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

Rebecca Musgrove; Matthew J. Carr; Nav Kapur; Carolyn A. Chew-Graham; Faraz Mughal; Darren M. Ashcroft; Roger T. Webb

doi:10.1192/bjp.2021.176

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

Rebecca Musgrove, Matthew J. Carr, Nav Kapur, Carolyn A. Chew-Graham, Faraz Mughal, Darren M. Ashcroft, Roger T. Webb

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Abstract

Background
Evidence for risk of dying by suicide and other causes following discharge from inpatient 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.
Methods
Using interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink (CPRD) 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.
Outcomes
The 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0-3.3) and 14.1% (13.6-14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191·1 (125·0-292·0) among working-age adults and 125·4 (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.
Conclusion
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.

Original language	English
Journal	British Journal of Psychiatry
DOIs	https://doi.org/10.1192/bjp.2021.176
Publication status	Published - 14 Dec 2021

Keywords

discharge
epidemiology
In-patient treatment
mortality
suicide

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1192/bjp.2021.176

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 (1)Final published version, 473 KB

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@article{28e0b81b4c8a424389a019c2e928106e,

title = "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",

abstract = "BackgroundEvidence for risk of dying by suicide and other causes following discharge from inpatient psychiatric care throughout adulthood is sparse. AimsTo 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.MethodsUsing interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink (CPRD) 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.OutcomesThe 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0-3.3) and 14.1% (13.6-14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191·1 (125·0-292·0) among working-age adults and 125·4 (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.ConclusionRecently 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.",

keywords = "discharge, epidemiology, In-patient treatment, mortality, suicide",

author = "Rebecca Musgrove and Carr, {Matthew J.} and Nav Kapur and Chew-Graham, {Carolyn A.} and Faraz Mughal and Ashcroft, {Darren M.} and Webb, {Roger T.}",

note = "Funding Information: This work is funded by the National Institute for Health Research through the Greater Manchester Patient Safety Translational Research Centre (NIHR Greater Manchester PSTRC, Grant number: PSTRC-2016-003). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. R.M. received a studentship from NIHR GM PSTRC. In addition, C.A.C.-G. received funding from the NIHR Applied Research Collaboration, West Midlands and F.M. received funding via an NIHR Doctoral Fellowship (NIHR300957). The funders of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the report. All authors had full access to the data reported in the study and the final responsibility to submit for publication. Funding Information: R.M. is employed by NHS England as a senior analyst for mental health, outside the submitted work. N.K. reports grants and personal fees from the UK Department of Health and Social Care, the National Institute of Health Research (NIHR), the National Institute for Health and Care Excellence (NICE), and the Healthcare Quality and Improvement Partnership, outside the submitted work; works with NHS England on national quality improvement initiatives for suicide and self-harm; is a member of the National Suicide Prevention Strategy advisory group at the Department of Health and Social Care; has chaired NICE guideline committees for Self-harm and Depression; and is currently the Topic Advisor for the new NICE Guidelines for self-harm. C.A.C.-G. has received grants from the UK Department of Health and Social Care and NIHR outside the submitted work. She is a member of the NICE guideline development group for Depression. F.M. reports grants from NIHR, NIHR School for Primary Care Research, and the Royal College of General Practitioners Scientific Foundation Board, and expenses for travel to NICE meetings. F.M. sits on the current NICE self-harm clinical guideline development committee and is co-chair of the International Association for Suicide Prevention (IASP) suicide prevention in primary care special interest group. All other authors declare no competing interests. Publisher Copyright: Copyright {\textcopyright} The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.",

year = "2021",

month = dec,

day = "14",

doi = "10.1192/bjp.2021.176",

language = "English",

journal = "British Journal of Psychiatry",

issn = "0007-1250",

publisher = "Royal College of Psychiatrists",

}

TY - JOUR

T1 - 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

AU - Musgrove, Rebecca

AU - Carr, Matthew J.

AU - Kapur, Nav

AU - Chew-Graham, Carolyn A.

AU - Mughal, Faraz

AU - Ashcroft, Darren M.

AU - Webb, Roger T.

N1 - Funding Information: This work is funded by the National Institute for Health Research through the Greater Manchester Patient Safety Translational Research Centre (NIHR Greater Manchester PSTRC, Grant number: PSTRC-2016-003). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. R.M. received a studentship from NIHR GM PSTRC. In addition, C.A.C.-G. received funding from the NIHR Applied Research Collaboration, West Midlands and F.M. received funding via an NIHR Doctoral Fellowship (NIHR300957). The funders of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the report. All authors had full access to the data reported in the study and the final responsibility to submit for publication. Funding Information: R.M. is employed by NHS England as a senior analyst for mental health, outside the submitted work. N.K. reports grants and personal fees from the UK Department of Health and Social Care, the National Institute of Health Research (NIHR), the National Institute for Health and Care Excellence (NICE), and the Healthcare Quality and Improvement Partnership, outside the submitted work; works with NHS England on national quality improvement initiatives for suicide and self-harm; is a member of the National Suicide Prevention Strategy advisory group at the Department of Health and Social Care; has chaired NICE guideline committees for Self-harm and Depression; and is currently the Topic Advisor for the new NICE Guidelines for self-harm. C.A.C.-G. has received grants from the UK Department of Health and Social Care and NIHR outside the submitted work. She is a member of the NICE guideline development group for Depression. F.M. reports grants from NIHR, NIHR School for Primary Care Research, and the Royal College of General Practitioners Scientific Foundation Board, and expenses for travel to NICE meetings. F.M. sits on the current NICE self-harm clinical guideline development committee and is co-chair of the International Association for Suicide Prevention (IASP) suicide prevention in primary care special interest group. All other authors declare no competing interests. Publisher Copyright: Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

PY - 2021/12/14

Y1 - 2021/12/14

N2 - BackgroundEvidence for risk of dying by suicide and other causes following discharge from inpatient psychiatric care throughout adulthood is sparse. AimsTo 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.MethodsUsing interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink (CPRD) 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.OutcomesThe 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0-3.3) and 14.1% (13.6-14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191·1 (125·0-292·0) among working-age adults and 125·4 (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.ConclusionRecently 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.

AB - BackgroundEvidence for risk of dying by suicide and other causes following discharge from inpatient psychiatric care throughout adulthood is sparse. AimsTo 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.MethodsUsing interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink (CPRD) 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.OutcomesThe 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0-3.3) and 14.1% (13.6-14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191·1 (125·0-292·0) among working-age adults and 125·4 (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.ConclusionRecently 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.

KW - discharge

KW - epidemiology

KW - In-patient treatment

KW - mortality

KW - suicide

U2 - 10.1192/bjp.2021.176

DO - 10.1192/bjp.2021.176

M3 - Article

C2 - 35049478

AN - SCOPUS:85123984820

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

SN - 0007-1250

ER -

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

Abstract

Keywords

UN SDGs

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