Logan Reid
Suicide is a serious global public health problem that requires a public health response. In the United States, between 48.5 and 65 suicides in hospital inpatient units occur annually, with most of them taking place among psychiatric inpatients. While the actual incidence of inpatient suicides is poorly understood, it is classified as a never event by the Joint Commission, indicating that it is a serious, adverse, and usually preventable event. Hanging is the most common method of inpatient suicide, highlighting the importance of careful environmental assessments and prevention efforts in hospitals.
| Characteristics | Values |
|---|---|
| Number of suicides in hospital inpatient units in the U.S. | 49 to 65 per year |
| Percentage of hospital inpatient suicides involving psychiatric inpatients | 31.0 to 51.7% |
| Percentage of hospital inpatient suicides occurring during psychiatric treatment | 73.9% |
| Most common method of inpatient suicide | Hanging |
| Percentage of suicides in the U.S. involving firearms | 55.36% |
| Number of adults in the U.S. with thoughts of suicide in 2023 | 12.8 million |
| Number of adults in the U.S. who attempted suicide in 2023 | 1.5 million |
| Suicide rate among individuals aged 85 and older in the U.S. in 2023 | 22.66 per 100,000 |
| Suicide rate among individuals aged 75 to 84 in the U.S. in 2023 | 19.44 per 100,000 |
| Suicide rate among white males in the U.S. in 2023 | 25.23 per 100,000 |
| Suicide rate among white females in the U.S. in 2023 | 6.53 per 100,000 |
| Suicide rate among Black or African American males in the U.S. in 2023 | 14.59 per 100,000 |
| Suicide rate among Black or African American females in the U.S. in 2023 | 3.44 per 100,000 |
| Suicide rate among Asian males in the U.S. in 2023 | 9.71 per 100,000 |
| Suicide rate among Asian females in the U.S. in 2023 | 3.55 per 100,000 |
| Overall age-adjusted suicide rate in the U.S. in 2023 | 14.12 per 100,000 |
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What You'll Learn
- Between 48.5 and 64.9 hospital inpatient suicides occur annually in the US
- Hanging is the most common method of inpatient suicide
- Suicide is considered a never event by the Joint Commission
- The US Department of Veterans Affairs has reduced in-hospital suicides by 82.4%
- Hospitals should conduct careful environmental assessments to prevent suicides
Between 48.5 and 64.9 hospital inpatient suicides occur annually in the US
Suicide is a serious public health problem that requires a public health response. It is a global phenomenon that occurs in all regions of the world, with close to three-quarters (73%) of suicides occurring in low- and middle-income countries in 2021. The prevention of suicide has been neglected due to a lack of awareness and the taboo in many societies surrounding discussions of suicide. Globally, the availability and quality of data on suicide are poor, with only around 80 WHO member states having good-quality data that can be used to estimate suicide rates directly.
In the United States, there is no complete count of suicide attempt data available. However, studies have estimated that between 48.5 and 64.9 hospital inpatient suicides occur annually, with most of them taking place among psychiatric inpatients. This estimate is based on an analysis of two national data sets: data from 27 states reporting to the National Violent Death Reporting System (NVDRS) for 2014-2015, and data from hospitals reporting to The Joint Commission's Sentinel Event (SE) Database from 2010 to 2017. The Joint Commission classifies in-hospital suicide as a sentinel event, which is a patient safety event that results in death or severe harm and is preventable.
Hanging is the most common method of inpatient suicide, and hospitals are advised to conduct careful environmental assessments to ensure that potential fixation points, such as door handles and hinges, are "ligature-resistant." The US Department of Veterans Affairs (VA) has successfully reduced the number of in-hospital suicides on mental health units, demonstrating that well-designed quality improvement initiatives can effectively reduce these tragic events.
While the incidence of inpatient suicides in the US is poorly understood, it is clear that suicide prevention efforts are crucial. This includes improving the surveillance and monitoring of suicide and self-harm data, addressing risk factors such as mental health disorders, and implementing timely, evidence-based interventions to prevent suicides.
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Hanging is the most common method of inpatient suicide
Hanging is also a historically common method of suicide. It was the most common method in primitive and pre-industrial societies, and in ancient China, it was considered the "final, but unequivocal, way of standing still against and above oppressive authorities". In ancient Rome, however, death by hanging was considered particularly shameful, and those who died by this method were refused burial. In more recent times, a study of 56 countries found that hanging was the most common method in most, accounting for 53% of male suicides and 39% of female suicides. Hanging is also the most common method of suicide in England and Wales, particularly among men aged 15-44, and the second most common method among women.
In the hospital setting, the most common fixture points for hanging are doors, door handles, or door hinges. Over 90% of suicides take place in private spaces such as bathrooms, bedrooms, closets, and showers. Hospitals can help prevent hanging suicides by conducting careful environmental assessments to ensure that door handles and door hinges are "ligature-resistant".
While hanging is the most common method of inpatient suicide, it is important to note that inpatient suicides are rare and occur mostly in psychiatry wards. The risk of suicide in psychiatric hospitals is 50 times higher than in the general population. However, due to the complexity of assessing suicide risk, there is no consensus on the suicide prevention measures that should be in place in hospitals.
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Suicide is considered a never event by the Joint Commission
Suicide is a serious issue that can occur in hospital settings. While the exact incidence of inpatient suicides in the United States is not reliably known, studies estimate that between 48.5 and 64.9 hospital inpatient suicides occur per year in the country. The Joint Commission, a prominent healthcare accreditation organisation, plays a crucial role in addressing this issue by classifying inpatient suicide as a sentinel event and a never event.
A sentinel event refers to a patient safety incident that deviates from the expected course of the patient's illness or underlying condition and results in death, severe harm, or permanent harm. The Joint Commission has long recognised the significance of sentinel events, encouraging hospitals to report them voluntarily since 1995 and establishing a formal sentinel event policy in 1996. This policy aims to improve patient care, analyse root causes, enhance awareness, and maintain trust in patient safety.
The Joint Commission's definition of a sentinel event has evolved to include time frames with the highest risk for suicide, emphasising the continued responsibility of healthcare organisations in assessing patients' suicide risk throughout their treatment. Specifically, the definition now encompasses suicides that occur within 7 days of discharge from inpatient services, emergency departments, or specific behavioural health care services. This expanded definition underscores the organisation's commitment to addressing the issue.
By classifying inpatient suicide as a never event, the Joint Commission acknowledges that it is an adverse event that is unambiguous, serious, and usually preventable. Never events are devastating incidents that healthcare organisations are under immense pressure to eliminate. In the context of suicide, prevention strategies include environmental assessments to minimise ligature fixation points, such as doors, door handles, and door hinges, in hospitals. Additionally, psychiatric rooms and restrooms can be modified to reduce anchoring points and fixtures, which has proven effective in lowering inpatient suicide rates.
In conclusion, suicide is considered a never event by the Joint Commission due to its devastating and preventable nature. The organisation actively works to address this issue by classifying inpatient suicide as a sentinel event, providing definitions and time frames to guide healthcare organisations, and promoting preventive measures to reduce the risk of inpatient suicide. These efforts reflect the Joint Commission's commitment to improving patient safety and mitigating the occurrence of sentinel events.
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The US Department of Veterans Affairs has reduced in-hospital suicides by 82.4%
Suicide rates among veterans are higher than those of the general US population. Although veterans make up only 7.6% of the US population, nearly 14% of American adult suicides are among veterans. The rate of suicide is 1.5 times higher among all veterans and 2.1 times higher among female veterans compared to the general population. The US Department of Veterans Affairs (VA) has made veteran suicide prevention its highest clinical priority. The VA's 2024 National Veteran Suicide Prevention Annual Report highlights positive trends, such as a 3.8% decrease in suicide rates for veterans aged 18-34 and a 19.1% reduction in suicide rates for homeless veterans. The report also emphasizes the need for a broad public health approach and community collaborations to address veteran suicide.
The VA has successfully reduced in-hospital suicides by 82.4%, from 4.2 per 100,000 admissions to 0.74 per 100,000 admissions on mental health units. This significant reduction demonstrates the effectiveness of well-designed quality improvement initiatives in preventing these tragic events. While the actual incidence of inpatient suicides nationally is not fully understood, it is estimated that between 48.5 and 64.9 inpatient suicides occur annually in the United States, with 73.9% happening during psychiatric treatment. Hanging is the most common method, emphasizing the importance of hospitals conducting careful environmental assessments to prevent ligature fixation points.
The VA's efforts align with a comprehensive approach to suicide prevention, including primary, secondary, and tertiary prevention frameworks. Primary prevention focuses on whole health, financial stability, social networks, and healthcare access. Secondary prevention includes public education, risk assessment, mental health screening, and reducing access to lethal means. Tertiary prevention involves crisis hotlines, urgent care, specialty mental health referrals, and hospitalization for those at imminent risk.
The VA's initiatives have led to notable improvements, such as a 22.5% decrease in the suicide rate among veterans with Veterans Crisis Line contacts in 2021 compared to 2019. Additionally, from 2001 to 2022, suicide rates fell for veterans in VHA care with diagnoses of anxiety, depression, post-traumatic stress disorder, and alcohol use disorder. These reductions in suicide rates among veterans underscore the impact of the VA's dedicated prevention efforts and the potential for further progress through continued collaboration and evidence-based initiatives.
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Hospitals should conduct careful environmental assessments to prevent suicides
Suicide is a serious public health problem that requires a public health response. Hospitals should conduct careful environmental assessments to prevent suicides. While suicide in hospitals is rare, it is still a "sentinel event" or a "never event" that results in death or severe harm to the patient. Nationally, between 49 and 65 hospital suicides occur annually in the United States, with 75% of them taking place during psychiatric treatment and hanging as the most common method.
Hospitals should take proactive steps to address this issue by conducting thorough environmental assessments to identify potential risks and implement preventive measures. This includes evaluating the physical environment, such as doors, door handles, and door hinges, to ensure they are "ligature-resistant" and cannot be used for hanging. Over-door alarm devices may also be considered as a preventive measure, but further data is needed to assess their effectiveness.
In addition to environmental assessments, hospitals should also focus on comprehensive patient monitoring and surveillance. This includes improving the quality and timeliness of data collection related to suicide and self-harm. Vital registration of suicide, hospital-based registries of self-harm, and nationally representative surveys can provide valuable information for hospitals to identify at-risk patients and implement targeted interventions.
Furthermore, hospitals should prioritize raising community awareness about suicide prevention and breaking the taboo surrounding the discussion of suicide. This can help encourage individuals to seek help and reduce the stigma associated with mental health issues. Additionally, hospitals can play a crucial role in providing mental health support and resources to patients and their families, particularly during the patient's hospital stay and after discharge.
By conducting careful environmental assessments, improving data collection and surveillance, raising awareness, and offering mental health support, hospitals can take a proactive approach to preventing suicides and saving lives. These measures demonstrate a commitment to patient safety and well-being, ensuring that patients receive the necessary care and protection during their most vulnerable moments.
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Frequently asked questions
Between 48.5 and 65 hospital inpatient suicides occur per year in the United States.
73.9% of hospital inpatient suicides occur during psychiatric treatment. This amounts to about 31 to 51.7 suicides per year.
Hanging is the most common method of suicide in hospitals. Hospitals should ensure that door handles and door hinges are "ligature resistant".
The age-adjusted suicide rate in the United States was 14.12 per 100,000 in 2023. Firearms were the most common method of suicide, accounting for 55.36% of all suicide deaths.
Suicide is strongly associated with mental disorders, particularly depression and alcohol use disorders. A previous suicide attempt is also a significant risk factor. Additionally, experiencing conflict, disaster, violence, abuse, loss, and a sense of isolation are all risk factors for suicide.
