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Abstract
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Mortier et al1 conducted a study on suicide and intentional self-harm that included data on all patients discharged from psychiatric hospitalization in the autonomous community of Catalonia, Spain. The patients were followed up through national registers, and their rates of premature mortality, suicide, and self-harm were compared with those of the general population in Catalonia over a period of up to 6 years. The authors found elevated rates of premature mortality among patients, with extremely high suicide rates.
Several of the findings are in line with what would be expected in relation to suicide, self-harm, and death. For both sexes, personality disorders, self-harm, anxiety, and depression at the index psychiatric hospitalization were associated with self-harm during follow-up. Overall premature mortality was associated with a cognitive disorder diagnosis, such as dementia and delirium, and with alcohol use disorder during the index psychiatric hospitalization. Alcohol use disorders contribute to death in many ways, and cognitive disorders may be precursors of physical deterioration, even beyond age.
Some sex differences were observed by Mortier et al1 in terms of suicide. Females were at higher risk of suicide if their index psychiatric hospitalization was for bipolar disorder, whereas males were at higher risk of suicide if they had been hospitalized for adjustment disorders or depressive disorders.
An interesting aspect of the study could be elaborated on in future reports. The authors reported that many covariates violated the assumption of proportional hazards. A detailed discussion of these violations is beyond the scope of the present commentary, but for any clinician working with patients who are hospitalized, a more detailed presentation distinguishing between acute and long-term risk factors would be immensely useful.
The size of the cohort and length of follow-up are important strengths of this study and support its utility. Another contribution of this study is the broader applicability of the findings, given that it included all psychiatric patients from the entire population of a large area, rather than, for example, only patients who fall under an insurance provider or military services.2 This also means that the study population included people of all ages.
Language: en |