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Suicide prediction during psychiatric in-patient treatment remains an
To identify determinants of railway suicides in individuals receiving
in-patient psychiatric treatment.
The study population was drawn from patients admitted to six psychiatric
hospitals in Germany during a 10-year period (1997–2006). Data from 101
railway suicide cases were compared with a control group of 101
discharged patients matched for age, gender and diagnosis.
Predictors of suicide were change of therapist (OR = 22.86,
P = 0.004), suicidal ideation (OR = 7.92,
P<0.001), negative or unchanged therapeutic course
(OR = 7.73, P<0.001), need of polypharmaceutical
treatment (OR = 2.81, P = 0.04) and unemployment (OR =
2.72, P = 0.04). Neither restlessness nor impulsivity
predicted in-patient suicide.
Suicidal ideation, unfavourable clinical course and the use of multiple
psychotropic substances (reflecting the severity of illness) were strong
determinants of railway suicides. The most salient finding was the vital
impact of a change of therapist. These findings deserve integration into
the clinical management of patients with serious mental disease.
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