Elsevier

General Hospital Psychiatry

Volume 33, Issue 6, November–December 2011, Pages 572-578
General Hospital Psychiatry

Psychiatric–Medical Comorbidity
Suicidal ideation in medical inpatients: psychosocial and clinical correlates

https://doi.org/10.1016/j.genhosppsych.2011.08.002Get rights and content

Abstract

Objective

To identify psychosocial and clinical correlates of suicidal ideation in medical inpatients.

Method

In a cross-sectional study, all adults consecutively admitted to the medical wards of a University Hospital had their names recorded and were randomized and evaluated during the first week of admission. Suicidal ideation was assessed using Item 9 of Patient Health Questionnaire-9. The Beck Depression Inventory, the Beck Anxiety Inventory, the WHO Subjective well-being scale, the Charlson Comorbidity Index and other numerical rating scales (pain and self-reported physical illness severity) were used. Patients with less than four confidants were considered with poor social support. The Student's t test, Mann-Whitney U test, chi-square test and stepwise logistic regression analysis were used.

Results

Of the 1092 patients who composed the sample, 7.2% reported having suicidal ideation. After adjusting for psychosocial and clinical confounders, prior suicide attempts (OR: 4.41; 95% CI: 2.12–9.15; P<.001), depressive symptoms (OR: 1.11; 95% CI: 1.06–1.17; P<.001), severe anxiety symptoms (OR: 3.04; 95% CI: 1.47–6.26; P=.003) and poor social support (OR: 2.02; 95% CI:1.03–3.96; P=.04) were independently associated with suicidal ideation.

Conclusions

Three out of the four correlates of suicidal ideation in medical inpatients are potentially modifiable factors: severe anxiety, depressive symptoms and poor social support. The fourth variable, prior suicide attempts, is not modifiable but should serve as a red flag to suspect and investigate current suicide risk. These findings highlight the importance of suicidal ideation as a proxy for the distress that is incumbent upon physicians to manage if they wish to provide excellent and comprehensive inpatient care.

Introduction

Medical illness increases suicidal behavior [1], [2], [3], [4], [5]. Suicidal intent is rarely discussed in general practice and nonpsychiatric specialist settings, even with patients who end up committing suicide in the next few days [6]. Suicidal inpatients in medical wards have a different profile from suicidal inpatients in psychiatric hospitals [6], [7], [8]. Furthermore, many physical conditions are associated with the subsequent first onset of suicidal ideation even in the absence of mental disorder [9]. In spite of these findings, the literature on suicidal ideation in the medical setting is still very limited. Most of the research was conducted in samples of patients with specific physical illnesses. Only two previous studies have analyzed suicidal ideation in large samples of medical inpatients with heterogeneous conditions [10], [11]. However, they did not measure physical illness comorbidity [10], [11], and only one evaluated patients' social support [11].

Previous studies have shown a higher prevalence of suicidal ideation among patients with specific medical conditions, such as chronic pain [9], [12], [13], [14], [15], heart attacks or stroke [9], congestive heart failure [16], arthritis [9], pulmonary diseases [1], [9], [17], [18], cancer [5], HIV [19] and epilepsy [9], [20]. Also, in medically and surgically hospitalized patients a diagnosis of depression, alcohol use disorder or smoking was independently associated with suicidal ideation [10]. Some sociodemographic factors have been associated with increased suicidal ideation in the medically ill: female gender [18], [21], male gender [19], younger age [10], [11], [22], [23], poor social support [23], [24], earlier disease course [24], lower income [24], not being married [24] and higher levels of physical disability [24]. However, in several studies, some of these variables were no longer associated with suicidal ideation after adjusting for depression severity (e.g., female gender, younger age, lower income, and not being married) [18], [21], [24].

Suicidal ideation has been identified among the strongest predictors of suicidal behavior. Little is known about the profiles or clinical characteristics of medical inpatients with suicidal ideation. Knowing these characteristics might help early detection and the development of interventions to manage those at risk. This study aimed to identify psychosocial and clinical correlates of suicidal ideation in medical inpatients.

Section snippets

Study population

In a cross-sectional study all patients consecutively admitted to the general medical wards of the Federal University of Santa Catarina Hospital, in Brazil, were eligible to participate. Their names were recorded and, after randomization, they were approached (n=1562). Eighty-nine individuals refused to take part, and 381 were excluded because they were too ill, had cognitive impairment or were discharged in a few hours. The patients who were excluded were older (mean age=57 years, S.D.=20.98) (

Results

Of the 1092 patients interviewed, 79 (7.2%) reported experiencing suicidal ideation and/or ideas of self-harm on at least several days over the previous 2 weeks. Table 1 describes psychosocial and clinical sample characteristics and the results of the univariate analyses. Patients with suicidal ideation had significantly increased rates of the following characteristics: female gender (P=.005), younger age (P=.04), poor social support (P<.001), lower household income (P=.01), longer time since

Discussion

To our knowledge, this was the first study examining psychosocial and medical characteristics of those with suicidal ideation in a large sample of medical inpatients with heterogeneous conditions, taking into account not only demographics and psychiatric profile but also physical illness comorbidity/severity and social support. After adjusting for confounders, the following characteristics helped to detect those with suicidal ideation: previous suicide attempts, poor social support, severe

Acknowledgments

We thank Neury Botega, M.D., Ph.D., for his critical comments on the manuscript.

This research was partially supported by the Ministry for Science and Technology of Brazil (CNPq).

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