Rebecca Musgrove1, Matthew J Carr2, Nav Kapur3, Carolyn A Chew-Graham4, Faraz Mughal5, Darren M Ashcroft2, Roger T Webb1. 1. National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Mental Health and Safety, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Manchester Academic Health Science Centre, UK. 2. National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Manchester Academic Health Science Centre, UK. 3. National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Mental Health and Safety, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK; and Greater Manchester Mental Health NHS Foundation Trust, UK. 4. School of Medicine, Keele University, UK. 5. School of Medicine, Keele University, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, UK; and Unit of Academic Primary Care, University of Warwick, UK.
Abstract
BACKGROUND: Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse. AIMS: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse. AIMS: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Matthew Large; Swapnil Sharma; Elisabeth Cannon; Christopher Ryan; Olav Nielssen Journal: Aust N Z J Psychiatry Date: 2011-07-11 Impact factor: 5.744
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Authors: Florian Walter; Matthew J Carr; Pearl L H Mok; Aske Astrup; Sussie Antonsen; Carsten B Pedersen; Jenny Shaw; Roger T Webb Journal: JAMA Psychiatry Date: 2017-05-01 Impact factor: 21.596
Authors: R Musgrove; M J Carr; N Kapur; C A Chew-Graham; F Mughal; D M Ashcroft; R T Webb Journal: Epidemiol Psychiatr Sci Date: 2022-05-06 Impact factor: 7.818