# Time to suicide after psychiatric inpatient discharge: a nationwide Swedish survival analysis

## TL;DR

This study finds that older individuals are more likely to die by suicide soon after being discharged from psychiatric care, suggesting routine follow-up may be more effective than targeting specific risk factors.

## Contribution

The study identifies older age as a novel predictor of shorter time to suicide after psychiatric discharge, challenging assumptions about risk markers.

## Key findings

- Older age was independently associated with a shorter time to suicide after psychiatric discharge.
- Neurotic, stress-related disorders were linked to a longer time to suicide, though not significantly after adjusting for age.
- Standard risk factors like suicide attempts and involuntary care did not predict earlier suicide.

## Abstract

The period immediately following psychiatric inpatient care is recognized as a time of elevated risk of suicide, yet little is known about factors that influence how soon suicide occurs after discharge.

To examine the timing of suicide among persons after psychiatric discharge and identify sociodemographic and clinical factors associated with a shorter time to death by suicide.

We included all adults in Sweden who died by suicide in 2015 and who had been discharged from psychiatric inpatient care during the last three months of life (n = 140). Sociodemographic and clinical variables were extracted from electronic medical records, including contextual factors from the last hospitalization (involuntary care, documented suicide risk, unplanned discharge). Time to suicide was modelled using stratified Cox proportional hazards regression.

The median time from discharge to death was 32 days. Older age was the only background factor independently associated with a shorter time to suicide; each additional 10 years of age was associated with shorter time to suicide, as indicated by an increased unadjusted hazard ratio (uHR) of 1.26 (95% CI: 1.12–14.2, p < .001). A diagnosed neurotic, stress-related and somatoform disorder (ICD-10 code F40-F49) was associated with a longer time to suicide (uHR = 0.68 (0.47–0.98), p = .036), although this association was not statistically significant when adjusting for age (aHR 0.82, 0.56–1.20, p = .310). Previous suicide attempts, sex, substance use disorder and depressive disorders were not associated with time to suicide. Neither involuntary care nor the presence or absence of a formal suicide risk assessment during inpatient stay predicted earlier suicide. Unplanned discharges were likewise unrelated to the time to suicide.

Among people who died by suicide within three months of psychiatric discharge, only older age independently predicted a shorter time to suicide. The absence of clear signals—particularly from routinely collected risk assessments—suggests that timely, universal follow-up may be more appropriate than attempts to target aftercare on the basis of standard risk markers.

Not applicable.

The online version contains supplementary material available at 10.1186/s12888-026-07878-5.