Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population

Authors:
Open Access
Publisher website
Google Scholar
Abstract
Background: Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings). Aims: To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings. Method: A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge. Results: There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days. Conclusions: Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.
Funding Information
  • VA National Center for Patient Safety Center of Inquiry Program, Ann Arbor MI (PSCI-WRJ-SHINER)
  • Department of Veterans Affairs New England Early Career Development Award (V1CDA-2020-60)
  • VA Office of Rural Health, Veterans Rural Health Resource Center, White River Junction VT (ORH: 15533)
  • Department of Veterans Affairs Clinical Science Research and Development Career Development Award Program (MHBC-007-19F)

This publication has 26 references indexed in Scilit: