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Contents
- Abstract
- Introduction
- Prevalence of Suicidal Thoughts and Behaviors
- The Role and Course of Inpatient Psychiatric Treatment
- State and Federal Guidelines
- Periods of High Risk for Suicide
- Suicide Death During Inpatient Hospitalization
- Suicide Following Inpatient Hospitalization Discharge
- Predictors of Suicide Risk During Admission and Postdischarge
- Psychological and Functional Consequences of Inpatient Hospitalization
- As-Yet-Unexamined Consequences of Inpatient Hospitalization
- Treatment Provided During Inpatient Hospitalization
- Why Hospitalization Remains the Standard of Care
- Difficulties Linking Postdischarge Outcomes to Inpatient Hospitalization
- Critical Future Research Directions
- Summary and Conclusions
Abstract
Suicide rates have risen in the United States, and there has been a simultaneous, nearly ubiquitous decrease in services provided on psychiatric inpatient units (e.g., shorter stays, almost exclusive emphasis on crisis management). Despite limited research demonstrating its efficacy for reducing suicide risk, inpatient hospitalization remains the treatment of choice (and often legally mandated) for highly suicidal individuals. In this review, we discuss the sometimes-confusing guidelines providers follow concerning psychiatric hospitalization for suicidal individuals. We then highlight the considerable evidence of heightened suicide risk and other negative outcomes during and immediately following hospitalization. Finally, we propose critical research directions to rigorously evaluate whether psychiatric hospitalization is iatrogenic, at least for some individuals. Such research has far-reaching implications for practice and policy.
Inpatient psychiatric hospitalization is a common, expected, and often legally required treatment for suicidal individuals; however, there is limited research on whether hospitalization actually reduces suicidal behavior. In this review, we summarize national and international evidence suggesting an increased risk for suicide and other negative outcomes during and following psychiatric hospitalization. We recommend crucial research that is necessary to determine whether such hospitalization is harmful, at least for some individuals.
Introduction
Suicidal thoughts and behaviors continue to present a national and international public health problem. Despite decades of research, there is a considerable gap between the prevalence of suicide and our understanding of the causes and most effective approaches to treatment and prevention. Within this context, providers must navigate working with suicidal patients without the assistance of a robust range of evidence-based options for intervention and management of suicide risk. Alongside unclear, and at times, inconsistent state and federal guidelines, routine clinical practice often involves inpatient psychiatric hospitalization to provide acute crisis intervention and monitoring. Despite the widespread...