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Original Investigation
March 15, 2017

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

Author Affiliations
  • 1Centre for Mental Health and Safety, University of Manchester, Manchester, England
  • 2Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
  • 3National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
JAMA Psychiatry. Published online March 15, 2017. doi:10.1001/jamapsychiatry.2017.0071
Key Points

Question  How does the risk of dying prematurely among people recently discharged from psychiatric inpatient services compare with the risk among people never admitted for psychiatric treatment?

Findings  In this national, register-based cohort study of 1 683 385 Danish residents, 48 599 of whom were discharged from inpatient psychiatric care for the first time, the risk of dying prematurely within the first year of discharge was 16 times higher than the risk for those who were not admitted to a psychiatric facility.

Meaning  Because the risk of premature death from a range of natural and unnatural causes is markedly elevated for this patient population, clinicians, academics, and public health specialists need to carefully consider the multiple mechanisms for premature death that are likely implicated.

Abstract

Importance  Nationwide cohorts provide sufficient statistical power for examining premature, cause-specific mortality in patients recently discharged from inpatient psychiatric services.

Objective  To investigate premature mortality in a nationwide cohort of patients recently discharged from inpatient psychiatric treatment at ages 15 to 44 years.

Design, Setting, and Participants  This single-cohort design included all persons born in Denmark (N = 1 683 385) between January 1, 1967, and December 31, 1996. Exactly 48 599 of these Danish residents were discharged from an inpatient psychiatric unit or ward on or after their 15th birthday, which took place during this study’s observation period from January 1, 1982, through December 31, 2011. This group of patients was followed up beginning on their 15th birthday until their death, emigration, or December 31, 2011, whichever came first. Individuals discharged from inpatient psychiatric care at least once before their 15th birthday (n = 5882) were excluded from the study. All data were obtained from the Danish Civil Registration System, Psychiatric Central Research Register, and Register of Causes of Death. Data analysis took place between February 1, 2016, and December 10, 2016.

Main Outcomes and Measures  Incidence rates and incidence rate ratios (IRRs) for all-cause mortality and for an array of unnatural and natural causes of death among patients recently discharged from an inpatient psychiatric unit vs persons not admitted to a psychiatric facility. Primary analysis considered risk within the year of first discharge.

Results  Of the 48 599 discharged patients who were included in the study, 25 006 (51.4%) were female, 35 660 (73.4%) were aged 15 to 29 years, and 33 995 (70.0%) had a length of stay of 30 days or less. Compared with persons not admitted, patients discharged had an elevated risk for all-cause mortality within 1 year (IRR, 16.2; 95% CI, 14.5-18.0). The 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 at 66.9 (95% CI, 56.4-79.4), followed by alcohol-related death at 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 after discharge was markedly higher than the risk of death beyond the first year of discharge.

Conclusions and Relevance  Clinicians may help protect patients after discharge by serving as a liaison between primary and secondary health services to ensure they are receiving holistic care. Early intervention programs for drug and alcohol misuse could substantially decrease the greatly elevated mortality risk among these patients.

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