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Psychiatr Serv 50:1491-1493, November 1999

© 1999 American Psychiatric Association 

Brief Report

Assessment of Suicide Risk 24 Hours After Psychiatric Hospital Admission

Mark J. Russ, M.., !odd "ashdan, B.A., Simcha Pollack, Ph.. and Senada

Ba#mako$ic%"acila, M..

ABS!RA&!

Of 9 !atients a"mitte" to a hos!ita# beca$se of s$ici"e ris%,   30 &44 !ercent' (ere

com!#ete#y free of s$ici"a# i"eation )4   ho$rs after a"mission* Scores on the Sca#e for

S$ici"e +"eation  at the time of a"mission "istin$ishe" !atients (ho contin$e"   to have

s$ici"a# i"eation )4 ho$rs #ater &the s$staine"-i"eation ro$!' from those (ho "i" not &the

transient-i"eation ro$!'* Patients in the transient ro$! (ere more #i%e#y than those  in the

s$staine" ro$! to have ma"e a s$ici"e attem!t "$rin 

the (ee% before a"mission* Ata"mission !atients in the s$staine" ro$! (ere more #i%e#y to have !sychotic sym!toms

an" to re!ort a fami#y history of !sychiatric i##ness*  

'(!R)*&!')(S

#inica# .$"ment informe" by an assessment of ris% factors   is the mainstay of "ecision

ma%in (hen c#inicians are face"  (ith the !ros!ect of hos!ita#i/in a !otentia##y s$ici"a#

 !atient*  is% factors associate" (ith s$ici"a# behavior ten" to have   a hih "eree of

sensitivitythat is, they are ab#e to   i"entify in"ivi"$a#s (ho #ater commit s$ici"e &1'*

2o(ever, they have #o( s!ecificity, or #itt#e abi#ity to ec#$"e in"ivi"$a#s  (ho "o not #ater

commit s$ici"e &1'* h$s their !re"ictive !o(er   is serio$s#y com!romise"* iven the

$ncertainty of !re"ictin

 

s$ici"a# behavior, c#inicians ten" to favor hos!ita#i/in the !atient, "es!ite the #ac% of em!irica# "ata s$estin that ac$te hos!ita#i/ation is effective

in re"$cin s$ici"e ris%  &)'* 

+t has been o$r c#inica# im!ression that a s$bstantia# !ortion   of !atients a"mitte" to o$r

hos!ita# beca$se they are "eeme"  to be at sinificant ris% for s$ici"e are no #oner .$"e"

to  be ac$te#y s$ici"a# the net "ay* he !$r!ose of this st$"y   (as to systematica##y

investiate this c#inica# im!ression* +f it (as confirme", (e so$ht to "etermine (hether

se#ecte"  "emora!hic an" c#inica# variab#es co$#" "istin$ish the transient#y   s$ici"a#

ro$! &ca##e" the transient ro$!' from the remainin   !atients (ho contin$e" to be ac$te#y

s$ici"a# )4 ho$rs after  a"mission &ca##e" the s$staine" ro$!'*  

M+!H)S

S$b.ects consiste" of ) men an" 43 (omen !atients a"mitte"   to the 2i##si"e 2os!ita#-

6on +s#an" 7e(ish 8e"ica# enter (ith s$ici"e ris% s$fficient to (arrant hos!ita#i/ation,

as .$"e"  by the a"mittin !hysician* A## b$t fo$r !atients (ere a"mitte"  on a vo#$ntary

 basis* Patients (ere ec#$"e" if they #ac%e"  ca!acity to ive (ritten informe" consent for

 !artici!ation*  No !atients (ere ec#$"e" base" on "ianosis* 

A## 9 !atients (ere assesse" a!!roimate#y )4 ho$rs after a"mission   to the in!atient

service* Nineteen of these !atients (ere a#so  intervie(e" at the time of a"mission beca$se

research staff  (ere avai#ab#e* he intervie( !rotoco# (as the same for the  s$bsam!#e of

19 !atients assesse" at the time of a"mission   the st$"y instr$ments (ere a"ministere"

t(ice to these !atients* 

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ata athere" "$rin the intervie( inc#$"e" "emora!hic information  an" history re#ate"

to !sychiatric i##ness an" treatment* Severa#  instr$ments (ere a"ministere", inc#$"in the

Sca#e for S$ici"e +"eation &SS+' &3', the ;ec% e!ression +nventory &;+' &4',  the ;ec%

2o!e#essness Sca#e &;2S' &5', the ;rief Psychiatric  atin Sca#e &;PS' &', an" the

6ife <vents +nventory &='* A""itiona# "ata co##ecte" consiste" of  DSM-IV  ais + an" ais ++

"ianoses obtaine" from the a"mission me"ica# recor" ser$m 

cho#estero#, beca$se of theobserve" association bet(een #o( ser$m cho#estero# an" s$ici"a# behavior &>' an" #enth

of stay on the in!atient service* 

Patients (ere c#assifie" as bein transient#y s$ici"a# if at  the )4-ho$r fo##o(-$! a score of

/ero (as obtaine" for the first  five items on the SS+, in"icatin a tota# absence of s$ici"a#

i"eation* Patients (ho re!orte" any s$ici"a# i"eation at the  )4-ho$r fo##o(-$! as meas$re"

 by the SS+ (ere c#assifie" as  bein in the s$staine" ro$!* 

om!arisons bet(een the transient ro$! an" the s$staine" ro$!  (ere con"$cte" $sin

chi s?$are ana#yses for noncontin$o$s variab#es   an" in"e!en"ent t tests an" re!eate"-

meas$res ana#ysis of variance

 

&ANO@A' for contin$o$s variab#es*

 

R+S*!S

Of the 9 !atients a"mitte" beca$se of s$ici"e ris%, 30 &44   !ercent' (ere fo$n" to be

com!#ete#y free of s$ici"a# i"eation   )4 ho$rs after a"mission* he meanS ae of the

 !atients in this ro$! (as 3>1> years* he other 39 !atients  (ere c#assifie" as bein in

the s$staine" ro$! at )4 ho$rs* heir meanS ae (as 3>1) years* 

 No sinificant "ifferences bet(een the transient an" s$staine"   ro$!s (ere fo$n" in

en"er, race, re#iion, marita# stat$s,   chi#"ren $n"er 1> years o#" at home, #ivin a#one,

em!#oyment  stat$s, manae" care stat$s, #eve# of e"$cation, ae, an" n$mber   of #ife

stressors an" their !erceive" severity* he transient

 

an" s$staine" ro$!s "i" not "iffer inthe !ro!ortion of !atients  (ith ais + affective "isor"ers &>3 !ercent an" >= !ercent,

res!ective#y', ais ++ "isor"ers &30 !ercent an" 3 !ercent',   s$bstance ab$se history &10

 !ercent an" )> !ercent', an" fami#y history of s$ici"e &3= !ercent an" 3 !ercent'*  

+n a""ition, no "ifferences (ere fo$n" bet(een the transient  an" s$staine" ro$!s in the

meanS n$mber of #ifetime  s$ici"e attem!ts &1*= 1*9 an" 3*15*1 attem!ts,

res!ective#y', n$mber of !revio$s !sychiatric hos!ita#i/ations  &35*> an" 5*1=*4', ser$m

cho#estero# &19540  an" )01 51 mB"6', an" #enth of stay &1 14*)   an" 15*511*5

"ays'* 

Patients in the transient ro$! (ere sinificant#y more #i%e#y  than those in the s$staine"

ro$! to have ma"e a s$ici"e attem!t  in the (ee% before a"mission &50 !ercent vers$s )3

 !ercent  )C5*4), "fC1, !C*0)'* Patients in the s$staine" ro$! (ere sinificant#y  more

#i%e#y to have a fami#y history of !sychiatric i##ness  than !atients in the s$staine" ro$!

&4= !ercent vers$s > !ercent   )C*), "fC), !C*04' an" to have !sychotic sym!toms

on a"mission &43 !ercent vers$s !ercent )C3*=, "fC1, !C*05'* 

Psycho#oica# meas$res (ere ana#y/e" se!arate#y for !atients   eva#$ate" )4 ho$rs after

a"mission on#y an" for those eva#$ate"  both at a"mission an" )4 ho$rs #ater* Not

s$r!risin#y, as sho(n in ab#e 1, !atients in the transient ro$! ha" #o(er scores  on a##sca#es, in"icatin sinificant#y #ess severe sym!toms   an" #ess im!airment at a"mission

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an" at )4-ho$r fo##o(-$! than  !atients in the s$staine" ro$!* As ab#e 1  sho(s, a

sinificant  ro$!-by-time interaction (as evi"ent in scores on the SS+,   ;+, ;2S, an"

;PS for the 19 !atients assesse" on t(o occasions  a## scores im!rove" )4 ho$rs after

a"mission for the !atients in the transient ro$!* 

-ie thista/le0

Din this

(in"o(E

Din a ne(

(in"o(E

 

ab#e 1* Scores on the Sca#e for S$ici"e +"eation &SS+', ;ec%e!ression +nventory &;+', ;ec% 2o!e#essness Sca#e &;2S', an" ;rief

Psychiatric atin Sca#e &;PS' of !atients intervie(e" at hos!ita#

a"mission an" )4 ho$rs #ater, by (hether they (ere free of s$ici"a#

i"eation )4 ho$rs &transient ro$!' or not free &s$staine" ro$!' 1 

8oreover, !atientsF scores at a"mission on the tota# SS+ an"  on its first five items

 !re"icte" (hether they (o$#" be c#assifie"  at )4 ho$rs as bein transient#y s$ici"a# or in

the s$staine" 

ro$!* At a"mission, the SS+ scores of !atients in the transient 

ro$! (eresinificant#y #o(er than those of !atients in the  s$staine" ro$!, both the tota# SS+ score

&tC)*), "fC1)*4,  !C *0))' an" the score on the first five SS+ items &tC)*14,  "fC1=,

 !C*04='* 

'S&*SS')(S A( &)(&*S')(S

Gsin the criterion for Hs$ici"e non-i"eatorsH !ro!ose" by ;ec%  an" associates &3', (e

confirme" o$r c#inica# im!ression that  many !atients a"mitte" beca$se of s$ici"e ris% no

#oner !resente" an imminent s$ici"e ris% )4 ho$rs after a"mission* 8any !ossib#e  

e!#anations can be offere" for this observation, ranin from  the !ossibi#ity that !atients

initia##y !resente" an eaerate" s$ici"e ris% an" (ere ina!!ro!riate#y a"mitte" to the

vie( that 

 !atients en$ine#y benefite" from the safety, res!ite, an" s$!!ort 

ofhos!ita#i/ation* 

hese !re#iminary fin"ins s$est "irections for f$t$re investiation*   SS+ scores at the

time of a"mission (ere associate" (ith membershi!  in the transient an" s$staine" ro$!s

)4 ho$rs after a"mission#o(er  scores (ere associate" (ith transient s$ici"a# i"eation,

(hi#e hiher scores (ere associate" (ith s$staine" i"eation* Ie $ne!ecte"#y  fo$n" that

 !atients (ho recent#y ma"e a s$ici"e attem!t (ere  #ess #i%e#y to have s$ici"a# i"eation )4

ho$rs after a"mission* A s$ici"e attem!t may "ischare "ys!horic affect an" ame#iorate

s$ici"a# i"eation* A simi#ar i"ea has been !ro!ose" (ith res!ect  to se#f-in.$rio$s behavior

of !atients (ith bor"er#ine !ersona#ity  "isor"er &9'* 

Ie are not s$estin any chanes in the c$rrent c#inica# !ractice  of caref$#

in"ivi"$a#i/e" assessment of s$ici"e ris% an" nee"   for hos!ita#i/ation* his e!#oratory

st$"y is #imite" by its sma## sam!#e si/e, #are n$mber of variab#es, absence of str$ct$re"

"ianostic assessment, an" hih !ercentae of vo#$ntary !atients*   +n a""ition, the st$"y

"i" not eamine the "ecision-ma%in characteristics  of !hysicians* hese #imitations

affect the va#i"ity an" enera#i/abi#ity of o$r fin"ins* 

 Nonethe#ess, these !re#iminary res$#ts are enco$rain in that  they !oint to the $ti#ity of a

 !ost hoc a!!roach to refinin  too#s for assessin s$ici"e ris% (itho$t ris%in #ives* Jor

eam!#e, f$rther testin of the SS+ as an in"icator of s$ici"e   ris% may #ea" to the

i"entification at the time of hos!ita#  a"mission of !atients (ho are #i%e#y to ehibit

sinificant  im!rovement in the short r$n* hese !atients may benefit from  ra!i"

reassessment an" referra# to treatment in the comm$nity*  

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1))!()!+S

r. Russ  is "irector of ac$te care !sychiatry an" r. Ba#mako$ic%"acila  is staff

 !sychiatrist at 2i##si"e 2os!ita#-North Shore 6on  +s#an" 7e(ish 2ea#th System, #en

Oa%s, Ne( Kor% 11004 &e-mai#,   r$ssL#i.*e"$', (here Mr. "ashdan  (as a research

assistant (hen 

this (or% (as "one* Mr. "ashdan  is no( a ra"$ate st$"ent in 

the"e!artment of !sycho#oy at the State Gniversity of Ne(  Kor% at ;$ffa#o* r. Pollack  is

 !rofessor of statistics in the  com!$ter information systems an" "ecision sciences

"e!artment at St* 7ohnFs Gniversity in 7amaica, Ne( Kor%*  

R+1+R+(&+S

1* 8ann 77: Psychobio#oic !re"ictors of s$ici"e* 7o$rna# of #inica# Psychiatry 4>&s$!!# 1)':39-43, 19>=

)* 6inehan 88: onitive-;ehaviora# reatment of ;or"er#ine Persona#ity isor"er* Ne( Kor%,$i#for", 1993

3* ;ec% A, Movacs 8, Ieissman A: Assessment of s$ici"a# intention: the Sca#e for S$ici"e

+"eation* 7o$rna# of ons$#tation an" #inica# Psycho#oy 4=:343-35), 19=9D8e"#ineE 

4* ;ec% A, Steer A: 8an$a# for evise" ;ec% e!ression +nventory* San Antonio, e,

Psycho#oica# or!, 19>=

5* ;ec% A, Steer A: 8an$a# for ;ec% 2o!e#essness Sca#e* San Antonio, e, Psycho#oica#

or!, 19>>

* Overa## 7<, orham : he ;rief Psychiatric atin Sca#e* Psycho#oica# e!orts 10:=99-

>1), 19)

=* ochrane , obertson A: he 6ife <vents +nventory: a meas$re of the re#ative severity of

 !sychosocia# stressors* 7o$rna# of Psychosomatic esearch 1=:135-139, 19=3D8e"#ineE 

>* o#ier 7A, 8ar/$% P8, 6eon A, et a#: 6o( ser$m cho#estero# #eve# an" attem!te" s$ici"e*

American 7o$rna# of Psychiatry 15):419-4)3, 1995DAbstractE 

9* Mem!erman +, $ss 87, Shearin <: Se#f-in.$rio$s behavior an" moo" re$#ation in bor"er#ine

 !atients* 7o$rna# of Persona#ity isor"ers 11:14-15=, 199=D8e"#ineE