Understanding the Risks of Recent Discharge The Phenomenological Lived Experiences - "Existential Angst at the Prospect of Discharge"

Background: Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and that the time immediately following discharge after such hospitalizations is a particularly high-risk time. Aims: This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better understand the observed increased risk for suicide following discharge from an inpatient psychiatric service. Methods: A purposive sample of 20 recently discharged former suicidal inpatients was obtained. Data were collected in hermeneutic interviews lasting between 1 h and 2 h and analyzed according to van Manen's (1997) interpretation of hermeneutic phenomenology. Results: Two key themes, "existential angst at the prospect of discharge" and "trying to survive while living under the proverbial 'sword of Damocles'" were induced. Each of these was comprised of five themes with the first key theme (which is the focus of this paper) encompassing the following: "Feeling scared, anxious, fearful and/or stressed," "Preparedness," "Leaving the place of safety," "Duality and ambivalence," and "Feel like a burden." Conclusions: Early exploration of and reconciling of patients' expectations regarding inpatient care for their suicidality would be empirically based interventions that could diminish the postdischarge risk for further suicide attempts.