Intended for healthcare professionals

Letters Suicide risk and intervention in mental illness

Authors’ reply to Large

BMJ 2016; 352 doi: (Published 20 January 2016) Cite this as: BMJ 2016;352:i268
  1. James M Bolton, associate professor1,
  2. David Gunnell, professor of epidemiology2,
  3. Gustavo Turecki, professor of psychiatry3
  1. 1Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, MB, R3E 3N4, Canada
  2. 2School of Social and Community Medicine, University of Bristol, Bristol, UK
  3. 3Department of Psychiatry, McGill University, Montreal, QC, Canada
  1. jbolton{at}

Large brings attention to the observation that inpatients in psychiatric hospitals have a substantially increased risk of suicide.1 2 This point is reflected in our review, where we state: “Although admission to hospital is often intended to provide a safe environment for the suicidal patient, the risk of suicide while an inpatient is high.” In an effort to emphasise this point, we discuss the findings of the Walsh meta-analysis that showed a pooled rate of 147 suicides per 100 000 inpatient years, and then provide a reference for a recent study by Madsen and colleagues that found a strikingly high rate of 860 suicides per 100 000 inpatient years. As Large pointed out we did …

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