In a retrospective analysis of 229 (partially) inpatient suicides in 9 hospitals in North Rhine-Westphalia from 2008 to 2019, the authors found age-related differences in diagnoses, stressors, and medication, hanging as the most common method, and more than half of suicides occurring outside the hospital during staff-approved leave, and they conclude that approved leave should be considered carefully and that preventive construction measures matter.
The overall inpatient suicide rate per admission was low and ranged from 0.06% to 0.03% between 2008 and 2019.
Suicide rates per admission increased significantly in both women and men aged 60-69 years.
Diagnoses, stressors, and medication differed significantly across age groups among inpatient suicides.
Hanging was the most common suicide method overall, followed by railway suicide; railway suicide was the most common method in younger age groups.
More than half of suicides occurred outside the hospital environment, during hospital leave approved by staff.
The suicide rate per duration of hospitalization increased after the first month of treatment.
This study looked back at 229 suicides of psychiatric patients who were fully or partly hospitalized in 9 hospitals in North Rhine-Westphalia, Germany, between 2008 and 2019. Suicides were rare relative to the number of admissions (about 0.03-0.06% of admissions), but the rate rose significantly among men and women aged 60-69. Patients of different ages differed in their diagnoses, stressors, and medications. Hanging was the most common method, followed by railway suicide, which was most common among younger patients. More than half of the suicides took place outside the hospital while patients were on leave approved by staff. The risk per length of stay also increased after the first month of treatment, which the authors suggest may reflect more severe or treatment-resistant illness. This research suggests that decisions about granting leave may need careful consideration, especially for patients with long stays. It also suggests that older patients' physical illnesses and chronic pain deserve attention during treatment, and that building-related safety measures may help prevent suicides. Because the study is retrospective and descriptive, it cannot show that any of these factors directly cause suicide.
Julia Christl, E. Pense, S. Verhülsdonk, R. Mennicken, Mechthild Pott, M. Jänner, et al.. (2026). Clinical aspects of inpatient suicides: A retrospective analysis of suicides from 2008 to 2019 in 9 hospitals in North Rhine-Westphalia.. Advances in Clinical and Experimental Medicine. https://doi.org/10.17219/acem/216292