Suicide Prevention in Inpatient Psychiatric Wards

This dissertation focuses on conducting a systematic review of suicide prevention in inpatient psychiatric wards. It aims to investigate the extent of suicide prevention measures in inpatient psychiatric wards, evaluate the barriers to suicide prevention, and identify solutions to preventing suicides in inpatient psychiatric wards.

Running head: PSYCHOLOGY DISSERTATION
PSYCHOLOGY DISSERTATION
Name of the student
Name of the university
Author note

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Table of Contents
CHAPTER 1: INTRODUCTION....................................................................................................2
1.1 Introduction............................................................................................................................2
1.2 Background to the study........................................................................................................2
1.3 Problem statement.................................................................................................................3
1.4 Research aim..........................................................................................................................3
1.5 Objectives..............................................................................................................................3
1.6 Research question..................................................................................................................4
1.7 Significance of the study.......................................................................................................4
1.8 Summary................................................................................................................................5
Bibliography:...................................................................................................................................6

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Topic: Suicide Prevention in Inpatient Psychiatric Wards
CHAPTER 1: INTRODUCTION
1.1 Introduction
Suicide is one of the leading reasons for deaths across the world especially within the last
two or three decades. As per the World Health Organization report, almost 800,000 people die
every year owing to suicide. The rate for Saudi Arabia is 3.2 per 100,000 populations. The
number is staggering and demonstrates the need for effective intervention. Organizations, both
government and nonprofit, have been formed to curb the rate of suicides in different countries
such as the International Association for Suicide Prevention, the National Institute of Mental
Health and so on. In Saudi Arabia, these international organizations operate to help people
refrain from committing suicide. One grave matter of concern is the suicides occurring in
inpatient psychiatric wards. Sakinofsky (2014) conducted a study on the deaths of patients in
psychiatric wards in the United States and found that around 48.5 to 64.9 percent of inpatient
suicides take place every year in US hospitals. Robinson et al. (2018) on the other hand, suggest
that suicide prevention especially in youth could be effective if it is focused on specific
demography such as the youth. The authors explain that suicide prevention strategies applied
within certain educational and clinical settings help reduce the harm caused by the youth on self.
This could also help prevent inpatient suicides in psychiatric wards. The research is dedicated
towards conducting a systematic review of suicide prevention in inpatient psychiatric wards. the
1.2 Background to the study
Inpatient psychiatric wards refer to the mental health centers that provide methodical
treatment to psychiatric patients in a residential background. The wards are equipped with all
kinds of facilities and amenities that include bathing, sleeping, treatment, recreation and dining
amongst others. As per the suicide prevention strategies, the inpatient psychiatric wards are
effective places where patients with suicidal tendencies are provided utmost care and support.
Inpatient psychiatric wards are opted by the staff as well because of the separate facilities
available for their patients. As Sheehan et al. (2013) observe the built environment of the
inpatient psychiatric ward plays an important role in establishing staff satisfaction. The authors

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found, “staff satisfaction with the built in environment was associated with noncorridor design
and with the provision of personal bathrooms for patients”.
The issue of suicide prevention comes from the number of patients committing suicide
within these inpatient psychiatric wards. Sakinofsky (2014) also notes that most of the suicides
in inpatient wards occur not exactly within the wards but outside it. The patient who commits
suicide was either on leave or was absconding. Studies regarding suicide in inpatient psychiatric
wards are numerous, which include the reasons behind the suicides and interventions as well.
Multiple reasons have been identified for inpatient psychiatric ward suicide among which, the
most visible are mental disorders, inability to meet medical expenses, hospital environment and
loss of social support. Other studies in this field have covered issues such as the risk factors
associated with suicides in hospital establishments, risk estimates and so on. Therefore, these
facts further establish the need to conduct a systematic review on suicide prevention in inpatient
psychiatric wards.
1.3 Research Rationale
Suicides have become one of the largest causes of deaths across the globe and yet, little research
has been done to address the issue. Suicides take place for multiple reasons but suicides in
inpatient psychiatric wards are amongst the worst. Inagaki et al. (2014) in their study on suicides
in inpatient psychiatric units in Japan found that between April 2001 to December 2012, 83%
patients committed suicide whereas 17% attempted it and sustained severe injuries. The situation
is more or less the same in other Asian countries including Saudi Arabia. As Al-Habeeb and
Qureshi (2008) have found in their research, Saudi Arabia lacks greatly in mental health
legislation despite the high rates of suicides occurring in inpatient and outpatient psychiatric
wards. the authors state that there is a remarkable lack in mental health legislation in Saudi
Arabia that could help prevent suicides in psychiatric wards. In a study by Koenig et al. (2014), it
was revealed that suicide risks are the greatest in inpatient psychiatric patients. The psychiatric
inpatients include those receiving treatment in the hospital, or are on leave or have escaped.
Numerous other studies have varying numbers of suicides in inpatient psychiatric wards ranging
from nine to almost 10,500 per 100,000 every year. Therefore, based on these facts, it could be
reiterated that an extensive research in finding prevention strategies of inpatient psychiatric
suicides is crucial and relevant.

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1.4 Problem statement
It could be identified that the rate at which suicides are occurring in inpatient psychiatric
wards, it has become essential that a study on this phenomenon be conducted. The study must
involve a systematic review of the topic because without a systematic review, relevant facts and
data might not be available. Previous studies have been undertaken on the topic but limited
attention has been given to the prevention strategies in inpatient psychiatric wards. The available
studies focus on rates and reasons of inpatient suicides in inpatient wards but not on the
prevention of these suicides. Some studies have also shown that the severity of inpatient suicides
is more than that of outpatient wards (Knoll, 2012). The reason, states Knoll (2012), is that in
inpatient wards, the staff has greater control over the patient and hence, “a greater responsibility
to prevent suicides”. Inpatient suicides also make the authority responsible for the death of the
patient and might even face judicial action. Therefore, this vulnerable situation in terms of the
responsibility of inpatient staff in psychiatry wards is a big problem and must be addressed
competently.
1.4 Research aim
The research aims to investigate the extent of suicide prevention measures in inpatient
psychiatric wards. The research also aims to examine the obstacles that come in way of
implementing suicide prevention strategies in inpatient psychiatric wards.
1.5 Objectives
 To investigate the influence or impact of inpatient psychiatric wards in suicide prevention
 To evaluate the barriers to suicide prevention in inpatient psychiatric wards
 To identify the solutions to preventing suicides in inpatient psychiatric wards
1.6 Research question
 What is the extent of suicide prevention measures in inpatient psychiatric wards?
 What solutions could be developed to prevent suicides in inpatient psychiatric wards?
1.7 Literature Review

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Implementation of prevention strategies in inpatient psychiatric wards have not been
done effectively because of the absence of strong research on the issue. As Indu suggest, suicide
prevention strategies in inpatient psychiatric wards must be under primary prevention with
maximum priority given to it. The authors found in South Asian countries that minimal priority
in low-resource settings with no significant investments are the characteristics in most South
Asian metal health facilities. The authors provided the suggestion that preventive strategies could
be aimed at the patients coming to general hospitals for a variety of health services. Thus, these
facts necessitate the need for further research on the prevention of suicides in inpatient
psychiatric wards.
1.7 Research Methodology
The research methodology that the research work has employed assists in the
identification, processing and information analysis on topics of various kinds such as the one
chosen. Research methodology helps in bringing diverse perceptions, descriptions and such to
make the research significant, valid ad reliable for both the researcher and the reader. Therefore,
the use of research methodology in the current research would help in producing a work that
could be validated by the readers as well. The topic is crucial because very little research has
been done on it. the research has employed both quantitative and qualitative research specifically
explaining and measuring the influence of suicide prevention strategies in inpatient psychiatric
wards. In case of research design, the descriptive form has been employed in order to have a
clear understanding of the concepts associated with inpatient psychiatric wards and suicide
prevention in these wards. Descriptive research design helps in enabling clear observation by the
author and the readers on the issue.
1.7.1 Research Process
In order to explain and research on suicide prevention in inpatient psychiatric wards, the research
study employs both qualitative and quantitative research processes. Quantitative research method
has been sued because it emphasizes on the statistical, mathematical and/or numerical analysis
that is collected through questionnaires, polls or surveys. This method has been used for the
research study as it would help in measuring the effectiveness of the suicide prevention measures
in inpatient psychiatric wards. Thus, it could be stated that the process is helpful in providing an

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authentic and helpful insight into the suicide prevention strategies in inpatient psychiatric wards.
On the other hand, qualitative research process has also been used for the research study as it
helps in understanding the framework behind the different suicide prevention techniques
employed in various psychiatric inpatient wards as well for understanding the reasons behind the
failures of these strategies.
1.7.2 Data Collection Methods
The research uses secondary research for collecting the evidences of suicide prevention in
inpatient psychiatric wards although quantitative process, which is part of the primary data
collection process, has been used to record the opinions of the participants. The research study
has used survey forms as quantitative method of data collection. The quantitative data is used to
measure what percentage of respondents agrees with the present prevention strategies in inpatient
psychiatric wards and what percent of respondents oppose it.
1.7.3 Data Analysis Method
To conduct qualitative data analysis, the research study applies content analysis in which
the various documents and studies related to the topic is analyzed. Content analysis is done in a
systematic manner reveals without being invasive in nature. This form of analysis involves
observation of texts, systematic reading, and artifacts observation and so on. The present
research study undertakes observation and analysis of texts as well as the survey results.
1.8 Justification for the chosen methodologies
In the research study, qualitative and quantitative – both research processes have been
used to have a better understanding of the research topic and the research problems as identified
in the research study. Both the processes are important for the research study. while the
qualitative process helps in identifying the areas that have been covered already, the quantitative
process identifies the areas that need attention in terms of suicide prevention in inpatient
psychiatric wards.
1.9 Research Limitations

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The study has certain limitations the most important being the unavailability of a large
sample size. Further, the research study lacks the efficiency to prove that suicide prevention
strategies in inpatient psychiatric wards in the Saudi Arabia are effective because the sample
does not include a large demography.
1.10 Significance of the study
The systematic review of suicide prevention in inpatient psychiatric wards is important
because it would allow those associated with the patients to prevent suicides from occurring. The
study is also important because it would lay a foundation for future researchers to research on the
issue and bring in several other factors. Further, the study would ensure that the field of study is
focused on psychiatric wards because most of the studies focus on broad inpatient suicides rather
than focusing on psychiatric wards. In addition, cases including the suicide of inpatient patients
in the psychiatric wards have increased in the past few decades and this requires attention.
Moreover, not much research or study has been done regarding the psychiatric wards suicide as
most of the studies have focused on suicides occurring after the patient has left the inpatient ward
or tried to escape. Nonetheless, the limited studies that have highlighted the topic have been
limited to the number of suicides occurring and the rate at which it is increasing; there has not
been any substantial work done on the prevention if suicides in inpatient psychiatric wards. The
study will be focusing on these previously ignored and neglected areas in order to provide
concrete solutions to the issue of suicides in inpatient psychiatric wards.
The study will benefit the mental health practitioners who are responsible for looking
after the inpatient psychiatric ward patients so that they could take the necessary steps to prevent
suicides. Other than that, it will also help the nurses encountering patient suicides to cope with
the mental distress, as reduced rates of suicides will lead to better mental stability of the nurses.
Takahashi et al. (2011) found in a study that the nurses who are exposed to suicides in inpatient
wards “suffer significant mental distress”. The authors found that the absence of or lack of health
care programs for these nurses and the “suicide-related education initiatives and mental health
care are problematic”.
1.11 Summary

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The study wanted to find out the steps and procedures that could help in suicide
prevention in inpatient psychiatric wards. Recent studies have only focused on the causes and
rates of suicides in these wards; there is some gap in the research related to the prevention of
suicides. The study results could serve multiple stakeholders including the patients, the nurses,
the other healthcare practitioners, the doctors and the hospitals and healthcare institutions in the
larger context.
The study will include four more chapters apart from the introduction chapter. Chapter 2
will provide the review of literature on suicide prevention in inpatient psychiatric wards. The
chapter will also provide the gaps that will be identified in the review. Chapter 3 will provide the
methodology used for the study. This chapter will present the methods of research used, the
research philosophy, the research design, the research approach, data collection method and so
on. Chapter 4 will be the presentation of data, which is, findings and analysis. The study will
then end with Chapter 5, which are, recommendations, conclusions and future study.
1.12 Research Structure

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CHAPTER 2: LITERATURE REVIEW
2.1 Introduction
2.2 General causes and reasons of suicides
2.2.1 Suicide definition
2.2.2 Causes and reasons
2.2.3 Consequences of suicide
2.2.4 Prevalence
2.3 Inpatient psychiatric wards
2.3.1 Meaning of inpatient wards
2.3.2 Psychiatric wards
2.3.3 Inpatient psychiatric wards
2.4 Suicides in inpatient psychiatric wards
2.4.1 Reasons
2.4.2 Intervention strategies
2.4.3 Effectiveness of the strategies
2.4.4 Preventive measures
2.5 Suicide prevention in inpatient psychiatric wards
2.5.1 Reasons for suicide in inpatient psychiatric wards

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2.5.2 Measures taken
2.5.3 Effectiveness of the measures
2.6 Gaps in the literature review

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CHAPTER 3: RESEARCH METHODOLOGY
3.1 Introduction
This chapter is extremely crucial because it encompasses the presentation as well as the
discussion of research techniques and methods that might be beneficial for completing the
research study. Furthermore, the chapter uses techniques from which futuristic research
techniques could be derived for analysis of other works. As Mackey and Gass (2015) explain,
research instills scientific and synthetically thinking and supports development of rational habits
of philosophy and organization.
The primary aim of this research study is to examine the extent of suicide prevention in
inpatient psychiatric wards. The research study has primarily followed the secondary research
method in which existing research works have been analyzed to find the gap and work on it.
However, primary research method has also been used in that survey forms have been used to
find the respondents’ views on the effectiveness of the existing suicide prevention strategies in
inpatient psychiatric wards.
3.2 Research Approach and Methods
Research methods refer to the various types of techniques used by researchers for
conducting a particular research. As McCusker and Gunaydin (2015) describe, research methods
mean the tools that researchers use to do the research. According to the authors, choosing the
right research method is vital in ensuring a flawless research study that adheres to the rules and
norms of research writing. Research methods are categorized in three sub-parts that include
qualitative, quantitative and mixed. Researchers while conducting any particular research make
use of any of the three research methods according to the requirement of their research study.
Ormston et al. (2014) further describe the importance of using research methods stating that it is
“fundamental to the advancement of any particular study field and critical to identifying the most
optimal solutions unique to particular individuals, societies or experts”.
Research approaches on the other hand refer to the approaches to the research study.
These include descriptive study, an explanatory study or an exploratory study. The current
research study employs the explanatory research approach.

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3.2.1 Primary research
The current research study makes use of primary research in identifying the ways in
which the respondents considered the suicide prevention strategies implemented by various
hospitals in Asia particularly in inpatient psychiatric wards. Thus, for using the primary data in
the research study, both qualitative and quantitative data collection methods have been
employed.
3.2.2 Secondary research
Secondary research or data refer to that kind of research or data that is available already
for the researcher in the form of published books, journals, newspapers, magazines, online
sources and so on. In case of suicides in inpatient psychiatric wards, plenty of secondary data are
available including journals, books and newspaper articles. Therefore, in the present research
study, information from the sources mentioned above has been gathered to conduct an analysis
of the secondary data. Secondary research has been majorly conducted and secondary data
primarily used in order to perform analysis with authentic facts in relation to the research
statistics.
3.2.3 Quantitative approach
Flick (2018) informs that quantitative methods of data collection are commonly based on
mathematical calculation undertaken in different formats.
3.2.4 Qualitative approach
Qualitative approach on the other hand, involves no numerical or mathematical data and
depends largely on theoretical information. As Flick (2018) suggests, qualitative approach must
be used in research where the focus is on narratives by the respondents. Qualitative approach
employs inductive logic wherein the researcher collects the data first and then tries to obtain
explanations from these data. Several forms of qualitative approach are available in the field of
research that include focus groups, data collection, data analysis and written report.
3.2.5 Mixed research approach

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As Schoonenboom and Johnson (2017) explain, the mixed method design is that type of
research where the researcher combines aspects of both quantitative and qualitative research
approaches – quantitative and qualitative data collection, data analysis and inference techniques
– for the larger purpose of depth and breadth of understanding and validation. Known also as
MMR (Mixed Methods Research), it involves exclusively multiple qualitative methods or
exclusively quantitative methods in combination.
3.3 Research Philosophy
Padilla-Díaz (2015) explains research philosophy as the philosophy on which any framed
study is performed in a tentative domain. Research philosophy is the belief regarding the way in
which any data concerning any topic is gathered or must be gathered, evaluated and used.
Research philosophy has different types that include interpretivism, positivism and pragmatism.
In the views of Creswell and Poth (2017) it is very important to choose the right type of research
philosophy. The reason is that research philosophy shapes the nature of the entire research study.
They further state that the term ‘philosophy’ in research holds an important meaning that is the
development of knowledge and its nature.
The first important aspect of research philosophy is positivism, which means that similar
to physical and natural science, operating with an observable social reality always produces law
like generalized outcomes. A researcher would be considered employing positivism when she or
he is concerned more with the reality or facts related to research.
The second aspect is interpretivism. This aspect is based on the understanding of human
nature and their differing roles as social actors. As Khan (2014) explains, interpretivism shapes
the meanings or perspectives of the researcher helping her or him to interpret the social roles as
per their advantage. Interpretivism depends both on the human subject as the tool to measure
certain phenomena and on the trained researcher thus involving both interviews and observation.
Pragmatism or realism is the third aspect of the research philosophy, which refers to the
scientific theory that emphasizes on the reality estimated by the researcher’s sense of truth. In
research, pragmatism means using that method, which appears best suited for the topic in hand.

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Pragmatism
3.4 Research Design
Descriptive
Exploratory
Explanatory
3.5 Data Collection Methods
3.5.1 Primary data collection
3.5.2 Secondary data collection
3.6 Sampling Methods
3.7 Limitations
3.8 Reliability and Validity
3.9 Timeline of the study
3.10 Summary
CHAPTER 4: PRESENTATION OF DATA
4.1 Introduction
4.2 Quantitative data
4.3 Discussion
CHAPTER 5: DATA ANALYSIS
3.7 Data Analysis
3.8 Ethical Considerations
CHAPTER 6: DISCUSSION AND INTERPRETATION OF FINDINGS
6.1 Introduction

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6.2 Quantitative data
6.3 Discussion
CHAPTER 7: IMPLICATIONS, RECOMMENDATIONS AND CONCLUSION
7.1 Implications
7.2 Recommendations
7.3 Conclusion
7.4 Future Study

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References:
Al Habeeb, A.A. and Qureshi, N.A., 2010. Mental and Social Health Atlas I in Saudi Arabia:
2007-08.
Creswell, J.W. and Poth, C.N., 2017. Qualitative inquiry and research design: Choosing among
five approaches. Sage publications.
Flick, U., 2018. An introduction to qualitative research. Sage Publications Limited.
Huang, D., Hu, D.Y., Han, Y.H., Lu, C.H. and Liu, Y.L., 2014. Five high-risk factors for
inpatient suicide. Chinese Nursing Research, 1, pp.14-16.
Inagaki, M., Kawashima, Y., Kawanishi, C., Yonemoto, N., Sugimoto, T., Furuno, T., Ikeshita,
K., Eto, N., Tachikawa, H., Shiraishi, Y. and Yamada, M., 2015. Interventions to prevent repeat
suicidal behavior in patients admitted to an emergency department for a suicide attempt: a meta-
analysis. Journal of Affective Disorders, 175, pp.66-78.
Indu, P.S., Anilkumar, T.V., Pisharody, R., Russell, P.S.S., Raju, D., Sarma, P.S., Remadevi, S.,
Amma, K.L.I., Sheelamoni, A. and Andrade, C., 2017. Prevalence of depression and past suicide
attempt in primary care. Asian journal of psychiatry, 27, pp.48-52.
Khan, S.N., 2014. Qualitative research method: Grounded theory. International Journal of
Business and Management, 9(11), pp.224-233.
Koenig, H.G., Al Zaben, F., Sehlo, M.G., Khalifa, D.A., Al Ahwal, M.S., Qureshi, N.A. and Al-
Habeeb, A.A., 2014. Mental health care in Saudi Arabia: past, present and future. Open Journal
of Psychiatry, 4(02), p.113.
Mackey, A. and Gass, S.M., 2015. Second language research: Methodology and design.
Routledge.
Madsen, T., Erlangsen, A. and Nordentoft, M., 2017. Risk estimates and risk factors related to
psychiatric inpatient suicide—an overview. International journal of environmental research and
public health, 14(3), p.253.

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McCusker, K. and Gunaydin, S., 2015. Research using qualitative, quantitative or mixed
methods and choice based on the research. Perfusion, 30(7), pp.537-542.
Ormston, R., Spencer, L., Barnard, M. and Snape, D., 2014. The foundations of qualitative
research. Qualitative research practice: A guide for social science students and researchers, 2,
pp.52-55.
Padilla-Díaz, M., 2015. Phenomenology in educational qualitative research: Philosophy as
science or philosophical science. International Journal of Educational Excellence, 1(2), pp.101-
110.
Reger, M.A., Luxton, D.D., Tucker, R.P., Comtois, K.A., Keen, A.D., Landes, S.J., Matarazzo,
B.B. and Thompson, C., 2017. Implementation methods for the caring contacts suicide
prevention intervention. Professional psychology: research and practice, 48(5), p.369.
Robinson, J., Bailey, E., Witt, K., Stefanac, N., Milner, A., Currier, D., Pirkis, J., Condron, P.
and Hetrick, S., 2018. What Works in Youth Suicide Prevention? A Systematic Review and
Meta-Analysis. EClinicalMedicine.
Sakinofsky, I., 2014. Preventing suicide among inpatients. The Canadian journal of psychiatry,
59(3), pp.131-140.
Schoonenboom, J. and Johnson, R.B., 2017. How to construct a mixed methods research design.
KZfSS Kölner Zeitschrift für Soziologie und Sozialpsychologie, 69(2), pp.107-131.
Sheehan, B., Burton, E., Wood, S., Stride, C., Henderson, E. and Wearn, E., 2013. Evaluating the
built environment in inpatient psychiatric wards. Psychiatric Services, 64(8), pp.789-795.
Takahashi, C., Chida, F., Nakamura, H., Akasaka, H., Yagi, J., Koeda, A., Takusari, E., Otsuka,
K. and Sakai, A., 2011. The impact of inpatient suicide on psychiatric nurses and their need for
support. BMC psychiatry, 11(1), p.38.
Who.int 2019. Suicide rates per (100 000 population). [online] World Health Organization.
Available at: https://www.who.int/gho/mental_health/suicide_rates_crude/en/ [Accessed 4 Mar.
2019]. (who.int, 2019)

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Williams, S.C., Schmaltz, S.P., Castro, G.M. and Baker, D.W., 2018. Incidence and method of
suicide in hospitals in the United States. The Joint Commission Journal on Quality and Patient
Safety, 44(11), pp.643-650.