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Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge
Importance There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. Objective To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and in...
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| Published in: | JAMA network open 2024-06, Vol.7 (6), p.e2417131 |
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| creator | Mortier, Philippe Conde, Susana Alayo, Itxaso Amigo, Franco Ballester, Laura Cirici Amell, Roser Guinart, Daniel Contaldo, Salvatore Fabrizio Ferrer, Montserrat Leis, Angela Mayer, Miguel Angel Portillo-Van Diest, Ana Puértolas-Gracia, Beatriz Ramírez-Anguita, Juan Manuel Peña-Salazar, Carlos Sanz, Ferran Kessler, Ronald C. Palao, Diego Pérez Sola, Víctor Mehlum, Lars Qin, Ping Vilagut, Gemma Alonso, Jordi |
| description | Importance There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. Objective To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. Design, Setting, and Participants This retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. Exposures Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Main Outcomes and Measures Postdischarge premature death (ie, all-cause death before age 70 years) and suicide ( International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. Results A total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with po |
| doi_str_mv | 10.1001/jamanetworkopen.2024.17131 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11208976</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3072295381</sourcerecordid><originalsourceid>FETCH-LOGICAL-a296t-bd9dca43e42be05ad077b08c82b37ffcb58284aff2efa36388611f9fe22c4c453</originalsourceid><addsrcrecordid>eNpdkctO3jAQha2qqCDKO0SsWJAfe5yLwwYhKBcJtUi0i66siTMmpkn813aKeHvCRaiwmiPN0ZnLx9iu4CvBuTi4wxEnSvc-_PFrmlbAoViJWkjxiW1BWRe5VLz8_J_eZDsx3nHOgQvZVOUXtilVA1AB32K_rwONmOZA2Slh6vezm9kZ19F-hlOXfffTQKnHIbucEk3J-WnRNzTY_ALDmB3bRCG7jg-md5iCM9mpi6bHcEtf2YbFIdLOa91mv86-_Ty5yK9-nF-eHF_lCE2V8rZrOoOFpAJa4iV2vK5broyCVtbWmrZUoAq0FsiirKRSlRC2sQRgClOUcpsdveSu53akzixbBhz0OrgRw4P26PT7zuR6fev_aSGAq6auloS914Tg_84Ukx6XI2gYlkf7OWrJa4CmlEos1sMXqwk-xkD2bY7g-omP_sBHP_HRz3zkI6eTiVc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3072295381</pqid></control><display><type>article</type><title>Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge</title><source>Publicly Available Content Database</source><creator>Mortier, Philippe ; Conde, Susana ; Alayo, Itxaso ; Amigo, Franco ; Ballester, Laura ; Cirici Amell, Roser ; Guinart, Daniel ; Contaldo, Salvatore Fabrizio ; Ferrer, Montserrat ; Leis, Angela ; Mayer, Miguel Angel ; Portillo-Van Diest, Ana ; Puértolas-Gracia, Beatriz ; Ramírez-Anguita, Juan Manuel ; Peña-Salazar, Carlos ; Sanz, Ferran ; Kessler, Ronald C. ; Palao, Diego ; Pérez Sola, Víctor ; Mehlum, Lars ; Qin, Ping ; Vilagut, Gemma ; Alonso, Jordi</creator><creatorcontrib>Mortier, Philippe ; Conde, Susana ; Alayo, Itxaso ; Amigo, Franco ; Ballester, Laura ; Cirici Amell, Roser ; Guinart, Daniel ; Contaldo, Salvatore Fabrizio ; Ferrer, Montserrat ; Leis, Angela ; Mayer, Miguel Angel ; Portillo-Van Diest, Ana ; Puértolas-Gracia, Beatriz ; Ramírez-Anguita, Juan Manuel ; Peña-Salazar, Carlos ; Sanz, Ferran ; Kessler, Ronald C. ; Palao, Diego ; Pérez Sola, Víctor ; Mehlum, Lars ; Qin, Ping ; Vilagut, Gemma ; Alonso, Jordi</creatorcontrib><description>Importance There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. Objective To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. Design, Setting, and Participants This retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. Exposures Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Main Outcomes and Measures Postdischarge premature death (ie, all-cause death before age 70 years) and suicide ( International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. Results A total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males). Conclusions and Relevance In this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2024.17131</identifier><identifier>PMID: 38922620</identifier><language>eng</language><publisher>American Medical Association</publisher><subject>Online Only ; Original Investigation ; Psychiatry</subject><ispartof>JAMA network open, 2024-06, Vol.7 (6), p.e2417131</ispartof><rights>Copyright 2024 Mortier P et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-a296t-bd9dca43e42be05ad077b08c82b37ffcb58284aff2efa36388611f9fe22c4c453</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,786,790,891,27957,27958,37048</link.rule.ids></links><search><creatorcontrib>Mortier, Philippe</creatorcontrib><creatorcontrib>Conde, Susana</creatorcontrib><creatorcontrib>Alayo, Itxaso</creatorcontrib><creatorcontrib>Amigo, Franco</creatorcontrib><creatorcontrib>Ballester, Laura</creatorcontrib><creatorcontrib>Cirici Amell, Roser</creatorcontrib><creatorcontrib>Guinart, Daniel</creatorcontrib><creatorcontrib>Contaldo, Salvatore Fabrizio</creatorcontrib><creatorcontrib>Ferrer, Montserrat</creatorcontrib><creatorcontrib>Leis, Angela</creatorcontrib><creatorcontrib>Mayer, Miguel Angel</creatorcontrib><creatorcontrib>Portillo-Van Diest, Ana</creatorcontrib><creatorcontrib>Puértolas-Gracia, Beatriz</creatorcontrib><creatorcontrib>Ramírez-Anguita, Juan Manuel</creatorcontrib><creatorcontrib>Peña-Salazar, Carlos</creatorcontrib><creatorcontrib>Sanz, Ferran</creatorcontrib><creatorcontrib>Kessler, Ronald C.</creatorcontrib><creatorcontrib>Palao, Diego</creatorcontrib><creatorcontrib>Pérez Sola, Víctor</creatorcontrib><creatorcontrib>Mehlum, Lars</creatorcontrib><creatorcontrib>Qin, Ping</creatorcontrib><creatorcontrib>Vilagut, Gemma</creatorcontrib><creatorcontrib>Alonso, Jordi</creatorcontrib><title>Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge</title><title>JAMA network open</title><description>Importance There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. Objective To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. Design, Setting, and Participants This retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. Exposures Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Main Outcomes and Measures Postdischarge premature death (ie, all-cause death before age 70 years) and suicide ( International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. Results A total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males). Conclusions and Relevance In this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.</description><subject>Online Only</subject><subject>Original Investigation</subject><subject>Psychiatry</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpdkctO3jAQha2qqCDKO0SsWJAfe5yLwwYhKBcJtUi0i66siTMmpkn813aKeHvCRaiwmiPN0ZnLx9iu4CvBuTi4wxEnSvc-_PFrmlbAoViJWkjxiW1BWRe5VLz8_J_eZDsx3nHOgQvZVOUXtilVA1AB32K_rwONmOZA2Slh6vezm9kZ19F-hlOXfffTQKnHIbucEk3J-WnRNzTY_ALDmB3bRCG7jg-md5iCM9mpi6bHcEtf2YbFIdLOa91mv86-_Ty5yK9-nF-eHF_lCE2V8rZrOoOFpAJa4iV2vK5broyCVtbWmrZUoAq0FsiirKRSlRC2sQRgClOUcpsdveSu53akzixbBhz0OrgRw4P26PT7zuR6fev_aSGAq6auloS914Tg_84Ukx6XI2gYlkf7OWrJa4CmlEos1sMXqwk-xkD2bY7g-omP_sBHP_HRz3zkI6eTiVc</recordid><startdate>20240603</startdate><enddate>20240603</enddate><creator>Mortier, Philippe</creator><creator>Conde, Susana</creator><creator>Alayo, Itxaso</creator><creator>Amigo, Franco</creator><creator>Ballester, Laura</creator><creator>Cirici Amell, Roser</creator><creator>Guinart, Daniel</creator><creator>Contaldo, Salvatore Fabrizio</creator><creator>Ferrer, Montserrat</creator><creator>Leis, Angela</creator><creator>Mayer, Miguel Angel</creator><creator>Portillo-Van Diest, Ana</creator><creator>Puértolas-Gracia, Beatriz</creator><creator>Ramírez-Anguita, Juan Manuel</creator><creator>Peña-Salazar, Carlos</creator><creator>Sanz, Ferran</creator><creator>Kessler, Ronald C.</creator><creator>Palao, Diego</creator><creator>Pérez Sola, Víctor</creator><creator>Mehlum, Lars</creator><creator>Qin, Ping</creator><creator>Vilagut, Gemma</creator><creator>Alonso, Jordi</creator><general>American Medical Association</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240603</creationdate><title>Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge</title><author>Mortier, Philippe ; Conde, Susana ; Alayo, Itxaso ; Amigo, Franco ; Ballester, Laura ; Cirici Amell, Roser ; Guinart, Daniel ; Contaldo, Salvatore Fabrizio ; Ferrer, Montserrat ; Leis, Angela ; Mayer, Miguel Angel ; Portillo-Van Diest, Ana ; Puértolas-Gracia, Beatriz ; Ramírez-Anguita, Juan Manuel ; Peña-Salazar, Carlos ; Sanz, Ferran ; Kessler, Ronald C. ; Palao, Diego ; Pérez Sola, Víctor ; Mehlum, Lars ; Qin, Ping ; Vilagut, Gemma ; Alonso, Jordi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a296t-bd9dca43e42be05ad077b08c82b37ffcb58284aff2efa36388611f9fe22c4c453</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Online Only</topic><topic>Original Investigation</topic><topic>Psychiatry</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mortier, Philippe</creatorcontrib><creatorcontrib>Conde, Susana</creatorcontrib><creatorcontrib>Alayo, Itxaso</creatorcontrib><creatorcontrib>Amigo, Franco</creatorcontrib><creatorcontrib>Ballester, Laura</creatorcontrib><creatorcontrib>Cirici Amell, Roser</creatorcontrib><creatorcontrib>Guinart, Daniel</creatorcontrib><creatorcontrib>Contaldo, Salvatore Fabrizio</creatorcontrib><creatorcontrib>Ferrer, Montserrat</creatorcontrib><creatorcontrib>Leis, Angela</creatorcontrib><creatorcontrib>Mayer, Miguel Angel</creatorcontrib><creatorcontrib>Portillo-Van Diest, Ana</creatorcontrib><creatorcontrib>Puértolas-Gracia, Beatriz</creatorcontrib><creatorcontrib>Ramírez-Anguita, Juan Manuel</creatorcontrib><creatorcontrib>Peña-Salazar, Carlos</creatorcontrib><creatorcontrib>Sanz, Ferran</creatorcontrib><creatorcontrib>Kessler, Ronald C.</creatorcontrib><creatorcontrib>Palao, Diego</creatorcontrib><creatorcontrib>Pérez Sola, Víctor</creatorcontrib><creatorcontrib>Mehlum, Lars</creatorcontrib><creatorcontrib>Qin, Ping</creatorcontrib><creatorcontrib>Vilagut, Gemma</creatorcontrib><creatorcontrib>Alonso, Jordi</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mortier, Philippe</au><au>Conde, Susana</au><au>Alayo, Itxaso</au><au>Amigo, Franco</au><au>Ballester, Laura</au><au>Cirici Amell, Roser</au><au>Guinart, Daniel</au><au>Contaldo, Salvatore Fabrizio</au><au>Ferrer, Montserrat</au><au>Leis, Angela</au><au>Mayer, Miguel Angel</au><au>Portillo-Van Diest, Ana</au><au>Puértolas-Gracia, Beatriz</au><au>Ramírez-Anguita, Juan Manuel</au><au>Peña-Salazar, Carlos</au><au>Sanz, Ferran</au><au>Kessler, Ronald C.</au><au>Palao, Diego</au><au>Pérez Sola, Víctor</au><au>Mehlum, Lars</au><au>Qin, Ping</au><au>Vilagut, Gemma</au><au>Alonso, Jordi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge</atitle><jtitle>JAMA network open</jtitle><date>2024-06-03</date><risdate>2024</risdate><volume>7</volume><issue>6</issue><spage>e2417131</spage><pages>e2417131-</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Importance There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. Objective To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. Design, Setting, and Participants This retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. Exposures Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Main Outcomes and Measures Postdischarge premature death (ie, all-cause death before age 70 years) and suicide ( International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. Results A total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males). Conclusions and Relevance In this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.</abstract><pub>American Medical Association</pub><pmid>38922620</pmid><doi>10.1001/jamanetworkopen.2024.17131</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | JAMA network open, 2024-06, Vol.7 (6), p.e2417131 |
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| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11208976 |
| source | Publicly Available Content Database |
| subjects | Online Only Original Investigation Psychiatry |
| title | Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge |
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