Suicide is a prominent global public health problem, with approximately 800,000 people dying by suicide globally each year with a rate of 8/100,000 annually in China (WHO, 2020). While suicidality is a frequent focus of treatment in psychiatric hospital settings, far less attention has been paid to suicidality in non-psychiatric inpatient settings. Physical diseases, however, are also associated with an increased risk of suicide as nearly half of suicide deaths occur in individuals with serious physical illness (Kavalidou et al., 2017; Niu et al., 2006; Qin et al., 2008). In China, a large-scale epidemiological survey showed that the incidence of suicide attempt or suicide among inpatients in general hospitals was 3.26/100,000 (Wan et al., 2020). Nearly 6 % of inpatients reported serious suicidal ideation in a study of general hospital inpatients, a substantially higher proportion than among outpatients (Huang et al., 2019; Niu et al., 2006).

A simple explanation of this phenomena is that serious physical illnesses are often accompanied by high levels of distress and psychiatric symptoms, and are more likely to have co-morbid psychiatric disorders such as schizophrenia, mood disorders (i.e. depressive and bipolar disorders), substance use disorders, all of which are major risk factors for suicide (Paris, 2021; Shain, 2016). Previous studies have shown that physical illnesses and chronic pain were associated with increased suicide risk (Barak-Corren et al., 2023; Cheatle et al., 2023; Larsen et al., 2010; Lindner et al., 2014; Smith et al., 2004). For instance, compared with people without cancer, the risk of suicide was at least 10 times higher in the first week after receiving cancer diagnosis, more importantly, patients with a poor prognosis had a higher risk of suicide (Fang et al., 2012). Inpatients suffering from chronic diseases were at a higher suicide risk compared with other inpatients (Wan et al., 2020). Not surprisingly, severe physical symptoms, pain, and demoralizing poor prognoses are also associated with depression, anxiety and other psychiatric disorders as well as severe insomnia. Recent research has reported the prevalence of anxiety, depression and insomnia in general hospital patients to be 8.6 %, 12.0 % and 15.0 % (Cao et al., 2017; He et al., 2009) leading to higher suicide risk than in the general population (Kavalidou et al., 2017; Liu et al., 2020).

While previous studies have clearly demonstrated a strong association between physical diseases and suicidality, and that patients with significant physical illnesses were at higher suicide risk than general population (Huang et al., 2019; Niu et al., 2006; Wan et al., 2020), most of these studies were cross-sectional and lacked information on changes in suicidality and mental health status between general hospital admission and discharge. Furthermore, research on suicide risk prevention has focused almost exclusively on psychiatric inpatients with few intervention studies carried out among general hospital inpatients (Wan et al., 2020).

To address these issues, we conducted a prospective study as part of a larger “Guangdong Happiness Hospital (GHH)” initiative. We collected data exclusively on non-psychiatric inpatients from a tertiary general hospital in Guangdong Province to assess the levels of suicidality and mental health status at admission and subsequently at the time of discharge. We hope that the findings of this study will provide assistance for general hospitals in their efforts towards suicide prevention, mitigating the suicide risk, and ultimately reducing the incidence of suicidal behavior.