Suicide in a large population of former psychiatric inpatients

Authors

  • Gabriele Sani MD,

    1. Centro Lucio Bini, Rome and Cagliari
    2. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
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  • Leonardo Tondo MD,

    1. Centro Lucio Bini, Rome and Cagliari
    2. Department of Psychiatry and Neuroscience Program, Harvard Medical School and McLean Division of Massachusetts General Hospital, Boston, USA
    3. Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic University of Barcelona, Catalunya, Spain
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  • Athanasios Koukopoulos MD,

    1. Centro Lucio Bini, Rome and Cagliari
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  • Daniela Reginaldi MD,

    1. Centro Lucio Bini, Rome and Cagliari
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  • Giorgio D. Kotzalidis MD,

    Corresponding author
    1. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
      Giorgio D. Kotzalidis, MD, Department of Psychiatry, Sapienza University, Rome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health, and Sensory Functions), Sant'Andrea Hospital, Unit of Psychiatry, Via di Grottarossa 1035-1039, 00189 Rome, Italy. Email: giorgio.kotzalidis@uniroma1.it
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  • Alexia E. Koukopoulos MD,

    1. Centro Lucio Bini, Rome and Cagliari
    2. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
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  • Giovanni Manfredi MD, PhD,

    1. Centro Lucio Bini, Rome and Cagliari
    2. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
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  • Lorenzo Mazzarini MD,

    1. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
    2. Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic University of Barcelona, Catalunya, Spain
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  • Isabella Pacchiarotti MD,

    1. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
    2. Bipolar Disorders Program, Clinical Institute of Neurosciences, Hospital Clínic University of Barcelona, Catalunya, Spain
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  • Alessio Simonetti MD,

    1. Centro Lucio Bini, Rome and Cagliari
    2. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
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  • Elisa Ambrosi MD,

    1. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
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  • Gloria Angeletti MD,

    1. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
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  • Paolo Girardi MD,

    1. Centro Lucio Bini, Rome and Cagliari
    2. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
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  • Roberto Tatarelli MD

    1. Neurosciences, Mental Health and Sensory Functions Department, Psychiatry Unit, Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy
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Giorgio D. Kotzalidis, MD, Department of Psychiatry, Sapienza University, Rome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health, and Sensory Functions), Sant'Andrea Hospital, Unit of Psychiatry, Via di Grottarossa 1035-1039, 00189 Rome, Italy. Email: giorgio.kotzalidis@uniroma1.it

Abstract

Aims:  The aim of this study was to identify predictors of completed suicide in a wide sample of psychiatric inpatients receiving retrospective and prospective DSM-IV diagnoses.

Methods:  We followed up 4441 severe psychiatric patients who were hospitalized for some time during a 35-year period in a private hospital setting. We collected sociodemographic, clinical and temperamental data.

Results:  Ninety-six patients from the sample committed suicide. There were no sex differences in suicide completion and no differences between major psychiatric disorders, but people who had been hospitalized for anxiety disorders did not commit suicide and people with bipolar disorders were more likely to commit suicide than people with unipolar major depression. Shorter-term treatment with lithium and anticonvulsants, longer-term treatment with antidepressants, history of suicide attempts, suicidal thinking, and single status positively predicted completed suicide. Suicide tended to occur after a mean period of about 14 years of duration of disease. Patients' symptoms during the period preceding suicide were assessed through interviewing patients' physicians or family members. Symptoms occurring in >10% of cases were, in decreasing order, inner tension, racing/crowded thoughts, aggressive behavior, guilt, psychomotor agitation, persecutory ideation, anxiety, and hallucinations. Surprisingly, cyclothymic temperament was less associated with completed suicide as compared to other temperaments.

Conclusions:  Suicide is likely to occur in a milieu of agitation, mixed anxiety and depression, and psychosis. Longer-term mood stabilizer treatment may reduce the rate of completed suicide.

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