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Document type:
journal article 
Author(s):
Lukaschek, Karoline; Baumert, Jens; Krawitz, Marion; Erazo, Natalia; Förstl, Hans; Ladwig, Karl-Heinz 
Title:
Determinants of completed railway suicides by psychiatric in-patients: case-control study. 
Abstract:
Suicide prediction during psychiatric in-patient treatment remains an unresolved challenge.To identify determinants of railway suicides in individuals receiving in-patient psychiatric treatment.The study population was drawn from patients admitted to six psychiatric hospitals in Germany during a 10-year period (1997-2006). Data from 101 railway suicide cases were compared with a control group of 101 discharged patients matched for age, gender and diagnosis.Predictors of suicide were change of therapist (OR = 22.86, P = 0.004), suicidal ideation (OR = 7.92, P<0.001), negative or unchanged therapeutic course (OR = 7.73, P<0.001), need of polypharmaceutical treatment (OR = 2.81, P = 0.04) and unemployment (OR = 2.72, P = 0.04). Neither restlessness nor impulsivity predicted in-patient suicide.Suicidal ideation, unfavourable clinical course and the use of multiple psychotropic substances (reflecting the severity of illness) were strong determinants of railway suicides. The most salient finding was the vital impact of a change of therapist. These findings deserve integration into the clinical management of patients with serious mental disease. 
Journal title abbreviation:
Br J Psychiatry 
Year:
2014 
Journal volume:
205 
Journal issue:
Pages contribution:
398-406 
Language:
eng 
Print-ISSN:
0007-1250 
TUM Institution:
Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie; Klinik und Poliklinik für Psychiatrie und Psychotherapie