Predictors of nonfatal suicide attempts within 30 days of discharge from psychiatric hospitalization: Sex-specific models developed using population-based registries

• Type of Material: Article
• Authors: Rachel L Zelkowitz, VA Boston Healthcare System; Tammy Jiang, Boston University; Erzsébet Horváth-Puhó, Aarhus University; Amy E Street, VA Boston Healthcare System; Timothy Lash, Emory University; Henrik T Sorensen, Aarhus University; Anthony J Rosellini, Boston University; Jaimie L Gradus, Boston University
• Language: English
• Date: 2022-03-28
• Publisher: ELSEVIER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2024 Elsevier B.V
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jad.2022.03.034
• Title of Journal or Parent Work: JOURNAL OF AFFECTIVE DISORDERS
• Volume: 306
• Start Page: 260
• End Page: 268
• Keywords: Suicide attempt; SYSTEM; ARMY; Administrative health records; Case-cohort study; Science & Technology; RISK-FACTORS; Neurosciences & Neurology; BEHAVIORS; Clinical Neurology; Life Sciences & Biomedicine; DANISH REGISTERS; RESILIENCE; Psychiatric hospitalization; SELF-INJURY; Psychiatry; Machine learning
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background: Risk for nonfatal suicide attempts is heightened in the month after psychiatric hospitalization discharge. Investigations of factors associated with such attempts are limited. Methods: We conducted a case-subcohort study using data from Danish medical, administrative, and social registries to develop sex-specific risk models using two machine learning methods: classification trees and random forests. Cases included individuals who received a diagnostic code for a nonfatal suicide attempt within 30 days of discharge following a psychiatric hospitalization between January 1, 1995 and December 31, 2015 (n = 3166, 56.5% female). The comparison subcohort consisted of a 5% random sample of individuals living in Denmark (n = 24,559, 51.3% female) on January 1, 1995 who had a psychiatric hospitalization during the study period. Results: Histories of self-poisoning, substance-related disorders, and eating disorders were important predictors of nonfatal suicide attempt among women, with notable interactions observed between age, self-poisoning history, and other characteristics (e.g., medication use). Self-poisoning, substance-related disorders, and severe stress reactions were among the most important variables for men, with key interactions noted between self-poisoning history, age, major depressive disorder diagnosis, and prescription classes. Limitations: Findings are based on Danish administrative data, which may be subject to inaccuracies, missingness, etc. It is unclear whether results would generalize to other populations. Conclusions: Markers of behavioral dysregulation were important predictors of nonfatal suicide attempts in the 30 days after psychiatric hospitalization discharge for both sexes. Examining risk markers for nonfatal suicide attempt following discharge is important to enhance support for this vulnerable population.