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Meta-Analysis
. 2025 Aug;59(8):679-691.
doi: 10.1177/00048674251348372. Epub 2025 Jun 27.

Meta-analysis of risk factors for suicide after psychiatric discharge and meta-regression of the duration of follow-up

Allyson Tai  1 , Hannah Pincham  1   2 , Ashna Basu  1   2 , Matthew Large  1   2
Affiliations
Meta-Analysis

Meta-analysis of risk factors for suicide after psychiatric discharge and meta-regression of the duration of follow-up

Allyson Tai et al. Aust N Z J Psychiatry. 2025 Aug.

Abstract

Background: Rates of suicide following discharge from psychiatric hospitals are extraordinarily high in the first week post-discharge and then decline steeply over time. The aim of this meta-analysis is to evaluate the strength of risk factors for suicide after psychiatric discharge and to investigate the association between the strength of risk factors and duration of study follow-up.

Methods: A PROSPERO-registered meta-analysis of observational studies was performed in accordance with PRISMA guidelines. Post-discharge suicide risk factors reported five or more times were synthesised using a random-effects model. Mixed-effects meta-regression was used to examine whether the strength of suicide risk factors could be explained by duration of study follow-up.

Results: Searches located 83 primary studies. From this, 63 risk estimates were meta-analysed. The strongest risk factors were previous self-harm (odds ratio = 2.75, 95% confidence interval = [2.37, 3.19]), suicidal ideation (odds ratio = 2.15, 95% confidence interval = [1.73, 2.68]), depressive symptoms (odds ratio = 1.84, 95% confidence interval = [1.48, 2.30]), and high-risk categorisation (odds ratio = 7.65, 95% confidence interval = [5.48, 10.67]). Significantly protective factors included age ⩽30, age ⩾65, post-traumatic stress disorder, and dementia. The effect sizes for the strongest post-discharge suicide risk factors did not decline over longer periods of follow-up.

Conclusion: The effect sizes of post-discharge suicide risk factors were generally modest, suggesting that clinical risk factors may have limited value in distinguishing between high-risk and low-risk groups. The highly elevated rates of suicide immediately after discharge and their subsequent decline remain unexplained.

Keywords: Suicide; discharge; mental health; risk assessment.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: M.L. has provided evidence in legal matters following post-discharge suicides.

Figures

Figure 1.
Figure 1.
Flow chart of searches.
Figure 2.
Figure 2.
Funnel of 1698 effect sizes of risk factors for post-discharge suicide.
Figure 3.
Figure 3.
Forrest plot of the top 15 effect sizes of risk factors for post-discharge suicide.
See this image and copyright information in PMC

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