Wednesday, March 15, 2017

Risk of Premature Death May Be Highest in Year Following Psychiatric Hospital Discharge

Multiple studies have documented the challenges that patients with psychiatric disorders might face after being discharged from inpatient psychiatric services. A study published today in JAMA Psychiatry now finds that the first year following discharge may mark a period of increased risk of premature death from both natural and unnatural causes.

The study highlights the need for clinicians to work together to monitor and support patients shortly after a psychiatric hospitalization discharge. 

“In this national, register-based cohort study of 1,683,385 Danish residents, 48,599 of whom were discharged from inpatient psychiatric care for the first time, the risk of dying prematurely within the first year of discharge was 16 times higher than the risk for those who were not admitted to a psychiatric facility,” Roger T. Webb, Ph.D., of the University of Manchester in England and colleagues wrote. 

Webb and colleagues relied on information contained in Danish registries to identify individuals who experienced their first discharge from an inpatient psychiatric unit or a psychiatric ward in a general hospital from January 1, 1982, through December 31, 2011. The authors then compared causes of death in these patients with the remaining members of the cohort who had not been admitted for inpatient psychiatric services.

Of the 48,599 discharged patients who were included in the study, 25,006 (51.4%) were female, 35,660 (73.4%) were aged 15 to 29 years, and 33,995 (70.0%) had a length of stay of 30 days or less. Compared with people who were not admitted to psychiatric inpatient care, discharged patients were at elevated risk for all types of mortality examined (incidence rate ratio [IRR], 16.2), and their risk of dying from unnatural causes (IRR, 25.0) was considerably higher than dying from natural causes (IRR, 8.6). Patients at a particularly high risk of premature death were those who were admitted involuntarily (IRR, 30.0) and those who were diagnosed with psychoactive substance abuse disorders (IRR, 24.8). 

Across all outcomes examined, the risk of premature death during the first year after discharge was higher than the risk of death after the first year, with suicide representing the greatest differential between short-term (one-year) (IRR, 66.9) and long-term (IRR, 24.2) follow-up.

“For patients hospitalized with psychiatric disorders, the time shortly after discharge is the period in which they are at the highest risk for premature death from a variety of causes. Clinicians should keep these patients safe by serving as a liaison between primary and secondary health care services to ensure patients are receiving holistic care that meets their physical and mental health needs as well as addresses their psychosocial problems,” the authors wrote. “Patients with alcohol and drug use disorders and those admitted involuntary should be monitored particularly closely, interventions targeting substance abuse should be offered to patients at early stages of their treatment, and dedicated care coordinators should provide appropriate levels of clinical surveillance.”

For related information, see the Psychiatric News article “Psychiatric Patients at Highest Suicide Risk Following Hospital Discharge.”

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