Preventing Post-discharge Suicides in Psychiatric Patients: Insights from Patients, Lay Healthcare Supporters, and Mental Health Professionals-a Qualitative Analysis

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2024 Jan 3

PMID 38166746

Authors

Tiantian Fu

Huiming Liu

Chang Chen

Bin Zhang

Guanjie Chen

Yuanhan Bai

Jinghua Li

Fengsu Hou

Affiliations

Soon will be listed here.

Abstract

Background: Discharged psychiatric patients are at higher risk of suicide due to various risk factors in their lives compared to the general population. However, specific problems and needs of these patients after discharge remain unclear. This research constitutes a segment of a broader implementation study designed to formulate an interventional strategy targeting post-discharge suicide among Chinese psychiatric patients. The present study seeks to qualitatively investigate the problems and needs from the perspectives of patients, their lay healthcare supporters (LHSs), and mental health professionals (MPs), aiming to enhance the efficacy of the interventional strategy.

Methods: This study is part of a larger implementation study based on Shenzhen Kangning Hospital (SKH) in Shenzhen, Guangdong, China. Under the community-based participatory research framework, we recruited discharged psychiatric patients, their LHSs, and MPs as a collaborative community team, and we conducted individual in-depth interviews for patients and LSHs and focus group interviews with MPs. We utilized a thematic analysis approach to identify sub-themes and themes from interviews through systematically coding and analyzing the data.

Results: A total of 45 participants were recruited for interviews, comprising 17 patients, 8 LHSs, and 20 MPs. We conducted 25 individual in-depth interviews and 3 focus group interviews. Through the interviews, we identified three themes of post-discharge problems: problems related to self, family-related problems, societal and community-related problems. We also identified four themes related to reducing post-discharge suicide: proactive self-management, multifunctional relatives, multifunctional MP group, and a warm society. The tangible support from LHSs and emotional support from MPs are strongly emphasized. Follow-up interventions were identified as the most significant way to addressing these unmet needs. Instrumental support from the community and a caring and non-discriminatory environment for individuals with mental disorders are essential for reducing suicide risk.

Conclusions: Establishing an integrated mental health care service network that connects psychiatric patients, LHSs, and MPs cross community and societal sectors, with patient-centered follow-up care at its core, is a practical approach to better address patients' needs and reduce post-discharge suicide.

Trial Registration: Registration number: NCT04907669. Date of registration: May 26th,2021.

Citing Articles

Mental Healthcare Consumers' Experiences of Mental Health Care: Variation in Knowledge by the Family Members and Support.

Shimange M, Shilubane H, Ndou N, Mulondo A SAGE Open Nurs. 2024; 10:23779608241272489.

PMID: 39130055 PMC: 11311152. DOI: 10.1177/23779608241272489.

References

Van Orden K, Witte T, Cukrowicz K, Braithwaite S, Selby E, Joiner Jr T . The interpersonal theory of suicide. Psychol Rev. 2010; 117(2):575-600. PMC: 3130348. DOI: 10.1037/a0018697. View

Orbach I, Mikulincer M, Gilboa-Schechtman E, Sirota P . Mental pain and its relationship to suicidality and life meaning. Suicide Life Threat Behav. 2003; 33(3):231-41. DOI: 10.1521/suli.33.3.231.23213. View

Tomas M, Rebelo M . Everyday Life after the First Psychiatric Admission: A Portuguese Phenomenological Research. J Pers Med. 2022; 12(11). PMC: 9692884. DOI: 10.3390/jpm12111938. View

Moser A, Korstjens I . Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract. 2017; 24(1):9-18. PMC: 5774281. DOI: 10.1080/13814788.2017.1375091. View

Arsenault-Lapierre G, Kim C, Turecki G . Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry. 2004; 4:37. PMC: 534107. DOI: 10.1186/1471-244X-4-37. View

Deisenhammer E, Behrndt E, Kemmler G, Haring C, Miller C . A comparison of suicides in psychiatric in-patients, after discharge and in not recently hospitalized individuals. Compr Psychiatry. 2016; 69:100-5. DOI: 10.1016/j.comppsych.2016.05.003. View

Pirkola S, Sohlman B, Wahlbeck K . The characteristics of suicides within a week of discharge after psychiatric hospitalisation - a nationwide register study. BMC Psychiatry. 2005; 5:32. PMC: 1215492. DOI: 10.1186/1471-244X-5-32. View

Qin P, Nordentoft M . Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry. 2005; 62(4):427-32. DOI: 10.1001/archpsyc.62.4.427. View

Wahlbeck K, Westman J, Nordentoft M, Gissler M, Laursen T . Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry. 2011; 199(6):453-8. DOI: 10.1192/bjp.bp.110.085100. View

10.

Hoffmann H, Modestin J . Completed suicide in discharged psychiatric inpatients. Soc Psychiatry. 1987; 22(2):93-8. DOI: 10.1007/BF00584011. View

11.

Links P, Nisenbaum R, Ambreen M, Balderson K, Bergmans Y, Eynan R . Prospective study of risk factors for increased suicide ideation and behavior following recent discharge. Gen Hosp Psychiatry. 2011; 34(1):88-97. DOI: 10.1016/j.genhosppsych.2011.08.016. View

12.

Haglund A, Lysell H, Larsson H, Lichtenstein P, Runeson B . Suicide Immediately After Discharge From Psychiatric Inpatient Care: A Cohort Study of Nearly 2.9 Million Discharges. J Clin Psychiatry. 2019; 80(2). DOI: 10.4088/JCP.18m12172. View

13.

Thong J, Su A, Chan Y, Chia B . Suicide in psychiatric patients: case-control study in Singapore. Aust N Z J Psychiatry. 2008; 42(6):509-19. DOI: 10.1080/00048670802050553. View

14.

Rezaie L, Phillips D . Post-discharge needs of Iranian women diagnosed with severe mental illness: A qualitative study. J Psychiatr Ment Health Nurs. 2020; 27(6):752-762. DOI: 10.1111/jpm.12634. View

15.

Bickley H, Hunt I, Windfuhr K, Shaw J, Appleby L, Kapur N . Suicide within two weeks of discharge from psychiatric inpatient care: a case-control study. Psychiatr Serv. 2013; 64(7):653-9. DOI: 10.1176/appi.ps.201200026. View

16.

Hunt I, Kapur N, Webb R, Robinson J, Burns J, Shaw J . Suicide in recently discharged psychiatric patients: a case-control study. Psychol Med. 2008; 39(3):443-9. DOI: 10.1017/S0033291708003644. View

17.

Park S, Choi J, Yi K, Hong J . Suicide mortality and risk factors in the 12 months after discharge from psychiatric inpatient care in Korea: 1989-2006. Psychiatry Res. 2012; 208(2):145-50. DOI: 10.1016/j.psychres.2012.09.039. View

18.

Ali S, Mahoui I, Hassoun R, Mojaddidi H, Awaad R . The Bay Area Muslim mental health community advisory board: evaluation of a community based participatory approach. Epidemiol Psychiatr Sci. 2023; 32:e7. PMC: 9971854. DOI: 10.1017/S2045796022000786. View

19.

Appleby L, Shaw J, Amos T, McDonnell R, Harris C, McCann K . Suicide within 12 months of contact with mental health services: national clinical survey. BMJ. 1999; 318(7193):1235-9. PMC: 27859. DOI: 10.1136/bmj.318.7193.1235. View

20.

Cutcliffe J, Links P, Harder H, Bergmans Y, Balderson K, Eynan R . Understanding the risks of recent discharge: the phenomenological experiences: trying to survive while living under the proverbial "Sword of Damocles". Crisis. 2012; 33(5):265-72. DOI: 10.1027/0227-5910/a000132. View