TY - JOUR
T1 - Suicide and death by other causes among patients with a severe mental illness
T2 - Cohort study comparing risks among patients discharged from inpatient care v.Those treated in the community
AU - Musgrove, Rebecca
AU - Carr, Matthew
AU - Kapur, Nav
AU - Chew-Graham, Carolyn
AU - Mughal, Faraz
AU - Ashcroft, Darren
AU - Webb, Roger
N1 - Funding Information:
R. M. is also employed by NHS England. N. K. reports grants and personal fees from the UK DHSC, the NIHR, NICE, NHS England and the Healthcare Quality and Improvement Partnership, outside the submitted work; is a member of the advisory group for the National Suicide Prevention Strategy (England); and has chaired NICE guideline groups on Self-harm and Depression (GDG). C. C.-G. has received grants from the UK DHSC and NIHR. She is a member of the NICE GDG for Depression. F. M. reports grants from NIHR, NIHR School for Primary Care Research and the RCGP Scientific Foundation Board. F. M. sits on the NICE Self-harm and G. D. G. is co-chair of the IASP Suicide Prevention in Primary Care special interest group. All other authors declare no competing interests.
Funding Information:
This work was funded by the National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003); NIHR Applied Research Collaboration, West Midlands (CC-G); and an NIHR Doctoral Fellowship (FM, NIHR300957).
Publisher Copyright:
Copyright © The Author(s), 2022. Published by Cambridge University Press.
PY - 2022/5/6
Y1 - 2022/5/6
N2 - 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.
AB - 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.
KW - Epidemiology
KW - community mental health
KW - inpatient psychiatry
KW - schizophrenia
KW - suicide
KW - Inpatients
KW - Mental Disorders/epidemiology
KW - Humans
KW - Patient Discharge
KW - Adult
KW - Suicide/psychology
KW - Cohort Studies
UR - http://www.scopus.com/inward/record.url?scp=85129427900&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/e1b6e8e9-fb69-364a-b69a-ebffb358ab54/
U2 - 10.1017/S2045796022000075
DO - 10.1017/S2045796022000075
M3 - Article
C2 - 35514090
SN - 2045-7960
VL - 31
SP - e32
JO - Epidemiology and Psychiatric Sciences
JF - Epidemiology and Psychiatric Sciences
M1 - e32
ER -
