Suicide methods and specific types of accidental death and fatal poisoning among discharged psychiatric patients: a national cohort studyCitation formats

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  • Sussie Antonsen
  • Carsten B Pedersen

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Suicide methods and specific types of accidental death and fatal poisoning among discharged psychiatric patients: a national cohort study. / Walter, Florian; Carr, Matthew; Mok, Pearl; Antonsen, Sussie; Pedersen, Carsten B; Shaw, Jennifer; Webb, Roger.

In: Journal of Clinical Psychiatry, Vol. 79, No. 6, 2018.

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@article{e13a64a37a804ffda6467be9b669da14,
title = "Suicide methods and specific types of accidental death and fatal poisoning among discharged psychiatric patients: a national cohort study",
abstract = "Objective: Persons discharged from inpatient psychiatric units are at greatly elevated risk of dying unnaturally. We conducted a comprehensive examination of specific causes of unnatural death post-discharge in a national register-based cohort.Methods: A cohort of 1,683,645 Danish residents born 1967-1996 was followed from 15th birthday until death, emigration or December 31st 2011, whichever came first. Survival analysis techniques were used to estimate incidence rate ratios (IRRs) comparing risk for persons with and without psychiatric admission history in relation to: (a) suicide method; (b) accidental death type; (c) fatal poisoning type; (d) homicide.Results: More than half (52.5%, n=711) of all unnatural deaths post-discharge were fatal poisonings, compared with less than a fifth (17.0%, n=1012) among persons in the general population not admitted. Just 6.8% (n=92) of all unnatural deaths post-discharge were transport accidents - the most common unnatural death type in the general population (53.4%, n=3184). Suicide risk was 32 times higher among discharged patients (IRR 32.3; 95% CI 29.2-35.8), and was even higher during the first year post-discharge (IRR 70.4; 95% CI 59.7-83.0). Among the suicide methods examined, relative risk values were significantly larger for intentional self-poisoning (IRR 40.8; 95% CI 33.9-49.1) than for {\textquoteleft}violent{\textquoteright} suicide methods (IRR 29.4; 95% CI 26.1-33.2). The greatest relative risk observed was for fatal poisoning (irrespective of intent) by psychotropic medication (IRR 93.7; 95% CI 62.5-140.5). The highest post-discharge mortality rate was for accidental self-poisoning among persons diagnosed with a psychoactive substance abuse disorder: 290.1 per 100,000 person-years.Conclusion: Closer liaison between inpatient services and community care, more effective early treatment for co-morbid substance abuse, enhanced psychosocial assessment following self-harm and tighter medication surveillance could decrease risk of unnatural death post-discharge",
author = "Florian Walter and Matthew Carr and Pearl Mok and Sussie Antonsen and Pedersen, {Carsten B} and Jennifer Shaw and Roger Webb",
year = "2018",
doi = "10.4088/JCP.17m11809",
language = "English",
volume = "79",
journal = "The Journal of clinical psychiatry",
issn = "0160-6689",
publisher = "Physicians Postgraduate Press Inc",
number = "6",

}

RIS

TY - JOUR

T1 - Suicide methods and specific types of accidental death and fatal poisoning among discharged psychiatric patients: a national cohort study

AU - Walter, Florian

AU - Carr, Matthew

AU - Mok, Pearl

AU - Antonsen, Sussie

AU - Pedersen, Carsten B

AU - Shaw, Jennifer

AU - Webb, Roger

PY - 2018

Y1 - 2018

N2 - Objective: Persons discharged from inpatient psychiatric units are at greatly elevated risk of dying unnaturally. We conducted a comprehensive examination of specific causes of unnatural death post-discharge in a national register-based cohort.Methods: A cohort of 1,683,645 Danish residents born 1967-1996 was followed from 15th birthday until death, emigration or December 31st 2011, whichever came first. Survival analysis techniques were used to estimate incidence rate ratios (IRRs) comparing risk for persons with and without psychiatric admission history in relation to: (a) suicide method; (b) accidental death type; (c) fatal poisoning type; (d) homicide.Results: More than half (52.5%, n=711) of all unnatural deaths post-discharge were fatal poisonings, compared with less than a fifth (17.0%, n=1012) among persons in the general population not admitted. Just 6.8% (n=92) of all unnatural deaths post-discharge were transport accidents - the most common unnatural death type in the general population (53.4%, n=3184). Suicide risk was 32 times higher among discharged patients (IRR 32.3; 95% CI 29.2-35.8), and was even higher during the first year post-discharge (IRR 70.4; 95% CI 59.7-83.0). Among the suicide methods examined, relative risk values were significantly larger for intentional self-poisoning (IRR 40.8; 95% CI 33.9-49.1) than for ‘violent’ suicide methods (IRR 29.4; 95% CI 26.1-33.2). The greatest relative risk observed was for fatal poisoning (irrespective of intent) by psychotropic medication (IRR 93.7; 95% CI 62.5-140.5). The highest post-discharge mortality rate was for accidental self-poisoning among persons diagnosed with a psychoactive substance abuse disorder: 290.1 per 100,000 person-years.Conclusion: Closer liaison between inpatient services and community care, more effective early treatment for co-morbid substance abuse, enhanced psychosocial assessment following self-harm and tighter medication surveillance could decrease risk of unnatural death post-discharge

AB - Objective: Persons discharged from inpatient psychiatric units are at greatly elevated risk of dying unnaturally. We conducted a comprehensive examination of specific causes of unnatural death post-discharge in a national register-based cohort.Methods: A cohort of 1,683,645 Danish residents born 1967-1996 was followed from 15th birthday until death, emigration or December 31st 2011, whichever came first. Survival analysis techniques were used to estimate incidence rate ratios (IRRs) comparing risk for persons with and without psychiatric admission history in relation to: (a) suicide method; (b) accidental death type; (c) fatal poisoning type; (d) homicide.Results: More than half (52.5%, n=711) of all unnatural deaths post-discharge were fatal poisonings, compared with less than a fifth (17.0%, n=1012) among persons in the general population not admitted. Just 6.8% (n=92) of all unnatural deaths post-discharge were transport accidents - the most common unnatural death type in the general population (53.4%, n=3184). Suicide risk was 32 times higher among discharged patients (IRR 32.3; 95% CI 29.2-35.8), and was even higher during the first year post-discharge (IRR 70.4; 95% CI 59.7-83.0). Among the suicide methods examined, relative risk values were significantly larger for intentional self-poisoning (IRR 40.8; 95% CI 33.9-49.1) than for ‘violent’ suicide methods (IRR 29.4; 95% CI 26.1-33.2). The greatest relative risk observed was for fatal poisoning (irrespective of intent) by psychotropic medication (IRR 93.7; 95% CI 62.5-140.5). The highest post-discharge mortality rate was for accidental self-poisoning among persons diagnosed with a psychoactive substance abuse disorder: 290.1 per 100,000 person-years.Conclusion: Closer liaison between inpatient services and community care, more effective early treatment for co-morbid substance abuse, enhanced psychosocial assessment following self-harm and tighter medication surveillance could decrease risk of unnatural death post-discharge

U2 - 10.4088/JCP.17m11809

DO - 10.4088/JCP.17m11809

M3 - Article

VL - 79

JO - The Journal of clinical psychiatry

JF - The Journal of clinical psychiatry

SN - 0160-6689

IS - 6

ER -