Suicide Prevention at the Psychiatric Hospital
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Slide 1 :
Strategies for the Prevention of Suicide: an empirical Study Frank Matakas, Elisabeth Rohrbach Tagesklinik Alteburger Strasse, Cologne Germany
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Clinical experience any patient with moderate to severe symptoms of depression is at risk of suicide
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Treatment distinguishes between regressive and progressive measures
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Regressive Treatment The patient is temporarily relieved of his responsibility for himself and others. - inpatient care - drug therapy - an ordered daily routine - no leaving the ward without supervision - no discussion of family conflicts with the therapists - no dealing with the patient’s social problems - no contact with his work environment
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Progressive treatment All measures that give back the patient his responsibilities - permission to go out of the hospital- - visits home - discussion of the patient’s social situation - planning the patient’s life after completion of hospital treatment - conflict-oriented rather than purely supportive psychotherapy - day-patient treatment or outpatient treatment
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Therapy Regressive measures are used on all patients in a depressive condition Progressive measures are gradually introduced only when all symptoms of depression have disappeared
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Difference Before:doctor‘s decision, whether the patient‘s interpersonal conflicts and social difficulties were discussed ... After: a regressive and a progressive treatment method were defined in detail, and there is a criterion that determines when which form of treatment should be used
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Patients 11,798 patients admitted to the hospital between 1984 and 2005
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Diagnoses 20% schizophrenia 40% affective disorder 6% addiction (alcohol and/or prescription drugs) 34% other disorders (mainly personality disorders)
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Results period before: 15 years (1984 - 1999) 6,891 admissions 22 suicides rate: 345 suicides / 100 000 admissions
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Results period after: 6 years (1999 – 2005) 4, 907 admissions 5 suicides rate: 88 suicides / 100 000 admissions
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Results Suicide rate before 345 / 100 000 admissions Suicide rate after 88 / 100 000 admissions
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Suicide rate rolling average/3 years
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Conclusion Wherever regression is possible for a depressed patient, the mood is alleviates As a result, there is a reduced tendency towards siucidality
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Conclusion The urge for regression and depressive mood are two distinct conditions in a depressed person
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