DEATHS BY SUICIDE DURING INPATIENT TREATMENT AMONG FINNISH FORENSIC PSYCHIATRIC PATIENTS

This study examined deaths by suicide during inpatient forensic psychiatric treatment in Finland between 1980 and 2009. The cohort included 1,253 patients (153 women, 1,100 men) assigned to involuntary treatment after being deemed criminally irresponsible due to mental illness. The patients were followed until the end of 2011, during which 351 deaths occurred, including 31 suicides. Suicides occurred on average 3.3 years after treatment initiation, with a mean age of 37.2 years at death. Hanging was the most common method (64.5%), followed by drug overdose, drowning and jumping from a height. Suicide risk persisted throughout the entire course of treatment, from as early as one month to more than 14 years after admission. The analyses revealed that 32.3% of those who died by suicide had committed a violent offense against a family member (e.g. parent, child or spouse), compared to 17.7% of those who did not, a statistically significant difference (p=0.037). Additionally, substance use disorder (SUD) was significantly less common among patients committing suicide (41.9%) than among non-suicide patients (60.5%), a difference that was statistically significant (p=0.042). These findings suggest that suicide during forensic psychiatric care may be associated with a history of serious intrafamilial violence and that it may occur independently of comorbid substance use. The persistence of suicide risk over extended treatment periods highlights the importance of continuous risk assessment and individualized support strategies throughout the course of forensic psychiatric hospitalization.