Abstract
Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse. To estimate risks of all-cause mortality, natural and external-cause deaths, suicide and accidental, alcohol-specific and drug-related deaths in working-age and older adults within a year post-discharge. Using interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink we delineated a cohort of discharged adults in England, 2001-2018. Each patient was matched to up to 20 general population comparator patients. Cumulative incidence (absolute risks) and hazard ratios (relative risks) were estimated separately for ages 18-64 and ≥65 years with additional stratification by gender and practice-level deprivation. The 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0-2.3) and 14.1% (95% CI 13.6-14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191.1 (95% CI 125.0-292.0) among working-age adults and 125.4 (95% CI 52.6-298.9) in older adults. Older patients were vulnerable to dying by natural causes within 3 months post-discharge. Risk of dying by external causes was greater among discharged working-age adults in the least deprived areas. Relative risk of suicide in discharged working-age women relative to their general population peers was double the equivalent male risk elevation. Recently discharged adults at any age are at increased risk of dying from external and natural causes, indicating the importance of close monitoring and provision of optimal support to all such patients, particularly during the first 3 months post-discharge.
Highlights
Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse
The elevated risk for each cause of death examined in the workingage population, in the first three months after discharge, was similar to the results reported in a study conducted using national interlinked Danish registry data, the relative risk for all-cause mortality was lower and that for suicide was higher in our study.[13]
The elevated risk of death by natural causes in the first 3 months after discharge identified in older adults with and without dementia was identified in American Veterans with dementia discharged from in-patient psychiatric care.[20]. This is of concern and we suggest that follow-up support for older adults should be holistic, including social support, physical health assessment and adjustments to living arrangements
Summary
Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse. Patients may still be extremely unwell and could be returning to difficult life circumstances.[1] The period shortly after discharge has been identified as a time of greatly elevated suicide risk.[2,3] Studies have identified an increased risk of dying by natural causes in people with experience of in-patient psychiatric admission relative to those without such a history.[4] heightened suicide risk after discharge is well established[2,3] studies often lack a comparison with the general population. Few studies have examined the relative risk for a range of causes of death occurring within the first year of discharge across both working-age and older adult populations, precluding direct comparison of these risks.[6]
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