PERIOD TRENDS IN RATE OF SUICIDE IN FIRST 28 DAYS AFTER-DISCHARGE FROM PSYCHIATRIC-HOSPITAL IN SCOTLAND, 1968-92

Objective-To examine period trends in the rate of suicide in the first 28 days after discharge from psychiatric hospital. Design-Cohort stud y of patients discharged from psychiatric hospital. Setting-Scotland. Subjects-Ah patients aged 15-84 who were discharged from Scottish psyc hiatric hospitals during 1968 to 1992. Outcome measure-The rate of sui cide (classified as codes E950-9 and E980-9 according to the Internati onal Classification of Diseases, Ninth Revision) within 28 days of dis charge per 100 000 person years at risk for five year periods during 1 968 to 1992. Crude, within cohort rates and externally standardised ra tes were calculated. Results-Overall, 196 male patients committed suic ide in 20 520 person years at risk, and 171 female patients committed suicide in 24 114 person years at risk. A significant Linear trend was seen in period effect on externally standardised mortality ratios in both sexes: a decrease in male patients (P=0.008) and an increase in f emale patients (P=0.0001). The adjusted standardised mortality ratio i n 1988-92 compared with 1968-72 was 0.62 (95% confidence interval 0.39 to 0.98) in male patients and 2.73 (1.64 to 4.56) in female patients. Conclusion-The increase in the rate of suicide in the 28 days after d ischarge in female psychiatric patients makes this an increasingly imp ortant period to target. The rise has occurred against the background of a reduction of 60% in the number of psychiatric beds for adults.