Multiple adverse outcomes following first discharge from inpatient psychiatric care: a national cohort study

Florian Walter, Matthew Carr, Pearl Mok, Sussie Antonsen, Carsten Pedersen, Louis Appleby, Seena Fazel, Jennifer Shaw, Roger Webb

Research output: Contribution to journalArticlepeer-review


Background: Discharged psychiatric inpatients are at elevated risk for serious adverse outcomes, but no previous study has comprehensively examined an array of multiple risks in a single cohort.
Methods: Among all persons born in Denmark, 1967-2000, we delineated a cohort of individuals discharged from their first inpatient psychiatric episode following 15th birthday (N=62,922) who were matched on age and gender with 25 comparators without history of psychiatric admission. Using survival analysis techniques, absolute and relative risks to 31st December 2015 were estimated for: 1.all-cause mortality; 2. suicide; 3. accidental death; 4. homicide victimisation; 5. homicide perpetration; 6. non-fatal self-harm; 7. violent criminality; 8. hospitalisation following violence.
Findings: Risks for each of the eight outcomes examined were markedly elevated in the discharged cohort. Within 10 years of their first discharge, 37.1% (95% confidence interval, CI 36.5, 37.8) of males and 27.2% of females (95% CI 26.7, 27.8) will have died, harmed themselves, committed a violent crime, or been hospitalised due to interpersonal violence. Absolute risks for experiencing at least one of the adverse outcomes examined within this timeframe were highest in persons diagnosed with a psychoactive substance abuse disorder at first discharge and lowest in those diagnosed with a mood disorder. For suicide and non-fatal self-harm, risks were especially high during the first three months post-discharge, whereas risks for accidental death, violent criminality and being hospitalised due to violence were relatively constant throughout the 10-year follow-up.
Interpretation: Discharged persons are at much higher risk than the rest of the population for experiencing a range of serious fatal and non-fatal adverse outcomes. Improved inter-agency liaison, intensive follow-up immediately after discharge and longer-term social support are therefore indicated.
Original languageEnglish
Pages (from-to)582-589
JournalThe Lancet Psychiatry
Issue number7
Early online date4 Jun 2019
Publication statusPublished - 4 Jun 2019


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