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September 5, 2024 - Press notes

The risk of suicide skyrockets in people who have been hospitalized for a mental health issue

For women who have been admitted to a hospital for a mental disorder, the risk of suicide is 48 times higher than in the general female population. For men in the same situation, the risk is 28 times higher, according to a study by the Hospital del Mar Research Institute published in JAMA Network Open.

The risk of premature death, meaning dying before the age of 70, is also higher in people hospitalized for a mental disorder. This group has nearly eight times the mortality risk compared to the rest of the population.

The study analyzed data from nearly 50,000 people. The disorders with the most impact are depression, cognitive disorders, adjustment and bipolar disorders, and alcohol use.

Women who have been admitted to a hospital for a mental disorder have a risk of suicide that is 48 times higher than that of women in the general population. For men, the risk is 28 times higher, as revealed by a study from the Health Services Research Group of the Hospital del Mar Research Institute, published in JAMA Network Open. Regarding premature death, which occurs for various reasons before the age of 70, the risk is 7.5 times higher in men and 7.7 times in women. These findings lead researchers to highlight the need to improve the healthcare processes for people hospitalized for mental health issues once they are discharged.

Jordi Alonso and Philippe Mortier

The study was based on data from nearly 50,000 people hospitalized for a mental health disorder between 2014 and 2018, obtained through the Data Analytics Program for Research and Innovation in Health (PADRIS) of the Catalan Agency for Health Quality and Evaluation (AQuAS) and data from the National Institute of Statistics (INE). Fifty-three percent of the patients were men, and the average age at hospital discharge was 44 years. Of the total, 2,260 people, or 4.6%, died prematurely during the follow-up period, which continued until the end of 2019. Four hundred thirty-seven people,
or 1%, died by suicide, and 4,752, nearly 10%, experienced a non-lethal self-harm episode. One in four people had already been hospitalized for psychiatric reasons in the six years preceding the study period.

These data lead Dr. Jordi Alonso, coordinator of the Health Services Group at the Hospital del Mar Research Institute, to state that "although the absolute number of suicides is small, only 1% of the total, the magnitude we have observed suggests that suicide is one of the ways in which elevated mortality is expressed in people with mental disorders."

Differences between men and women

The most prevalent disorders in the analyzed population are schizophrenia and other psychotic disorders, substance and alcohol use disorders, depression, and personality disorders. However, the study reveals differences between men and women regarding the risk of suicide after hospital discharge. Researchers point out that the proportionally higher suicide risk among women, compared to the general female population, may be due to two simultaneous factors: greater healthcare-seeking behavior among women and underdiagnosis of depression in men. In women, the risk was higher in cases of hospitalization for bipolar disorder and depression, while in men, it was higher for adjustment disorders those caused by external stressors-and depression. In both groups, there was a link to non-lethal self-harm after hospital discharge. The fact that more suicides occur among women contrasts with the situation in the general population, where men are more affected. Regarding this, Dr. Alonso adds that "it must be taken into account that in women, the suicide risk is higher in those who have been hospitalized for a psychiatric disorder when defining personalized prevention and care strategies."

Dr. Víctor Pérez, co-author of the study and head of the Psychiatry Department at Hospital del Mar, emphasizes the importance of the study. "Mental illness is one of the main risk factors for suicidal behavior, as 90% of people who die by suicide had a diagnosis of mental illness. This risk increases when the illness is severe and requires hospitalization," he adds.

Regarding premature death, the most common disorders among both men and women were cognitive disorders (6.3%), such as dementia or delirium, and alcohol use disorder, which affected over 24% of the studied population. This finding leads Philippe Mortier, the study's lead author and researcher at Hospital del Mar, to stress that "preventive interventions are needed to avoid deaths resulting from alcohol use in this population." He advocates for the development of tools using machine learning and artificial intelligence to create personalized predictive models.

For this reason, Mortier argues that "mental health services need to be integrated with general healthcare services. A multidisciplinary approach is necessary for this population, one that goes beyond mental health care." He adds that the study suggests that "individuals discharged from psychiatric hospitalization are a vulnerable population prone to premature death and suicidal behavior."

This work is the first of its kind conducted in Catalonia and has been featured in an editorial comment in the same journal (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820376). Researchers from the CIBER in Epidemiology and Public Health (CIBERESP) and the CIBER in Mental Health (CIBERSAM) also participated.

Reference Article

Mortier P, Conde S, Alayo I, et al. Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge. JAMA Netw Open. 2024;7(6). doi:10.1001/jamanetworkopen.2024.17131