Mortality Increased in Patients Recently Discharged From Inpatient Treatment

Clinicians should serve as a liaison between primary and secondary caregivers for patients recently discharged from inpatient psychiatric care.
Clinicians should serve as a liaison between primary and secondary caregivers for patients recently discharged from inpatient psychiatric care.

Results of a cohort study published in JAMA Psychiatry show that mortality due to various causes is elevated in patients who were recently discharged from inpatient psychiatric treatment for the first time.1

Individuals with mental disorders have an increased risk of premature death, which may be exacerbated by the shift in psychiatric care from inpatient facilities to community settings, jails, and prisons in recent decades.2-4 This risk of mortality has been found to be particularly elevated soon after discharge from inpatient psychiatric care.5 In previous research on the topic, there has been substantial variation in the types of settings, outcome measures, and patients included.

The current study focused on a national cohort of patients (age 15 to 44) in the first year following discharge from an inpatient psychiatric facility, although the mortality risk up to 30 years post-discharge was also examined in order to understand the short-term risk in a broader context. Of the 1,683,385 people born in Denmark over a 30-year period, 48,599 (51.4% female) were discharged from a psychiatric unit on or after their 15th birthday, and they were followed from that point until death, emigration, or the end of the study.

These patients, whose length of stay was 30 days or less in 70% of cases, were compared with individuals who had not been admitted to a psychiatric facility with a variety of diagnoses, including substance abuse disorders, and 5 different causes of death. Patient information was obtained from several national Danish registries.

The findings reveal the following observations in the patient group vs the rest of the population.

  • a higher risk of all-cause mortality within 1 year (incident rate ratio [IRR], 16.2; 95% CI, 14.5-18.0)
  • a higher risk of unnatural death (IRR, 25.0; 95% CI, 22.0-28.4) vs natural death (IRR, 8.6; 95% CI, 7.0-10.7)
  • the highest IRR for suicide, at 66.9 (95% CI, 56.4-79.4), followed by alcohol-related death, at 42.0 (95% CI, 26.6-66.1)
  • substance abuse was linked with the highest risk of all-cause mortality vs other psychiatric categories (IRR, 24.8; 95% CI, 21.0-29.4).
  • a higher risk of premature death in the first year post-discharge (vs subsequent years) across the range of mortality causes

For patients recently discharged from inpatient psychiatric care, clinicians should “keep these patients safe by serving as a liaison between primary and secondary health care services to ensure [it] meets their physical and mental health needs as well as addresses their psychosocial problems,” the investigators wrote. “Given that risk is markedly elevated for so many causes of death, and especially so soon after discharge, clinicians, academics, and public health specialists should carefully consider the multiple mechanisms for premature death that are likely implicated.”

References

  1. Walter F, Carr MJ, Mok PL, et al. Premature mortality among patients recently discharged from their first inpatient psychiatric treatment [published online March 15, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.0071
  2. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015;72(4):334-341. doi:10.1001/jamapsychiatry.2014.2502
  3. Salinsky E, Loftis C. Issue Brief Natl Health Policy Forum. 2007;(823):1-21.
  4. Lamb HR, Weinberger LE. The shift of psychiatric inpatient care from hospitals to jails and prisons. J Am Acad Psychiatry Law. 2005;33(4):529-534.
  5. Hoang U, Stewart R, Goldacre MJ. Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006. BMJ. 2011;343:d5422.  
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