Premature Mortality Among Patients Recently Discharged From Their First Inpatient Psychiatric Treatment

Florian Walter, Matthew Carr, Pearl Mok, Aske Astrup, Sussie Antonsen, Carsten B. Pedersen, Jennifer Shaw, Roger Webb

Research output: Contribution to journalArticlepeer-review


Importance: Patients recently discharged from psychiatric inpatient services are at elevated risk of dying prematurely. National cohorts provide sufficient statistical power for examining cause-specific mortality in this population.

Objective: To comprehensively investigate premature mortality in a national cohort of recently discharged psychiatric patients at 15-44 years of age.
Design, setting, and participants: Cohort study of all persons born in Denmark during 1967-1996 (N=1,683,385). Participants were followed up from their 15th birthday until their date of death, emigration or December 31st 2011, whichever came first.

Exposures: First discharge from inpatient psychiatric care.
Main outcome measures: Incidence rates and incidence rate ratios (IRRs) for all-cause mortality and for an array of unnatural and natural causes among discharged patients versus persons not admitted for psychiatric care. Our primary analysis considered risk within a year of first discharge.

Results: Compared to persons not admitted, discharged patients had an elevated risk for all-cause mortality within a year (IRR 16.2, 95% CI 14.5-18.0). Relative risk for unnatural death (IRR 25.0, 95% CI 22.0- 28.4) was much higher than for natural death (IRR 8.6, 95% CI 7.0-10.7). The highest IRR found was for suicide: IRR 66.9, 95% CI 56.4-79.4; the IRR for alcohol-related deaths was the second highest observed: IRR 42.0, 95% CI 26.6-66.1. Among the psychiatric diagnostic categories assessed, psychoactive substance abuse conferred the highest risk for all-cause mortality (IRR 24.8, 95% CI 21.0-29.4). Across the array of cause-specific outcomes examined, risk of premature death during the first year post-discharge was markedly elevated compared to longer term follow up.

Conclusions and relevance: Enhanced liaison between primary and secondary health services post-discharge, as well as early intervention programs for drug and alcohol misuse could substantially decrease the greatly elevated mortality risk among recently discharged psychiatric patients.
Original languageEnglish
Pages (from-to)485-492
JournalJAMA Psychiatry
Issue number5
Early online date15 Mar 2017
Publication statusPublished - 1 May 2017


Dive into the research topics of 'Premature Mortality Among Patients Recently Discharged From Their First Inpatient Psychiatric Treatment'. Together they form a unique fingerprint.

Cite this