Death by Suicide in the First Year After Irregular Discharge From Inpatient Hospitalization

OBJECTIVE: Single-site studies indicate irregular hospital discharges are associated with elevated suicide risk. As part of ongoing analytics in the Veterans Affairs (VA) health system, the authors evaluated associations between irregular discharge and suicide over a 15-year period. METHODS: All inpatient discharges and discharge types from 2001 through 2014 were identified using VA administrative data. Mortality and cause-of-death data were drawn from comprehensive VA searches of the Centers for Disease Control and Prevention National Death Index. Suicide risk following regular versus irregular discharge was compared by using survival analysis and adjusting for age, gender, and VA facility. RESULTS: Among 5,051,051 discharges, 2.1% (103,995) were irregular. Adjusted suicide risk was higher following irregular discharge compared with regular discharge (hazard ratio [HR]=2.02, 95% confidence interval [CI]=1.78–2.29). Stratified analyses by unit type showed that the association was nonsignificant for psychiatric discharges but significant for general medical discharges (HR=3.01, CI=2.54–3.57). CONCLUSIONS: Patients were at increased suicide risk after irregular hospital discharges.