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The year following inpatient psychiatric hospitalization—particularly the first three months following discharge—are a period of high risk for suicidal behavior among psychiatric patients. Prior history of suicidal behavior, mood, anxiety, substance use, and post-traumatic stress disorders contribute to risk for future suicidal behavior within this population. Psychosocial stressors also contribute to risk for suicidal behavior among psychiatric patients, including history of childhood abuse and acute stress.

Sexual and gender minority individuals (here, sexual minority refers to those who identify as lesbian, gay, bisexual, or queer; gender minority refers to those whose gender identity is different than their sex assigned at birth) have elevated risk for suicidal behavior. However, little is known about the risk during this critical time period among sexual and gender minority individuals, a population at disproportionately high-risk for suicidal behavior across the lifespan. 

A team of University of Pittsburgh scientists evaluated whether sexual and gender minority patients have elevated risk for suicidal behavior following discharge from psychiatric hospitalization compared with heterosexual and cisgender patients, and examined whether differences in risk across groups were accounted for by demographic characteristics and clinical factors known to be associated with suicidal behavior. Investigators including Brian Thoma, PhD (Assistant Professor of Psychiatry); Dara Sakolsky, MD, PhD (Associate Professor of Psychiatry); Antoine Douaihy, MD (Professor of Psychiatry and Medicine); David Brent, MD (Distinguished Professor of Psychiatry, Pediatrics, Epidemiology, and Clinical and Translational Science and Endowed Chair in Suicide Studies); and Nadine Melhem, PhD (Associate Professor of Psychiatry and Clinical and Translational Science), from Pitt Psychiatry, conducted a prospective cohort study among inpatients between 18-30 years old who were hospitalized at UPMC Western Psychiatric Hospital, with prospective data collected via follow-up visits and electronic health records. 

The findings were recently published in JAMA Network Open. The investigators reported that sexual and gender minority patients had higher risk for suicidal behavior than heterosexual and cisgender patients following discharge. While sexual minority patients’ risk was accounted for by clinical characteristics, gender minority patients’ risk for suicidal behavior was not accounted for by their acute psychiatric state on admission. 

“This is the first study to document increased risk for suicidal behavior among sexual and gender minority patients following their discharge from psychiatric inpatient care, including evidence of particularly high risk during this time period among gender minority patients. Our results indicate inpatient clinicians must attend to the unique needs of sexual and gender minority patients to ensure they receive affirming services,” said Dr. Thoma, the study’s first and corresponding author.

Risk for Suicidal Behavior after Psychiatric Hospitalization among Sexual and Gender Minority Patients
Thoma BC, Hone E, Roig A, Goodfriend E, Jardas EJ, Brummitt B, Riston S, Sakolsky D, Zelazny J, Marsland AL, Chen K, Douaihy AB, Brent DA, Melhem NM.
JAMA Network Open. 2023;6(9):e2333060. doi:10.1001/jamanetworkopen.2023.33060