ing the first week (Crammer, 1984). However, longer stays do not prevent suicide in the hospital (Jacobson, 1999).

After Discharge Risk

The period directly following discharge from a psychiatric hospitalization is a period of significantly increased risk. There appear to be multiple reasons for this. Patients who are hospitalized are some of the most severely affected individuals. While in the hospital, they are under surveillance and do not have the opportunity or means to commit suicide. When these patients are released from the hospital, they frequently lose their support system and they again have the opportunity and the means to commit suicide. A study in Great Britain reported that within the first 28 days after discharge, suicide was more likely (7 times in men and 3 times in women) than during the remaining 48 weeks of the year (Goldacre et al., 1993). Another study similarly found that 24 percent of the suicides among discharged patients occurred within the first 3 months of discharge, primarily in the first week (see Figure 7-1) (Appleby et al., 1999b).

FIGURE 7-1. Number of suicides each week after discharge. SOURCE: Appleby et al., 1999b. Reprinted with permission from the BMJ Publishing Group.

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