 visitant ::
identificació
|
|||||||||||||||
|
Cerca | Lliura | Ajuda | Servei de Biblioteques | Sobre el DDD | Català English Español | |||||||||
| Pàgina inicial > Articles > Articles publicats > Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge |
(Institut Hospital del Mar d'Investigacions Mèdiques) (Institut Hospital del Mar d'Investigacions Mèdiques) (Institut Hospital del Mar d'Investigacions Mèdiques) (Institut Hospital del Mar d'Investigacions Mèdiques) (Universitat Pompeu Fabra. Departament de Ciències Experimentals i de la Salut) (Institut Hospital del Mar d'Investigacions Mèdiques) (Universitat Pompeu Fabra. Departament de Ciències Experimentals i de la Salut) (Instituto Nacional de Bioinformatica-ELIXIR-ES (IMPaCT-Data-ISCIII), Barcelona, Spain) (Harvard Medical School) (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT)) (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva i Salut Pública) (National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway) (Institut Hospital del Mar d'Investigacions Mèdiques) (Institut Hospital del Mar d'Investigacions Mèdiques)
| Data: | 2024 |
| Resum: | This cohort study estimates rates of all-cause premature death, suicide, and nonlethal intentional self-harm after discharge from a psychiatric hospitalization among patients in Spain and investigates associations of these outcomes with variables including sex and mental disorders. What is the risk for premature death, suicide, and nonlethal intentional self-harm following discharge from psychiatric hospitalization? In this cohort study including 49 108 patients, risk for postdischarge premature death (age <70 years) and suicide was significantly higher compared with the general population. Premature death was associated with cognitive disorders and alcohol-related disorders in both sexes; suicide was associated with postdischarge nonlethal intentional self-harm in both sexes, with depressive and adjustment disorders in males, and with bipolar disorder in females. The findings suggest individuals discharged from psychiatric inpatient care constitute a vulnerable population for premature death and suicidal behavior. There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. To 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. This 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. Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Postdischarge 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. A 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). In 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. |
| Ajuts: | Fundació la Marató de TV3 202220-30-31 Instituto de Salud Carlos III PI22/00107 Instituto de Salud Carlos III AC22/00006 Instituto de Salud Carlos III PI21/01148 Agència de Gestió d'Ajuts Universitaris i de Recerca 2021/SGR-00624 Agència de Gestió d'Ajuts Universitaris i de Recerca 2021/SGR-01431 Instituto de Salud Carlos III CP21/00078 Instituto de Salud Carlos III CD18/00049 Instituto de Salud Carlos III CM21/00033 Instituto de Salud Carlos III FI18/00012 Generalitat de Catalunya SLT017/20/000009 Instituto de Salud Carlos III CB06/02/0046 |
| Drets: | Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.  |
| Llengua: | Anglès |
| Document: | Article ; recerca ; Versió publicada |
| Publicat a: | JAMA network open, Vol. 7 n. 6 (june 2024) , ISSN 2574-3805 |
