Rates and trends of psychiatric inpatient and postdischarge suicides in Taiwan, 2002–2013: a national register-based study
In contrast to the downsizing trend of psychiatric beds in the Western world, the psychiatric bed capacity in Taiwan has steadily increased in recent decades. This study aimed to assess the suicide rates and their variations over time among psychiatric inpatients and recently discharged patients.
Data on psychiatric inpatients admitted from 2002 to 2013 were extracted from the psychiatric inpatient registry of the National Health Insurance and merged with information from the Cause of Death data by means of unique identified numbers. Suicides occurring during admission and within 90 days after discharge were defined as inpatient and postdischarge suicides, respectively. Calendar year was fitted as a continuous variable in multivariate Poisson regression models to evaluate these rates over time. The analyses were adjusted for sex, age, primary psychiatric diagnosis, and number of admissions in the preceding year.
The overall inpatient suicide rate was very low (81 per 100,000 person-years). It decreased significantly from 146 to 74 per 100,000 person-years over the study period. This fall was observed among both genders and across all psychiatric diagnoses. The postdischarge suicide rate was comparatively high (1108 per 100,000 person-years) and did not show statistically significant change over the study period.
Our results suggest that efforts to increase public awareness of mental disorders and efficient utilization of psychiatric inpatient care are essential for suicide prevention despite the comparatively high bed capacity. The discharge plans of inpatients should be bridged with population suicide prevention programs for continuity of care after discharge.
KeywordsClaim data Incidence Inpatient suicide Postdischarge suicide Psychiatric hospitalization Time trend
The authors acknowledge statistical assistance provided by the Department of Medical Research in National Taiwan University Hospital.
Data preparation of this study was supported by grants from the Ministry of Science and Technology of Taiwan (MOST 103-2314-B-418-010 and MOST 104-2314-B-418-016), and manuscript preparation was supported by grants from the Far Eastern Memorial Hospital (FEMH-103-2314-B-418-010 and FEMH-106-2410-H-418-001).
Compliance with ethical standards
Conflict of interest
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