Has deinstitutionalization affected inpatient suicide? Psychiatric inpatient suicide rates between 1990 and 2013 in Israel

Objective: To examine variations in rates of inpatient suicide and clinical risk factors for this phenomenon. Method: The National Israeli Psychiatric Hospitalization Case Registry was used to study inpatient suicide. Clinical risk factors for inpatient suicide were examined in a nested case control design. Results: Between 1990 and 2013 there were 326 inpatient suicides, at an average of one inpatient suicide per 1614 admissions. A significant decline in rates of suicide per admission over time (p < 0.001) was associated with a reduced number of beds (p < 0.001) and a decline in nationwide suicide rates (p = 0.001). Clinical risk factors for inpatient suicide were: affective disorders (OR = 5.95), schizoaffective disorder (OR = 5.27), schizophrenia (OR = 3.82), previous suicide attempts (OR = 2.59), involuntary hospitalization (OR = 1.67), and more previous hospitalizations (OR = 1.16,). A multivariate model with sensitivity of 27.3% and specificity of 95.3% for inpatient suicide, showed a positive predictive value of 0.4%. Conclusions: The absolute number and rates of inpatient suicide per admission have decreased over time, probably due to the decreased number of beds lowering total time at risk. Patients with affective and psychotic disorders and with previous suicide attempts have the greatest risk of inpatient suicide. However, clinical characteristics do not enable identification of patients who are at risk for suicide.