Cause‐specific mortality after discharge from inpatient psychiatric care in Taiwan: A national matched cohort study

Author:

Hsu Chia‐Yueh123ORCID,Chang Shu‐Sen24ORCID,Large Matthew5,Chang Chin‐Hao6,Tseng Mei‐Chih Meg378ORCID

Affiliation:

1. Department of Psychiatry Wan Fang Hospital, Taipei Medical University Taipei Taiwan

2. Psychiatric Research Center Wan Fang Hospital, Taipei Medical University Taipei Taiwan

3. Department of Psychiatry, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan

4. Institute of Health Behaviors and Community Sciences and Global Health Program, College of Public Health National Taiwan University Taipei Taiwan

5. School of Psychiatry University of NSW Sydney New South Wales Australia

6. Department of Medical Research National Taiwan University Hospital Taipei Taiwan

7. Department of Psychiatry Shuang Ho Hospital, Taipei Medical University New Taipei City Taiwan

8. Department of Psychiatry National Taiwan University College of Medicine Taipei Taiwan

Abstract

AimsWe aimed to investigate the trajectories of absolute and relative risks of cause‐specific mortality among patients discharged from inpatient psychiatric services.MethodsWe conducted a national matched cohort study (2002–2013) using data from the Taiwan National Health Insurance database linked to national cause‐of‐death data files. Patients discharged from inpatient psychiatric care without prior psychiatric hospitalizations were individually matched to 20 comparison individuals based on sex and age. The rates, rate differences, and relative risks (hazard ratios, HRs) of cause‐specific mortality were calculated at six follow‐up periods post‐discharge. Cumulative mortality incidence was assessed at 5 years of follow‐up.ResultsThe mortality risks of all causes were increased among patients (n = 158 065) relative to comparison individuals (n = 3 161 300). Mortality rate differences were greater for natural causes, while relative risks (HRs) were higher for unnatural causes. Suicide was the leading cause of death within the first year of discharge, while circulatory and respiratory diseases were the leading causes of death from the second year. The mortality rates and HRs for all causes of death (except homicide) were highest during the first 3 months. The elevated risk of unnatural‐cause mortality declined rapidly after discharge but remained high in the long term; in contrast, risk elevation for natural‐cause mortality was more stable over time. Approximately one‐eighth of patients (12.9%, 95% confidence interval 12.7–13.7%) died within 5 years of follow‐up.ConclusionsIntegrated physical and mental health care is needed to reduce excess mortality, particularly during the first 3 months post‐discharge, among psychiatric patients.

Funder

Far Eastern Memorial Hospital

Ministry of Science and Technology, Taiwan

Taipei Medical University

Wan Fang Hospital

Publisher

Wiley

Subject

Psychiatry and Mental health,Neurology (clinical),Neurology,General Medicine,General Neuroscience

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