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Suicide and other causes of death among working-age and older adults in the year after discharge from in-patient mental healthcare in England : matched cohort study
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Musgrove, Rebecca, Carr, Matthew J., Kapur, Nav, Chew-Graham, Carolyn A., Mughal, Faraz, Ashcroft, Darren M. and Webb, Roger T. (2022) Suicide and other causes of death among working-age and older adults in the year after discharge from in-patient mental healthcare in England : matched cohort study. The British Journal of Psychiatry, 221 (2). pp. 468-475. doi:10.1192/bjp.2021.176 ISSN 0007-1250.
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Official URL: http://dx.doi.org/10.1192/bjp.2021.176
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.
Item Type: | Journal Article | ||||||||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||||||
Library of Congress Subject Headings (LCSH): | Psychiatric hospital patients -- Great Britain, Mentally ill -- Care -- Great Britain, Suicidal behavior -- Treatment, Suicide -- Prevention, Self-mutilation, Mentally ill -- Rehabilitation, Suicide -- Risk factors | ||||||||||||
Journal or Publication Title: | The British Journal of Psychiatry | ||||||||||||
Publisher: | Cambridge University Press | ||||||||||||
ISSN: | 0007-1250 | ||||||||||||
Official Date: | August 2022 | ||||||||||||
Dates: |
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Volume: | 221 | ||||||||||||
Number: | 2 | ||||||||||||
Page Range: | pp. 468-475 | ||||||||||||
DOI: | 10.1192/bjp.2021.176 | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||
Date of first compliant deposit: | 25 July 2022 | ||||||||||||
Date of first compliant Open Access: | 26 July 2022 | ||||||||||||
RIOXX Funder/Project Grant: |
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