Research Article| Volume 34, ISSUE 2, P8-13, April 2020

Suicide in Belgian psychiatric inpatients. A matched case-control study in a Belgian teaching hospital

Published:December 12, 2019DOI:


      • 68% of the inpatient suicides was diagnosed with a mood disorder.
      • First weeks of admission are a significant risk factor for suicide.
      • There is a direct association between hopelessness and inpatient suicide.


      Background and objectives

      Patients admitted to a psychiatric hospital show an increased risk for suicide but specific risk factors are not well understood.


      In this case-control study we describe suicides (n = 37) that took place during admission in a Flemish psychiatric teaching hospital between 2007 and 2015 and investigate predictive factors for suicide.


      Inpatient suicide is a rare condition (37 patients among 20,442 admission periods between 2007 and 2015). Most inpatients who completed suicide were diagnosed with a mood disorder (68%); 38% committed suicide in the first month of hospitalization and 19% in the first week following admission. The majority of suicides took place just before or during the weekend (57%), with hanging as the prominent method (41%). Multivariate analysis showed that hopelessness was the only significant risk factor for inpatient suicide.


      Inpatient suicide remains a very rare event in inpatient care. Enquiring and managing hopelessness is essential in inpatient treatment of psychiatric patients.


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      1. Agentschap zorg & gezondheid, 2017a. Evolutie van sterfte door zelfdoding 2014. (accessed 23 April 2017).

      2. Agentschap zorg & gezondheid, 2017b. Zelfdoding: Vlaanderen in Europa (2011−2013). (accessed 23 April 2017).

        • Beck A.T.
        • Weissman A.
        • Lester D.
        • Trexler L.
        The measurement of pessimism: The hopelessness scale.
        Journal of Consulting and Clinical Psychology. 1974; 42: 861-865
        • Bose S.
        • Khanra S.
        • Umesh S.
        • Khess C.R.
        • Ram D.
        Inpatient suicide in a psychiatric hospital: Fourteen years' observation.
        Asian Journal of Psychiatry. 2016; 19: 56-58
        • Bowers L.
        • Banda T.
        • Nijman H.
        Suicide inside: A systematic review of inpatient suicides.
        Journal of Nervous and Mental Disease. 2010; 198: 315-328
        • Bruffaerts R.
        Uitdagingen voor suïcidepreventie in de eenentwintigste eeuw.
        in: D'Hoine P. Pattyn B. verscheidenheid verenigd: lessen voor de eenentwintigste eeuw. Universitaire Pers Leuven, Leuven2016: 82-87
        • Centers for Disease Control and Prevention (CDC)
        Strategic direction for the prevention of suicidal behavior: Promoting individual, family, and community connectedness to prevent suicidal behavior.
        • Chesley K.
        • Loring-McNulty N.E.
        Process of suicide: Perspective of the suicide attempter.
        Journal of the American Psychiattric Nurse Association. 2003; 9: 41-45
        • Dahale A.
        • Sherine L.
        • Chaturvedi S.K.
        In-patient suicide in psychiatry - an Indian experience.
        Epidemiology and Psychiatric Sciences. 2017; 26: 565-569
        • De Leo D.
        • Burgis S.
        • Bertolote J.
        • Kerkhof A.
        • Bille-Brahe U.
        Definitions of suicidal behaviour.
        in: De Leo D. Bille-Brahe U. Kerkhof A. Schmidtke A. Suicidal behaviour: Theories and research findings. Hogrefe & Huber, 2004: 17-39
        • Dong J.
        • Ho T.
        • Kan C.
        A case-control study of 92 cases of in-patient suicides.
        Journal of Affective Disorders. 2005; 87: 91-99
        • Hagen J.
        • Knizek B.L.
        • Hjelmeland H.
        Mental health nurses' experiences of caring for suicidal patients in psychiatric wards: An emotional endeavor.
        Archives of Psychiatric Nursing. 2017; 31: 31-37
        • Høyer E.
        • Licht R.
        • Mortensen P.
        Risk factors of suicide in inpatients and recently discharged patients with affective disorders: a case-control study.
        European Psychiatry. 2009; 24: 317-321
        • Hunt I.
        • Bickley H.
        • Windfuhr K.
        • et al.
        Suicide in recently admitted psychiatric in-patients: a case-control study.
        Journal of Affective Disorders. 2013; 144: 123-128
        • Hunt I.
        • Kapur N.
        • Webb R.
        • et al.
        Suicide in current psychiatric in-patients: a case-control study.
        Psychological Medicine. 2007; 37: 831-837
        • Joiner T.
        The trajectory of suicidal behavior over time.
        Suicide and Life Threatening Behaviors. 2002; 32: 33-41
        • Joiner T.
        • Brown J.
        • Wingate L.
        The psychology and neurobiology of suicidal behavior.
        Annual Review of Psychology. 2005; 56: 287-314
        • Kessler R.
        • Hwang I.
        • Hoffmire C.
        • et al.
        Developing a practical suicide risk prediction model for targeting high-risk patients in the Veterans health administration.
        International Journal of Methods in Psychiatric Research. 2017; 26: 1-7
        • Khanra S.
        • Mahintamani T.
        • Bose S.
        • Khess C.R.
        • Umesh S.
        • Ram D.
        Inpatient suicide in a psychiatric hospital: A nested case-control study.
        Indian Journal of Psychological Medicine. 2016; 38: 571-576
        • King E.
        • Baldwin D.
        • Sinclair J.
        • Campbell M.
        The Wessex recent inpatient suicide study, 2: Case-control study of 59 inpatient suicides.
        British Journal of Psychiatry. 2001; 178: 537-542
        • Lukaschek K.
        • Engelhardt H.
        • Baumert J.
        • Ladwig K.
        No correlation between rates of suicidal ideation and completed suicides in Europe: analysis of 49008 participants (55+ years) based on the Survey of Health, Ageing and Retirement in Europe (SHARE).
        European Psychiatry. 2015; 30: 874-879
        • Madsen T.
        • Agerbo E.
        • Mortensen P.
        • Nordentoft M.
        Predictors of psychiatric inpatient suicide: a national prospective register-based study.
        Journal of Clinical Psychiatry. 2012; 73: 144-151
        • Mann J.
        • Apter A.
        • Bertolote J.
        • et al.
        Suicide prevention strategies: a systematic review.
        Journal of the American Medical Association. 2005; 294: 2064-2074
        • Martelli C.
        • Awad H.
        • Hardy P.
        Le suicide dans les établissements de santé: données épidémiologiques et prévention.
        Encéphale. 2010; 36: 83-91
        • Mortier P.
        • Kiekens G.
        • Auerbach R.
        • et al.
        A risk algorithm for the persistence of suicidal thought and behaviors during college.
        Journal of Clinical Psychiatry. 2017; 78: 828-836
        • Nahm M.
        Data quality in clinical research.
        in: Richesson R. Andrews J. Clinical research informatics. Health informatics. Springer, London2012: 175-201
        • Nock M.
        • Borges G.
        • Bromet E.
        • et al.
        Suicide and suicidal behavior.
        Epidemiological Reviews. 2008; 30: 133-154
        • Powell J.
        • Geddes J.
        • Hawton K.
        • Deeks J.
        • Goldacre M.
        Suicide in psychiatric hospital in-patients: Risk factors and their predictive power.
        British Journal of Psychiatry. 2000; 176: 266-272
        • Qin P.
        • Nordentoft M.
        Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers.
        Archives of General Psychiatry. 2005; 62: 427-432
        • Tschacher W.
        • Jacobshagen N.
        Analysis of crisis intervention processes.
        Crisis. 2002; 23: 59-67
        • Van Orden K.
        • Witte T.
        • Cukrowicz K.
        • et al.
        The interpersonal theory of suicide.
        Psychological Reviews. 2010; 117: 575-600
        • Williams S.C.
        • Schmaltz S.P.
        • Castro G.M.
        • Baker D.W.
        Incidence and method of suicide in hospitals in the United States.
        The Joint Commission Journal on Quality and Patient Safety. 2018; 44: 643-650
        • World Health Organization
        Suicide data 2017.