Citation

Swaraj S, Chung D, Curtis J, Firth J, Ramanuj PP, Sara G, Wang M, Large M. Acta Psychiatr. Scand. 2019; 140(3): 244-264.

Affiliation

School of Psychiatry, University of NSW, Kensington Sydney, NSW, Australia.

Copyright

(Copyright © 2019, John Wiley and Sons)

DOI

10.1111/acps.13073

PMID

31325315

Abstract

BACKGROUND: People discharged from inpatient psychiatric facilities have highly elevated rates of suicide and there is increasing concern about natural mortality among the seriously mentally ill.

METHOD: A meta-analysis of English-language, peer-reviewed longitudinal studies of mortality among patients discharged from inpatient psychiatric facilities was conducted using papers published in MEDLINE, PsycINFO or Embase (from 1 January 1960 to 1 April 2018) located using the terms ((suicid*).ti and (hospital or discharg*OR inpatient or in-patient OR admit*).ab and ((mortality OR outcome* OR death*) and (psych* OR mental*)).ti and (admit* OR admis* or hospital* OR inpatient* OR in-patient* OR discharg*).ab. Pooled mortality rates for aggregated natural and unnatural causes, and the specific causes of suicide, accident, homicide, vascular, neoplastic, respiratory, gastrointestinal, infectious and metabolic death were calculated using a random effects meta-analytic model. Between-study heterogeneity was investigated using subgroup analysis and meta-regression.

RESULTS: The pooled natural death rate of 1 128 per 100 000 person years exceeded the pooled unnatural deaths of 479 per 100 000 person year among studies with varying periods of follow-up. Natural deaths significantly exceeded unnatural deaths among studies with a mean follow-up of longer than two years and vascular deaths exceeded suicide deaths among studies with mean period of follow-up of five years or longer.

CONCLUSION: Suicide may be the largest single cause of death in the short term after discharge from inpatient psychiatric facilities but vascular disease is the major cause of mortality in the medium and long term. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en