THE IMPACT OF HOSPITALIZATION ON CLINICAL ASSESSMENTS OF SUICIDE RISK

Objective: Clinicians' assessments of patients' suicide risk at admiss ion to and discharge from a psychiatric hospital were examined to lear n how clinical estimates of risk changed over the course of hospitaliz ation and to identify which demographic and clinical characteristics w ere associated with higher estimates of risk at admission and discharg e. Methods: Seventy-one treating physicians evaluated risk of self-har m of 241 patients at admission to and discharge from a short-term inpa tient unit. Risk within the next week (short-term risk) and within the next year (long-term risk) was estimated. At discharge and admission, the physicians also rated patients' symptoms using the Brief Psychiat ric Rating Scale. Nurses rated self-directed aggression during hospita lization with the Overt Aggression Scale. Results: Ratings of short-te rm risk were lower at discharge than at admission, whereas ratings of long-term risk showed relatively little change. At both discharge and admission, the estimated risk of self-harm was associated with a histo ry of suicidal behavior and with acute symptoms, such as depression, a nxiety, and emotional withdrawal. At discharge, the estimated risk was also associated with substance abuse, severity of psychosocial stress ors, and living alone. Conclusions: Clinicians appeared to view their hospital-based interventions as influencing variables relevant to shor t-term risk of suicide but as having little impact on long-term risk. Implications are discussed for management of suicide risk and for medi colegal assertions regarding prevailing community practices that are m ade in litigation alleging negligent release of patients from hospital s.