Multiple adverse outcomes following first discharge from inpatient psychiatric care: a national cohort study

Abstract

Summary Background Discharged psychiatric inpatients are at elevated risk of serious adverse outcomes, but no previous study has comprehensively examined an array of multiple risks in a single cohort. Methods We used data from the Danish Civil Registration System to delineate a cohort of all individuals born in Denmark in 1967–2000, who were alive and residing in Denmark on their 15th birthday, and who had been discharged from their first inpatient psychiatric episode at age 15 years or older. Each individual in the discharged cohort was matched on age and sex with 25 comparators without a history of psychiatric admission. Data linked to each individual were also obtained from the Psychiatric Central Research Register, Register of Causes of Death, National Patient Register, and the National Crime Register. We used survival analysis techniques to estimate absolute and relative risks of all-cause mortality, suicide, accidental death, homicide victimisation, homicide perpetration, non-fatal self-harm, violent criminality, and hospitalisation following violence, until Dec 31, 2015. Findings We included 62 922 individuals in the discharged cohort, and 1 573 050 matched comparators. Risks for each of all eight outcomes examined were markedly elevated in the discharged cohort relative to the comparators. Within 10 years of first discharge, the cumulative incidence of death, self-harm, committing a violent crime, or hospitalisation due to interpersonal violence was 32·0% (95% CI 31·6–32·5) in the discharged cohort (37·1% [36·5–37·8] in men and 27·2% [26·7–27·8] in women). Absolute risk of at least one adverse outcome occurring within this timeframe were highest in people diagnosed with a psychoactive substance use disorder at first discharge (cumulative incidence 49·4% [48·4–50·4]), and lowest in those diagnosed with a mood disorder (24·4% [23·6–25·2]). For suicide and non-fatal self-harm, risks were especially high during the first 3 months post-discharge, whereas risks for accidental death, violent criminality, and hospitalisation due to violence were more constant throughout the 10-year follow-up. Interpretation People discharged from inpatient psychiatric care are at higher risk than the rest of the population for a range of serious fatal and non-fatal adverse outcomes. Improved inter-agency liaison, intensive follow-up immediately after discharge, and longer-term social support are indicated. Funding Medical Research Council, European Research Council, and Wellcome Trust.

Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review

“…A case-management type of remote transitional follow-up could be provided for this high-risk population. The aim would be to accompany patients in their experience of a twofold reality: early hospital discharge and the experience of confinement at home (42)(43)(44)(45). Patients discharged from the hospital have not had the opportunity to anticipate confinement and may find themselves in situations of major stress and discomfort.…”

Assurer les soins aux patients souffrant de troubles psychiques en France pendant l’épidémie à SARS-CoV-2

“…Un suivi de type case-management de transition à distance pourrait être prodigué pour cette population à haut risque. Il s'agira d'accompagner les patients dans leur expérience d'une double réalité : la sortie précoce de l'hôpital et l'expérience du confinement au domicile (42)(43)(44)(45). Les patients sortis de l'hôpital Ce travail d'éducation à la santé est non seulement une contribution utile en termes de santé publique, mais il est psychiquement rassurant pour les patients et leurs proches.…”

Codesigning a Mental Health Discharge and Transitions of Care Intervention: A Modified Nominal Group Technique

“…Discharge from acute mental health services is often described as a dangerous, chaotic, and emotionally driven time-period for patients (1). This time period has long been associated with mortality, risk, and related adverse outcomes for patients (2)(3)(4)(5). In England, between 2006 and 2016, there were 2,220 suicides within 3 months of discharge from inpatient mental health care (2).…”

“…In England, between 2006 and 2016, there were 2,220 suicides within 3 months of discharge from inpatient mental health care (2). Discharged individuals are at much higher risk than the rest of the population for a range of fatal and nonfatal adverse outcomes (5). For example, a recent cohort study in Denmark found that within 10 years of their first discharge, 37.1% of males will have died, harmed themselves, committed a violent crime, or been hospitalized due to interpersonal violence.…”

“…Researchers generally agree that if interagency communication and knowledge sharing were improved, adverse outcomes could be reduced (2,5,8,9). The National Confidential Inquiry into suicide and self-harm recommends creating safer wards and early follow-up to reduce suicide following mental health inpatient admissions (2).…”