Die Suizide während des stationären Aufenthaltes an der psychiatrischen Universitätsklinik Tübingen von 1992 bis 2010

Abstract

Diese Arbeit führt die Untersuchungsreihe zu den Patientensuiziden in der Psychiatrischen Universitätsklinik Tübingen weiter. Seit 1965 verfolgt unsere Studie den Verlauf der Suizidrate an der psychiatrischen Klinik und vertieft den Einblick in die Vorfälle durch Vergleiche mit einer Kontrollgruppe. Es stellten sich in der vorliegenden Arbeit dieselben Fragen wie bei Grandel, Gill und Kliebhan: War ein Anstieg oder eine Abnahme in der Suizidrate zu verzeichnen, wie ließen sich die Kliniksuizide charakterisieren und fanden sich signifikante Unterschiede zwischen den Suizidenten und einer Kontrollgruppe bezüglich Sozialdaten, Krankheitsdaten, Therapie und Verlauf? Die Kontrollgruppe bestand in dieser Arbeit zum ersten Mal aus drei Kontrollpatienten pro Suizidpatient, abgestimmt nach Diagnose, Alter, Aufnahmezeitpunkt und Station.

Aims: This study follows on a series of clinical surveys at the psychiatry of Tübingen regarding in-patient suicides. On one hand it looks into the trend of the clinical suicidal rate over the period from 1965 to 2010, on the other hand the characteristics, risk factors and predictors of inpatient suicides in a case-control-study. Design: Retrospective case-control-study. Method:On the basis of medical files and on consultations with patients a data entry form was created. For both survey groups, suicide victims and control group (1:3), social and illness specific data, data on treatment, hospitalization and data on suicidal/suicide were compiled. Results: Considering the suicidal rate of the psychiatry of the University of Tübingen, a decline is recognisable. For 41.242 admissions at the hospital there where 41 suicides. This results in 99.4 suicides per 100.000. In comparison with the control group the social data of suicide victims showed a significant extend of isolation and often a higher education, a significantly higher desperation, desultoriness and often a broken-home-situation. The most frequent diagnoses where depression and schizophrenia. Many suicide patients had a family anamnesis with a background of mental illness, whereas family members often had the same diagnosis. Averaged, the suicide victims received a more intense medical treatment. Suicidality as reason for the actual hospitalization was found significantly more often in the suicide-group. Also a frequent change of ward, followed by a frequent change of care personal dominated in the suicide-group. Furthermore the group showed a significantly higher rate of suicide attempts in their history. In the most cases the suicide itself occurred unexpected, in the early phases of therapy, during the day, outside the ward, nearly exclusively with rigorous methods. Conclusions: It is recommended that the daily clinical routine should be organized in a way, to treat risk factors highly sensible. Especially the emergency psychiatry should provide a continuously stable and supportive environment for vulnerable patients.