Suicide after involuntary psychiatric care: a nationwide cohort study in Sweden.
Grossmann L., Johansson F., Fazel S., Kuja-Halkola R., Bråstad B., Mataix-Cols D., Fernández de la Cruz L., Runeson B., Lichtenstein P., Chang Z., Larsson H., Brikell I., D'Onofrio B., Pingel R., Rück C., Wallert J.
BACKGROUND: Little is known about the risk of suicide in individuals treated against their will in involuntary psychiatric care (IPC). This population-based study provides a first comprehensive description of suicide among individuals who experienced IPC. METHODS: We studied all individuals discharged from IPC in Sweden from 2010 through 2020. Clinical and sociodemographic characteristics are reported followed by suicide risk for the complete IPC population and stratified by sex, age, IPC history, and diagnostic category. Crude and adjusted relative risks compared to all individuals discharged from psychiatric in- and outpatient care and the general population were estimated using Poisson regression. Suicide methods, seasonal trends, and geographical variance are also reported. FINDINGS: We identified 72 275 patients treated in IPC with a total of 134 514 inpatient care episodes (mean age = 44·8 years, 37 462 [51·8%] males). Of these, 2104 (2·9%) died by suicide over a median follow-up time of 4·4 years (IQR: 1⋅8-7⋅5). Suicide decedents were younger, more often male, single, diagnosed with personality and substance use disorders, and had a history of self-harm and IPC, compared to those who did not die by suicide. The absolute risk (crude incidence rate (IR) per 100 000 person-years) for all IPC patients was highest closest to discharge (IR1month = 2941 [2538, 3408]) and decreased thereafter (IR5years = 738 [705, 773]). Suicide risk in IPC patients was elevated relative to psychiatric inpatients (crude IR ratio (IRR)5years = 1·57 [1·48, 1·65]), psychiatric outpatients (IRR5years = 3·77 [3·58, 3·97]), and the general population (IRR5years = 55·52 [52·65, 58·54]). INTERPRETATION: We found substantial risk differences in distinct subgroups of IPC patients and an excess suicide risk among IPC patients compared to other clinical populations. These findings warrant further investigation as they could inform clinicians and policy makers regarding potential risk stratification, monitoring, and care. Preventing suicides after IPC should be a priority. FUNDING: VR, ALF Medicine, CIMED, FORTE, and Söderström König Foundation.