Problems related to psychopharmacological treatment: A risk factor of inpatient suicidal behaviour?

Aim: The study aimed at exploring the relevance of problems with psychopharmacotherapy for inpatient suicides and attempted suicides. Methods: 20.543 patients with 40.451 episodes of inpatient care from 1995 to 2004 were included. Inpatient suicides and attempted suicides during hospitalization were recorded by the German Basic Documentation System (BADO), which contains also items regarding psychopharmacological treatment resistance, severe side effects and non-compliance. Fisher exact tests and multivariate logistic regression analyses were performed to explore predictors of inpatient suicides and attempted suicides. Results: 41 inpatient suicides and 214 attempted suicides were recorded during the 10-year period. Most suicides suffered from schizophrenia (26.8%) or depression (24.4%), majority received antipsychotics (56.1%), antidepressants (53.7%) and benzodiazepines (31.7%). There were significant differences between suicides and non-suicides regarding treatment resistance (p<=0.01) and severe side effects (p<=0.01),no significant difference could be found for non-compliance (p>0.01). According to regression analyses risk of inpatient suicide increases with treatment resistance and severe side effects, risk of attempted suicide with treatment resistance. Conclusion: Patient suffering from problems with psychopharmacotherapy require special attention regarding suicidal behaviour. Minimizing problems with psychopharmacotherapy may provide assistance in suicide prevention.