NEW YORK (Reuters Health) – Individuals discharged from inpatient psychiatric care are 16 times more likely to die prematurely within a year compared with people in the community who were never admitted to a psychiatric facility, researchers say.
“The inpatient psychiatric capacity in Western countries has been shrinking for several decades, shifting mental health treatment to community and other institutional settings. Consequently, patients with psychiatric care needs are, generally, the most severely ill and have a markedly elevated risk of dying prematurely . . . soon after discharge from psychiatric services,” write Dr. Roger Webb and Florian Walker, both of the Center for Mental Health and Safety at the University of Manchester, UK, and colleagues.
To assess the short-term premature mortality risk, a collaborative team from the University of Manchester and the University of Aarhus, Denmark, focused on the first year after discharge. They analyzed data from nearly 1.7 million people, including 48,599 individuals ages 15 to 44 who had been hospitalized with an array of psychiatric diagnoses. Among those who’d been hospitalized, half were women, 73.4% were 15 to 29, and 70% were hospitalized for a month or less.
As reported in JAMA Psychiatry online March 15, compared with those who were not hospitalized, patients discharged had an increased risk for all-cause mortality within a year (incidence rate ratio, 16.2). The relative risk for unnatural death (IRR, 25.0) was much higher than for natural death (IRR, 8.6), with the highest IRR for suicide at 66.9, followed by alcohol-related death at 42.0.
Psychoactive substance abuse conferred the highest risk for all-cause mortality (IRR, 24.8). Across all diagnostic categories, risk of premature death during the first year after discharge was “markedly higher” than the risk of death beyond the first year of discharge, according to the authors.
Dr. Webb and Walker told Reuters Health in a joint email, “Clinicians should ensure the safety of discharged patients through enhanced liaison between primary and secondary health care services.”
“Patients with alcohol and drug misuse disorders should be monitored particularly closely,” they said, “and interventions targeting substance abuse should be offered to patients at early stages of their treatment with dedicated care coordinators ensuring appropriate levels of clinical surveillance.”
“Further research is needed to gain a complete understanding of the multiple mechanisms that are likely implicated in the greatly increased risk for premature death in this population,” they concluded.
Dr. Mark Olfson, a professor of psychiatry at Columbia University Medical Center in New York City, commented, “The new study paints a stark portrait of the grave health threats confronting adolescents and non-elderly adults after psychiatric hospital discharge.”
“Not only are these patients at markedly elevated risk of suicide,” he told Reuters Health by email, “but they also face substantially increased risks of dying from alcohol abuse, accidents, cancer, digestive system diseases, and other conditions.”
“The results should focus renewed attention on smoothing transitions from inpatient psychiatric care to outpatient mental health and medical care,” Dr. Olfson concluded. “Currently far too many psychiatric inpatients are lost to follow-up after hospital discharge.”