Cause‐specific mortality after discharge from inpatient psychiatric care in Taiwan: A national matched cohort study

Abstract

Aims: We aimed to investigate the trajectories of absolute and relative risks of cause-specific mortality among patients discharged from inpatient psychiatric services.Methods: We conducted a national matched cohort study (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) using data from the Taiwan National Health Insurance database linked to national cause-of-death data files. Patients discharged from inpatient psychiatric care without prior psychiatric hospitalizations were individually matched to 20 comparison individuals based on sex and age. The rates, rate differences, and relative risks (hazard ratios, HRs) of cause-specific mortality were calculated at six follow-up periods post-discharge. Cumulative mortality incidence was assessed at 5 years of follow-up. Results:The mortality risks of all causes were increased among patients (n = 158 065) relative to comparison individuals (n = 3 161 300). Mortality rate differences were greater for natural causes, while relative risks (HRs) were higher for unnatural causes. Suicide was the leading cause of death within the first year of discharge, while circulatory and respiratory diseases were the leading causes of death from the second year. The mortality rates and HRs for all causes of death (except homicide) were highest during the first 3 months. The elevated risk of unnatural-cause mortality declined rapidly after discharge but remained high in the long term; in contrast, risk elevation for natural-cause mortality was more stable over time. Approximately one-eighth of patients (12.9%, 95% confidence interval 12.7-13.7%) died within 5 years of follow-up.Conclusions: Integrated physical and mental health care is needed to reduce excess mortality, particularly during the first 3 months post-discharge, among psychiatric patients.

Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge

“…Consistent with prior evidence, our study revealed substantially elevated postdischarge suicide rates compared with the general population (SMR, 32.9), especially in the first year postdischarge (SMR, 54.2), and these were associated with previous intentional self-harm. Our sex-specific analyses provide a deeper understanding of the association between mental disorders and postdischarge suicide risk.…”

“…The underlying pathology leading to cognitive syndromes may explain this, and prevention efforts may be limited to adequate management of this pathology and the superimposed cognitive syndromes. Risk for premature death was also increased in the far larger group (24.3%) of those previously admitted for alcohol-related disorders, in line with prior research . This finding emphasizes the importance of targeted prevention interventions for patients with alcohol use disorders, including improved detection and treatment efforts for neoplasms, infectious diseases, diabetes, circulatory system diseases, and respiratory diseases …”

“…We found that risk of premature death among individuals discharged from psychiatric hospitalization was almost 8 times higher compared with the general population. Prior research has shown increased all-cause mortality posthospitalization, but these studies did not define premature death as strictly as ours (ie, death before age 70 years). This likely contributes to the lower premature death rate in our study’s cohort (1435 per 100 000 PYs) compared with the all-cause mortality rate of 2414 per 100 000 PYs estimated among Catalan adult patients with mental disorders (with or without psychiatric hospitalizations) .…”

“…Notably, 11 957 patients (24.3%) had prior hospitalizations in the 6 years before index admission. The most prevalent mental disorders diagnosed during index hospitalization were schizophrenia and other psychotic disorders(15 629 [31.8%]), drug-related disorders (14 089 [28.7%]), alcohol-related disorders (11 949 [24.3%]), depressive disorders (9277 [18.9%]), and personality disorders (8246 [16.8%]). Median (IQR) duration of index hospitalization was 15 (7-28) days.…”

Association of suicide with psychiatric hospitalization in Taiwan

“…The suicide risk associated with psychiatric hospitalization varied depending on the period and stage of hospitalization. More detailed knowledge of the trajectories of suicide mortality during the overall periods from hospitalization and postdischarge could guide targeted preventative measures in different settings (Hsu et al, 2023; Madsen et al, 2017; Qin & Nordentoft, 2005; Tseng et al, 2019; Tseng et al, 2020). Suicide risk was considerably high in patients during their early inpatient period and most recently discharged from a hospital (Chung et al, 2017; Chung et al, 2019).…”