Inpatient suicides in psychosis at a mental health care facility: A mixed methods study

INTRODUCTION

National Institute of Mental Health (NIMH) defines suicide as death caused by self-directed injurious behavior with intent to die as a result of the behavior. According to the World Health Organization, nearly 703,000 people in the world die by suicide each year, at a rate of one death every 40 seconds. Approximately 90% of these individuals suffer from a psychiatric pathology, the most common being mood disorders. Inpatient suicide is an important issue which has significant administrative, legislative, and therapeutic underpinnings NEED FOR STUDY

In comparison to the abundant information on inpatient suicide in the West, there is a paucity of data on inpatient suicide in Asia, even so lesser in India. Very few studies have been done in India regarding inpatient suicides, especially in a mental health facility with none to our knowledge that have focused exclusively on psychotic disorders. Furthermore, details about the course of illness and psychopathology have not been assessed in these studies. Paris (2007) has pointed out over-caution arising from fear within the clinician that leads to hospitalization and not, because of the belief that hospitalization is the best possible management. Although many patients benefit from the protective and containing environment of the hospital during a suicidal crisis, hospitalization of chronically suicidal patients can turn counterproductive and may also be replaced by outpatient management if required information and expertise is available with the clinician.

 AIM

To evaluate the factors associated inpatient suicides among patients with psychosis over a period of 25 years and exploring the perspectives of nurses related to inpatient suicides.

OBJECTIVES

1.      To evaluate the factors (demographic & clinical) associated with inpatient suicides in-patients with psychosis in comparison to matched living in-patients with psychosis.

2.      To explore the perspectives of nurses related to inpatient suicides providing care to patients within the mental health care facility.

MATERIALS AND METHODS

1.      VENUE The study will be conducted at Central Institute of Psychiatry, Ranchi.

2.      STUDY DESIGN The study will adopt a mixed methods design. The first part will involve a retrospective review of medical records of in-patients with psychosis who died by suicide during their hospitalization at the Institute. The medical records will be reviewed for 25 years’ duration from 2000 to 2024. The qualitative aspect will include ten In-depth interviews (IDIs) with nurses exploring their perspectives related to inpatient suicides.

3.     SAMPLE SIZE & SAMPLING STRATEGY The total number of inpatient suicide deaths occurring during the past 25 years will be determined by review of the register and medical records maintained at the Institute. For the IDIs, 10 nurses would be recruited through convenience sampling.

TOOLS:

1.      CASE RECORD FILE

2.      STRUCTURED ASSESSMENT QUESTIONNAIRE

3.      INTERVIEW GUIDE FOR IN-DEPTH INTERVIEWS