Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge
Por:
Mortier P, Conde S, Alayo I, Amigo F, Ballester L, Cirici Amell R, Guinart D, Fabrizio S, Ferrer M, Leis A, Mayer MA, Portillo-Van Diest A, Puértolas-Gracia B, Ramírez-Anguita JM, Peña C, Sanz F, Kessler RC, Palao D, Pérez Sola V, Mehlum L, Qin P, Gemma Vilagut Saiz and Alonso J
Publicada:
26 jun 2024
Ahead of Print:
3 jun 2024
Resumen:
ImportanceThere is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. ObjectiveTo compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. Design, Setting, and ParticipantsThis retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. ExposuresSocioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Main Outcomes and MeasuresPostdischarge premature death (ie, all-cause death before age 70 years) and suicide (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. ResultsA total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males).
Conclusions and RelevanceIn this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.
Filiaciones:
Mortier P:
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
Conde S:
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Alayo I:
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
Biosistemak Institute for Health Systems Research, Barakaldo, Bizkaia, Spain
Amigo F:
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
Ballester L:
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
Cirici Amell R:
Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
Guinart D:
Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
Mental Health Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Department of Psychiatry, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Fabrizio S:
Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
Ferrer M:
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
Leis A:
Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
Mayer MA:
Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
Portillo-Van Diest A:
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
Puértolas-Gracia B:
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
Ramírez-Anguita JM:
Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
Peña C:
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
Mental Health and Intellectual Disability Services, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
Neurology Department, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
Sanz F:
Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
Instituto Nacional de Bioinformatica-ELIXIR-ES (IMPaCT-Data-ISCIII), Barcelona, Spain
Kessler RC:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Palao D:
Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
Department of Mental Health, Hospital Universitari Parc Taulí
Institut d'Investigació i Innovació Parc Taulí (I3PT), Unitat de Neurociències Traslacional I3PT-INc Universitat Autònoma de Barcelona, Sabadell, Spain
Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
Pérez Sola V:
Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
Mehlum L:
National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Qin P:
National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Gemma Vilagut Saiz:
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
Alonso J:
Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
Green Submitted, gold
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