Mental Health Service Delivery and Suicide Risk: The Role of Individual Patient and Facility Factors

Department of Psychiatry, Yale University, New Haven, Connecticut, United States
American Journal of Psychiatry (Impact Factor: 12.3). 03/2005; 162(2):311-8. DOI: 10.1176/appi.ajp.162.2.311
Source: PubMed


This study explores suicide rates as a quality measure and identifies risk factors for suicide among psychiatric inpatients.
Data from a prospective mortality study of psychiatric inpatients from 128 U.S. Department of Veterans Affairs hospitals throughout the United States were utilized to examine the relationship of death by suicide to patient-level sociodemographic, clinical, and mental health service delivery characteristics, as well as to facility-level measures of service delivery. Data were collected on all patients discharged with a diagnosis of schizophrenia, major depression, posttraumatic stress disorder, or bipolar disorder (N=121,933) between 1994 and 1998.
There were 481 suicides in the study sample. Several variables were associated with higher risk for suicide risk, including length of stay less than 14 days, poorer continuity of care, and lack of readmission within 6 months. These variables were significant even after adjustment for state suicide rates, the proportion of members of racial minority groups in the state population, and state-level social capital.
Suicide rates are not likely to be a useful indicator of the quality of mental health care because of the instability of suicide rates, difficulty collecting data, and the lack of association between suicide and facility quality of care. The lack of association with facility-level variables suggests that systemic changes in these performance measures would be unlikely to significantly reduce suicide rates.

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Available from: David J Dausey, Mar 11, 2014
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    • "Several authors have demonstrated that suicide mortality is influenced by contextual factors related to: (1) the socio-economic characteristics, such as poverty (Ferretti and Coluccia, 2009; Murali, 2004), deprivation (Burrows et al., 2011, 2010; Kim et al., 2010; Murali, 2004; Rezaeian et al., 2007; Stark et al., 2007), income and socioeconomic status (Agerbo et al., 2007; Andrés and Halicioglu, 2010; Ceccherini-Nelli and Priebe, 2011; Chang et al., 2011; Derek Cheung et al., 2014; Milner et al., 2012), employment/ unemployment (Agerbo et al., 2007; Andrés and Halicioglu, 2010; Barr et al., 2012; Ceccherini-Nelli and Priebe, 2011); and (2) the characteristics of the built environment, such as density (Chang et al., 2011; Stark et al., 2007; Wang et al., 2013), urban/rural typology (Jagodic et al., 2012; Kim et al., 2010; Middleton et al., 2006; Page et al., 2007; Razvodovsky and Stickley, 2009) access to facilities and services (Cheung et al., 2012; Desai et al., 2005) and mobility (Haynie et al., 2006; Potter et al., 2001). "
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    ABSTRACT: This study compares the existing statistical association between suicide mortality and the characteristics of places of residence (municipalities), before and during the current economic crisis, in Portugal. We found that (1) the traditional culture-based North/South pattern of suicidal behaviour has faded away, while the socioeconomic urban/rural divide has become more pronounced;(2) suicide is associated with higher levels of rurality and material deprivation; and (3) recent shifts in suicidal trends may result from the current period of crisis. Strategies targeting rural areas combined with public policies that address area deprivation may have importan timplications for tackling suicide.
    Full-text · Article · Jul 2015 · Health & Place
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    • "For example, factors such as male gender (Desai et al., 2008), and Caucasian ethnicity are considered as risk for suicide (Zivin et al., 2007). With regard to age, some studies documented increased risk among younger veterans (Zivin et al., 2007), while others point to older veterans (Desai et al., 2005). "
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    ABSTRACT: Objectives: The current study aims to assess the relations between war captivity, PTSD, suicidal ideation (SI) and deliberate self-harm (DSH) among former prisoners of war (ex-POWs). Methods: Israeli ex-POWs (N = 176) and a matched control group of combat veterans (controls; N = 118) were assessed using self-report measures. Results: Ex-POWs with PTSD reported higher levels of both SI and DSH compared to ex-POWs and comparable veterans without PTSD. Furthermore, captivity-related variables as well as PTSD symptom clusters were positively related to both SI and DSH. However, only loss of emotional control in captivity and posttraumatic intrusion and emotional numbing symptoms, predicted SI. Conclusion: Ex-POWs with PTSD endorse high levels of SI and DSH. Among ex-POWs, both SI and DSH share similar captivity-related and posttraumatic symptoms correlates but only posttraumatic intrusion and emotional numbing symptoms predict SI.
    Full-text · Article · Jul 2014 · Archives of suicide research: official journal of the International Academy for Suicide Research
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    • "Five articles used individual-level social capital variables in the analysis (1 article in a community setting23 and 4 in a workplace setting30–32,52), while the other studies did not include individual-level variables of social capital. Regarding outcome variables, mortality was set as the outcome in 6 articles24,45,46,48,50,51; hospitalization,47,49 self-rated health,23,32 and health-related behavior were used as outcomes in 2 articles each31,52; and depression was used as the outcome in 1 article.30 "
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    ABSTRACT: This article presents an overview of the concept of social capital, reviews prospective multilevel analytic studies of the association between social capital and health, and discusses intervention strategies that enhance social capital. We conducted a systematic search of published peer-reviewed literature on the PubMed database and categorized studies according to health outcome. We identified 13 articles that satisfied the inclusion criteria for the review. In general, both individual social capital and area/workplace social capital had positive effects on health outcomes, regardless of study design, setting, follow-up period, or type of health outcome. Prospective studies that used a multilevel approach were mainly conducted in Western countries. Although we identified some cross-sectional multilevel studies that were conducted in Asian countries, including Japan, no prospective studies have been conducted in Asia. Prospective evidence from multilevel analytic studies of the effect of social capital on health is very limited at present. If epidemiologic findings on the association between social capital and health are to be put to practical use, we must gather additional evidence and explore the feasibility of interventions that build social capital as a means of promoting health.
    Full-text · Article · Mar 2012 · Journal of Epidemiology
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