Last update:
07-Oct-2018

Physical illnesses increase the risk of suicide. Almost 2% of completed suicides take place in general hospitals, and 3–5.5% in psychiatric hospitals. The medical staff –other than mental health professionals– is generally unfamiliar with identifying and managing suicidal patients. Suicide victims in non-psychiatric units of general hospitals are usually men, aged over 50 years, and about 50% are married. They are often people with economic difficulties, a weak support system and/or family conflicts, but without a history of psychiatric disorder or prior suicide attempts. The diseases they are suffering from are most commonly malignant neoplasms (approximately 30%), cardiovascular and neurological diseases or chronic obstructive pulmonary disease (COPD). The commonest psychiatric diagnoses are depression and delirium. Uncontrolled pain, dyspnea, visual hallucinations, excessive anxiety and psychomotor agitation may act as precipitating factors. The periods which are considered particularly risk are the time of announcement of the diagnosis (or of the grave prognosis), and the one of the occurrence of the frequent or severe relapses. The individuals who succeed in taking their lives were usually "silent", withdrawn, apparently indifferent to treatment or prognosis, unwilling to be visited by relatives, and they may have asked for an early discharge; very rarely have they expressed suicidal intentions. They usually die by jumping from a height. Suicide usually takes place within the first 1–2 weeks of hospitalization, mostly at night (probably due to reduced supervision). By comparison, suicide victims in psychiatric units are younger, 2/3 are single, and they more commonly have a positive personal/family psychiatric history and a history of prior attempts. They have usually communicated their intention, they act later during their hospitalization, and their predominant method is by hanging. In conclusion, suicide victims in non-psychiatric wards apparently constitute a distinct population from those who commit suicide in psychiatric units. The primary physician should be vigilant for such cases, and make an attempt to identify them early by asking direct questions about the patients' willingness to live (and fight) when confronted by the disease prognosis, and should swiftly ask for a psychiatric consultation when deemed necessary.

Key words: General hospital, Inpatient suicide, Psychiatric clinic, Psychiatric hospital, Suicide.