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Suicide and death by other causes among patients with a severe mental illness : cohort study comparing risks among patients discharged from inpatient care v. those treated in the community
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Musgrove, R., Carr, M. J., Kapur, N., Chew-Graham, C. A., Mughal, F., Ashcroft, D. M. and Webb, R. T. (2022) Suicide and death by other causes among patients with a severe mental illness : cohort study comparing risks among patients discharged from inpatient care v. those treated in the community. Epidemiology and Psychiatric Sciences, 31 . e32. doi:10.1017/S2045796022000075 ISSN 2045-7979.
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WRAP-Suicide-and-death by-other-causes-among-patients-with-a-severe-mental-illness-Mughar-2022.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (282Kb) | Preview |
Official URL: http://dx.doi.org/10.1017/S2045796022000075
Abstract
Aims
People diagnosed with a severe mental illness (SMI) are at elevated risk of dying prematurely compared to the general population. We aimed to understand the additional risk among people with SMI after discharge from inpatient psychiatric care, when many patients experience an acute phase of their illness.
Methods
In the Clinical Practice Research Datalink (CPRD) GOLD and Aurum datasets, adults aged 18 years and older who were discharged from psychiatric inpatient care in England between 2001 and 2018 with primary diagnoses of SMI (schizophrenia, bipolar disorder, other psychoses) were matched by age and gender with up to five individuals with SMI and without recent hospital stays. Using survival analysis approaches, cumulative incidence and adjusted hazard ratios were estimated for all-cause mortality, external and natural causes of death, and suicide. All analyses were stratified by younger, middle and older ages and also by gender.
Results
In the year after their discharge, the risk of dying by all causes examined was higher than among individuals with SMI who had not received inpatient psychiatric care recently. Suicide risk was 11.6 times (95% CI 6.4–20.9) higher in the first 3 months and remained greater at 2–5 years after discharge (HR 2.3, 1.7–3.2). This risk elevation remained after adjustment for self-harm in the 6 months prior to the discharge date. The relative risk of dying by natural causes was raised in the first 3 months (HR 1.6, 1.3–1.9), with no evidence of elevation during the second year following discharge.
Conclusions
There is an additional risk of death by suicide and natural causes for people with SMI who have been recently discharged from inpatient care over and above the general risk among people with the same diagnosis who have not recently been treated as an inpatient. This mortality gap shows the importance of continued focus, following discharge, on individuals who require inpatient care.
| Item Type: | Journal Article | |||||||||
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| Subjects: | H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Mentally ill , Mentally ill -- Rehabilitation, Mentally ill -- Patients -- Care , Mentally ill -- Suicidal behavior , Psychiatric hospital care , Community mental health services, Schizophrenia | |||||||||
| Journal or Publication Title: | Epidemiology and Psychiatric Sciences | |||||||||
| Publisher: | Cambridge University Press | |||||||||
| ISSN: | 2045-7979 | |||||||||
| Official Date: | 6 May 2022 | |||||||||
| Dates: |
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| Volume: | 31 | |||||||||
| Number of Pages: | 9 | |||||||||
| Article Number: | e32 | |||||||||
| DOI: | 10.1017/S2045796022000075 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 23 May 2022 | |||||||||
| Date of first compliant Open Access: | 23 May 2022 | |||||||||
| RIOXX Funder/Project Grant: |
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