2055. Mental Health Service
Delivery and Risk of Suicide in Psychiatric Patients
RA Desai, Northeast Program Evaluation Center, DJ Dausey, Northeast Program Evaluation Center, RA Rosenheck, Northeast Program Evaluation Center
Objectives: This study
had four main objectives: first, to examine variation in suicide rates among
discharged psychiatric patients across VA facilities; second, to examine
individual and clinical factors that predicted suicide risk (i.e. case-mix);
third, to examine individual delivery of care factors as they relate to suicide
risk; and fourth, to examine facility and environmental factors as they relate
to suicide risk.
Methods: All unique
discharged psychiatric inpatients in the VA system between 1994 and 1998 with a
diagnosis of PTSD, schizophrenia, major depression or bipolar disorder were
included in the sample (n=121,933). The sample was merged with National Death
Index data to determine death from suicide within one year of discharge.
Administrative data on individual, clinical, service delivery (e.g. length of
stay, continuity of care), facility-level variables (e.g. size of facility,
academic affiliation, average length of stay), and social environment variables
(e.g. social capital, State suicide rate) were used to build sequential GEE
Results: Out of 121,933
discharges, 481 patient committed suicide within one year of discharge
(0.39%).Adjusting for case-mix (age, gender, race, disability, etc.), there was
significant variation across VA facilities in the suicide rate. Service delivery
variables that predicted suicide risk included length of inpatient stay,
readmission within 180 days of discharge, and continuity of care.
No facility-level variables were significantly associated with suicide
risk. Both social capital and the State-level suicide rate were significantly
associated with suicide risk.
adjusting for case mix, there are several individual delivery of care variables
that, if modified, may affect the risk of suicide in psychiatric patients.
However, there was no evidence that facility-wide characteristics or practice
patterns were significantly associated with such risk. It may be that there are
few system-wide policies that facilities could implement that would
significantly impact on the risk for suicide among psychiatric patients.
Impact: These results could impact on individual clinical care, since there are several modifiable factors that predict suicide risk. However, these results also highlight the liklihood that there are few, if any, system-wide changes that would substantially impact this tragic outcome.