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Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford
ICRF/NHS Centre for Statistics in Medicine, Institute of Health Sciences, Headington, Oxford
Unit of Health-Care Epidemiology, University of Oxford
Declaration of interest No conflict of interest. Financial support detailed in Acknowledgements.
Correspondence: Dr John Geddes, Warneford Hospital, Oxford OX37JX. Tel: 01865226480, fax: 01865 793101, e-mail: john.geddes{at}psych.ox.ac.uk
Background Psychiatric hospital inpatients are known to be at high risk of suicide, yetthere is little reliable knowledge of risk factors or their predictive power.
Aims To identify risk factors for suicide in psychiatric hospital in-patients and to evaluate their predictive power in detecting people at risk of suicide.
Method Using a case-control design, 112 people who committed suicide while in-patients in psychiatric hospitals were compared with 112 randomly selected controls. Univariate analysis and multivariate analyses were used to estimate odds ratios and adjusted likelihood ratios.
Results The rate of suicide in psychiatric in-patients was 13.7 (95% CI 11.7-16.1) per 10 000 admissions. There were five predictive factors with likelihood ratios >2, following adjustment: planned suicide attempt, 4.1; actual suicide attempt, 4.9; recent bereavement, 4.0; presence of delusions, 2.3; chronic mental illness, 2.2; and family history of suicide, 4.6. On this basis, only two of the patients who committed suicide had a predicted risk of suicide above 5%.
Conclusions Although several factors were identified that were strongly associated with suicide, their clinical utility is limited by low sensitivity and specificity, combined with the rarity of suicide, even in this high-risk group.
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