Suicide Risk in the Hospital
A woman with a history of depression, anxiety, and posttraumatic stress disorder presented to the emergency department after a suicide attempt. Physical examination was significant for depressed affect and superficial lacerations to the bilateral forearms. Her left forearm laceration was sutured and bandaged with gauze. A psychiatrist evaluated her and placed an involuntary legal hold. Upon arrival to the inpatient psychiatric unit, the patient asked to use the bathroom. She unwrapped her wrist bandage, wrapped it around her neck and over the shower bar, and tried to hang herself. A staff member heard noise in the bathroom, immediately entered, and cut the gauze before the patient was seriously injured. In the accompanying commentary, Peter D. Mills, PhD, MS, of Geisel School of Medicine at Dartmouth, reviews risk factors for inpatient suicide and outlines prevention strategies, such as using a standard environmental checklist to identify and address hazards, placing high-risk patients on one-to-one observation, and conducting risk assessment before allowing patients to be unsupervised.