Publication date: Jun 27, 2025
Rates of suicide following discharge from psychiatric hospitals are extraordinarily high in the first week post-discharge and then decline steeply over time. The aim of this meta-analysis is to evaluate the strength of risk factors for suicide after psychiatric discharge and to investigate the association between the strength of risk factors and duration of study follow-up. A PROSPERO-registered meta-analysis of observational studies was performed in accordance with PRISMA guidelines. Post-discharge suicide risk factors reported five or more times were synthesised using a random-effects model. Mixed-effects meta-regression was used to examine whether the strength of suicide risk factors could be explained by duration of study follow-up. Searches located 83 primary studies. From this, 63 risk estimates were meta-analysed. The strongest risk factors were previous self-harm (odds ratio = 2. 75, 95% confidence interval = [2. 37, 3. 19]), suicidal ideation (odds ratio = 2. 15, 95% confidence interval = [1. 73, 2. 68]), depressive symptoms (odds ratio = 1. 84, 95% confidence interval = [1. 48, 2. 30]), and high-risk categorisation (odds ratio = 7. 65, 95% confidence interval = [5. 48, 10. 67]). Significantly protective factors included age ⩽30, age ⩾65, post-traumatic stress disorder, and dementia. The effect sizes for the strongest post-discharge suicide risk factors did not decline over longer periods of follow-up. The effect sizes of post-discharge suicide risk factors were generally modest, suggesting that clinical risk factors may have limited value in distinguishing between high-risk and low-risk groups. The highly elevated rates of suicide immediately after discharge and their subsequent decline remain unexplained.
| Concepts | Keywords |
|---|---|
| Model | discharge |
| Psychiatry | mental health |
| Suicide | risk assessment |
| Week | Suicide |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | suicide |
| disease | MESH | suicidal ideation |
| disease | MESH | depressive symptoms |
| disease | MESH | post-traumatic stress disorder |
| disease | MESH | dementia |