply with the diagnostic criteria within the Mood Disorder category (CIE-10), in order to determine the association between the presence of the disease (Mood Disorder with suicidality) and clinical and socio-demographical risk factors. Data was gathered through a search of HSA databases and the individual review of each one of the clinical histories.

Project Status: Completed

Year Published: 2007

URL for published report: https://www.euskadi.eus/contenidos/informacion/2007_osteba_publicacion/es_def/adjuntos/d_07-02_inform_suicidio.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)</p>