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covered in the analysis are factors that were related to the hospital setting during the period in ques-tion. Examples include the conditions of in-patients, staff numbers and transfers, and relationships among the staff and between the frontline and other staff in the hierarchy of the organisation. Addressing these limitations in future research can provide insights on the signs of imminent suicide risk among psychiatric in-patients.AcknowledgmentsWe dedicate the results of this study to the memory of the 18 individuals whose cases we anal-ysed. We also express our sincere thanks to the faculty of the Graduate School of Health and Sports Science, Juntendo University, Doctor Masafumi Sato (Asahinooka Mental Clinics), and the staff at Asahinooka Hospital for the valuable advice they provided.Author contributionsHS, IU, NS, and TF designed this study. HS, IU, CS, SS, and KY carried out the analyses. HS summarised the result and wrote the manuscript with the support and guidance from IU, NS, and TO. IU, NS, and TF supervised the project. All authors read and approved this manuscript.Conflicts of interest statementThe authors declare that there are no conflicts of interest.References 1) Walsh G, Sara G, Ryan CJ, Large M: Meta-analysis of suicide rates among psychiatric in-patients. Acta Psychiatr Scand, 2015; 131: 174-184. 2) Large M, Smith G, Sharma S, Nielssen O, Singh SP: Systematic review and meta-analysis of the clinical factors associated with the suicide of psychiatric in- patients. Acta Psychiatr Scand, 2011; 124: 18-29. 3) Large M, Myles N, Myles H, et al: Suicide risk assess-270ment among psychiatric inpatients: a systematic review and meta-analysis of high-risk categories. Psychol Med, 2018; 48: 1119-1127. 4) Menon V: Suicide risk assessment and formulation: an update. Asian J Psychiatr, 2013; 6: 430-435. 5) Neuner T, Schmid R, Wolfersdorf M, Spiessl H: Predicting inpatient suicides and suicide attempts by using clinical routine data? Gen Hosp Psychiatry, 2008; 30: 324-330. 6) Powell J, Geddes J, Deeks J, Goldacre M, Hawton K: Suicide in psychiatric hospital in-patients. Risk factors and their predictive power. Br J Psychiatry, 2000; 176: 266-272. 7) Rudd MD, Berman AL, Joiner TE, et al: Warning signs for suicide: theory, research, and clinical applications. Suicide Life Threat Behav, 2006; 36: 255-262. 8) Yaseen ZS, Hawes M, Barzilay S, Galynker I: Predic-tive validity of proposed diagnostic criteria for the suicide crisis syndrome: an acute presuicidal state. Suicide Life Threat Behav, 2019; 49: 1124-1135. 9) Kim EJ, Kim Y, Lee G, et al: Comparing warning signs of suicide between suicide decedents with depression and those non-diagnosed psychiatric disorders. Suicide Life Threat Behav, 2021; 00: 1-12. 10) Janofsky JS: Reducing inpatient suicide risk: using human factors analysis to improve observation prac-tices. J Am Acad Psych Law, 2009; 37: 15-24.11) Sakinofsky I: Preventing suicide among inpatients. Can J Psych, 2014; 59: 131-140.12) Deisenhammer EA, Ing CM, Strauss R, Kemmler G, Hinterhuber H, Weiss EM: The duration of the suicidal process: How much time is left for intervention between consideration and accomplishment of a suicidal attempt? J Clin Psychiatry, 2009; 70: 19-24.13) Nagata K, Hasegawa M: Analysis of emotions and conditions of depression person before and after their suicide attempts -from the narrative by narrative approach. J Japan Acad Psych Mental Health Nurs, 2013; 22: 1-11. (in Japanese)14) Berman AL: Risk factors proximate to suicide and suicide risk assessment in the context of denied suicide ideation. Suicide Life Threat Behav, 2018; 48: 340-352.15) Takahata N: Jisatsu[suicide]. In: Itou M, Imura H, Takaku F eds. Igaku-shoin’s medical dictionary. Tokyo: Igakushoin, 2003: 1028. (in Japanese)16) Britton PC, Ilgen MA, Rudd MD, Conner KR: Warning signs for suicide within a week of healthcare contact in veteran decedents. Psych Res, 2012; 200: 395-399.17) Britton PC, Conner KR, Maisto SA: The living ladder: introduction and validity over 6-month follow-up of a one-item measure of readiness to continue living in suicidal patients. Suicide Life Threat Behav, 2020; 50: 1025-1040.18) Fukuoka K: Accident models and their applicable industries. J Sci Labour, 2017; 93: 48-60. (in Japanese)FundingNo funding was received.