Suicides in Psychiatric Patients: Identifying Health Care-Related Factors through Clinical Practice Reviews

Abstract

The objective of this study was to identify health care-related factors associated with death by suicide in psychiatric patients and to gain insight into clinician views on how to deal with suicidality. The study material derived from a clinician committee in a psychiatric department reviewing every outpatient and inpatient suicide in a standardized way. Reports’ conclusions and corresponding plenary discussion minutes regarding 94 suicides were analyzed using inductive thematic content analysis. Health care-related factors were categorized into 4 themes: patient evaluation, patient management, clinician training, and involvement of relevant non-clinical partners. Clinician views on the themes were expressed through statements (i) promoting or restricting an aspect of care (here called recommendations), which mainly followed existing guidelines and were consensual and (ii) without precise indication (here called comments), which departed from mainstream opinions or addressed topics not covered by existing policy. Involvement of non-clinical partners emerged as a new key issue for suicide prevention in psychiatric departments and should be openly discussed with patients. Clinicians preferred balanced conclusions when they reviewed suicide cases.

Keywords:

• deliberate self-harm
• education and training
• qualitative research
• risk assessment
• suicide

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1 Root cause analysis consists of case review by multidisciplinary teams, interviewing of the staff, determining underlying systematic (root) causes, and recommendations for future improvement.

Additional information

Notes on contributors

Laurent Michaud

Laurent Michaud, McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal (Québec), Canada; Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland.

Friedrich Stiefel

Friedrich Stiefel, Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland.

Delphine Moreau

Delphine Moreau, School of Health Science of Vaud (HESAV), University of applied sciences and art of Western Switzerland (HES-SO), Lausanne, Switzerland.

Yves Dorogi

Yves Dorogi, Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland.

Anouk Morier-Genoud

Anouk Morier-Genoud, Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland.

Céline Bourquin

Céline Bourquin, Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland.