Journal List > J Korean Neuropsychiatr Assoc > v.58(3) > 1131980

Kim, Kim, Kang, Kim, Lee, Kim, Shin, Yoon, and Kim: Factors Associated with Suicidal Behavior of Psychiatric Inpatients

Abstract

Objectives

This study examined the factors associated with suicidal behavior in psychiatric inpatients.

Methods

The medical records of 208 psychiatric inpatients were reviewed retrospectively. The factors related to suicide attempts and ideation at the time of admission, and during outpatient follow-up, were investigated.

Results

In total, 120 patients (57.7%) with a history of at least one suicide attempt, and 163 patients (78.4%) who reported active suicide ideation (e.g., a suicide plan or intention to commit suicide) at the time of admission were reviewed. Being unmarried or divorced, substance abuse, impulsivity, and a poor social support system were associated with a history of suicide attempts. The suicidal ideation group had significantly higher rates of coexisting depression, severe depressive symptoms, hopelessness, and impulsivity, as well as a lower incidence of moral objection to suicide and high religiosity. In total, 15 out of 193 patients (7.8%) who were followed-up at outpatient clinics attempted suicide after discharge. Patients who attempted suicide or reported suicidal ideation at the outpatient clinic after discharge were significantly more likely to have a history of previous suicide attempts, or have had active suicide ideation at the time of admission. Good social support and high responsibility to family were inversely associated with suicidal ideation as an outpatient.

Conclusion

A history of suicide attempts and ideation at the time of hospital admission were the risk factors for future outpatient suicidal behavior. Further study is warranted to develop a checklist and assessment measures of the various risk and protective factors associated with suicidal behavior. J Korean Neuropsychiatr Assoc 2019;58(3):202-208

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Table 1.
Characteristics of patients with a history of previous suicide attempt and current active suicide ideation
  Total Previous suicide attempt p-value Active suicide ideation p-value
n(%) 208 (100) Yes, n(%) 120 (57.7) No, n (%) 88 (42.3) χ2 or U Yes, n(%) 163 (78.4) No, n(%) 45 (21.6) χ2 or U
Sociodemographic risk factors                  
Gender, male 106 (51.0) 68 (56.7) 38 (43.2) 3.694 0.055 86 (52.8) 20 (44.4) 0.976 0.323
Age (yr) 38 (23-55) 33 (22-51) 43 (26-64) −2.278 0.023 36 (23-54) 42 (25-67) −1.394 0.163
Duration of hospitalization (day) 28 (21-38) 29 (20-40) 27 (21-36) −0.466 0.641 28 (20-37) 29 (21-43) −0.946 0.344
Abuse history 33 (15.9) 23 (19.2) 10 (11.4) 2.316 0.128 26 (16.0) 7 (15.6) 0.004 0.949
Family history 20 (9.6) 10 (8.3) 10 (11.4) 0.536 0.464 18 (11.0) 2 (4.4) 1.767 0.184
Marital status                  
Married 72 (34.6) 36 (30.0) 36 (40.9) 14.210 0.003 55 (33.7) 17 (37.8) 0.690 0.876
Unmarried 101(48.6) 64 (53.3) 37 (42.0) 81 (49.7) 20 (44.4)
Widowed 19 (9.1) 6 (5.0) 13 (14.8) 14 (8.6) 5 (11.1)
Divorced 16 (7.7) 14 (11.7) 2 (2.3) 13 (8.0) 3 (6.7)
Economic problem, yes 81 (38.9) 47 (39.2) 34 (38.6) 0.006 0.938 64 (39.3) 17 (37.8) 0.033 0.856
Clinical risk factors                  
Physical health problem, yes 102 (49.0) 58 (48.3) 44 (50.0) 0.056 0.812 85 (52.1) 17 (37.8) 2.914 0.088
Depression 174 (83.7) 105 (87.5) 69 (78.4) 3.068 0.080 1 142 (87.1) 32 (71.1) 6.606 0.010
Severe depressive symptoms 156 (75.0) 96 (80.0) 60 (68.2) 3.782 0.052 1 128 (78.5) 28 (62.2) 5.000 0.025
Alcohol drinking, ≥2/week 70 (33.7) 45 (37.3) 25 (28.4) 1.879 0.170 32 (19.6) 4 (8.9) 2.844 0.092
Substance use disorder 18 (8.7) 15 (12.5) 3 (3.4) 5.308 0.021 17 (10.4) 1 (2.2) 3.005 0.130
Hopelessness 169 (81.3) 93 (77.5) 76 (86.4) 2.618 0.106 1 137 (84.0) 32 (71.1) 3.875 0.049
Agitation 162 (77.9) 88 (73.3) 74 (84.1) 3.411 0.065 1 131 (80.4) 31 (68.9) 2.698 0.100
Impulsivity, moderate 121 (58.2) 84 (70.0) 37 (42.0) 16.305 < <0.001 1 103 (63.2) 18 (40.0) 7.794 0.005
Delusion 45 (21.6) 19 (21.6) 26 (21.7) 0.000 0.990 36 (22.1) 9 (20.0) 0.090 0.764
Hallucination 17 (8.2) 8 (6.7) 9 (10.2) 0.858 0.354 14 (8.6) 3 (6.7) 0.174 1.000
Protective factors                  
Moral objection to suicide, high 11 (5.3) 3 (2.5) 8 (9.1) 4.403 0.056 3 (1.8) 8 (17.8) 17.883 < <0.001
Responsibility to family, high 40 (19.2) 22 (18.3) 18 (20.5) 0.147 0.701 28 (17.2) 12 (26.7) 2.044 0.153
Social support, good 125 (60.1) 64 (53.3) 61 (69.3) 5.409 0.020 94 (57.7) 31 (68.9) 1.851 0.174
Religiosity, high 12 (5.8) 6 (5.0) 6 (6.8) 0.309 0.578 6 (3.7) 6 (13.3) 6.044 0.014
Motivation to treatment, high 91 (43.8) 50 (41.7) 41 (46.6) 0.500 0.479 66 (40.5) 25 (55.6) 3.252 0.071
Coping strategy, active 16 (7.7) 8 (6.7) 8 (9.1) 0.420 0.517 9 (5.5) 7 (15.6) 5.000 0.051

Values are number (%) or median (interquartile range)

Table 2.
Characteristics of patients with suicide ideation or attempting suicide during follow up
  Total Suicide ideation p-value Suicide attempt p-value
n (%) 193 (100) Yes, n(%) 51 (26.4) No, n (%) 142 (73.6) χ2 or U Yes, n(%) 15 (7.8) No, n (%) 178 (92.2) χ2 or U
Previous suicide attempt 112 (58.0) 38 (74.5) 74 (52.1) 7.729 0.005 13 (86.7) 99 (55.6) 5.476 0.019
Active suicide ideation 150 (77.7) 47 (92.2) 103 (72.5) 8.343 0.004 15 (100) 135 (75.8) 4.662 0.026
Sociodemographic risk factors                  
Gender, male 96 (49.7) 31 (60.8) 65 (45.8) 3.382 0.066 10 (66.7) 86 (48.3) 1.864 0.172
Age (yr) 36 (23-54) 30 (21-47) 39 (24-56) −1.808 0.071 31 (21-55) 37 (24-54) −0.684 0.494
Duration of hospitalization (day) 29 (21-39) 26 (20-32) 29 (21-41) −1.981 0.048 26 (17-32) 29 (21-39) −1.610 0.107
Abuse history 29 (15.0) 8 (15.7) 21 (14.8) 0.024 0.878 5 (33.3) 24 (13.5) 4.269 0.054
Family history 18 (9.3) 7 (13.7) 11 (7.7) 1.586 0.260 2 (13.3) 16 (9.0) 0.309 0.636
Marital status                  
Married 66 (34.2) 15 (29.4) 51 (35.9) 2.201 0.352 4 (26.7) 62 (34.8) 0.613 0.893
Unmarried 95 (49.2) 29 (56.9) 66 (46.5) 8 (53.3) 87 (48.9)
Widowed 18 (9.3) 3 (5.9) 15 (10.6) 2 (13.3) 16 (9.0)
Divorced 14 (7.3) 4 (7.8) 10 (7.0) 1 (6.7) 13 (7.3)
Economic problem, yes 74 (38.3) 22 (43.1) 52 (36.6) 0.674 0.412 8 (53.3) 66 (37.1) 1.546 0.214
Clinical risk factors                  
Physical health problem, yes 97 (50.3) 24 (47.1) 73 (51.4) 0.284 0.594 8 (53.3) 89 (50.0) 0.061 0.804
Depression 162 (83.9) 45 (88.2) 117 (82.4) 0.950 0.330 13 (86.7) 149 (83.7) 0.090 1.000
Severe depressive symptoms 146 (75.6) 39 (76.5) 107 (75.4) 0.025 0.873 12 (80.0) 134 (75.3) 0.167 0.683
Alcohol drinking, ≥2/week 31 (16.1) 7 (13.7) 24 (16.9) 0.281 0.596 2 (13.3) 29 (16.3) 0.090 1.000
Substance use disorder 17 (8.8) 4 (7.8) 13 (9.2) 0.080 1.000 2 (13.3) 15 (8.4) 0.415 0.627
Hopelessness 157 (81.3) 44 (86.3) 113 (79.6) 1.109 0.292 12 (80.0) 145 (81.5) 0.019 1.000
Agitation 149 (77.2) 37 (72.5) 112 (78.9) 0.853 0.356 10 (66.7) 139 (78.1) 1.026 0.311
Impulsivity, moderate 111 (57.5) 33 (64.7) 78 (54.9) 1.468 0.226 9 (60.0) 102 (57.3) 0.041 0.839
Delusion 42 (21.8) 10 (19.6) 32 (22.5) 0.189 0.664 2 (13.3) 40 (22.5) 0.679 0.410
Hallucination 16 (8.3) 4 (7.8) 12 (8.5) 0.018 1.000 0 (0.0) 16 (9.0) 1.470 0.618
Protective factors                  
Moral objection to suicide, high 11 (5.7) 9 (6.3) 2 (3.9) 0.408 0.731 10 (5.6) 1 (6.7) 0.028 0.599
Responsibility to family, high 38 (19.7) 5 (9.8) 33 (23.2) 4.284 0.038 3 (20.0) 35 (19.7) 0.001 0.975
Social support, good 119 (61.7) 25 (49.0) 94 (66.2) 4.683 0.030 7 (46.7) 112 (62.9) 1.546 0.214
Religiosity, high 12 (6.2) 3 (5.9) 9 (6.3) 0.013 1.000 42 (82.4) 109 (76.8) 0.689 0.406
Motivation to treatment, high 87 (45.1) 26 (51.0) 61 (43.0) 0.975 0.323 6 (40.0) 81 (45.5) 0.169 0.681
Coping strategy to stress, active 16 (8.3) 5 (9.8) 11 (7.7) 0.209 0.767 1 (6.7) 15 (8.4) 0.056 1.000

Values are number (%) or median (interquartile range)

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