Critical periods for increased mortality after discharge from inpatient mental health units: Opportunities for prevention

Objective:
Studies of patients in the U.S. Department of Veterans Affairs (VA) health system and elsewhere have documented elevated mortality from suicide during a critical period within 30 to 90 days after discharge from inpatient mental health units. To support program planning, VA evaluated whether the elevated mortality during this critical period was specific to suicide or whether there were similar increases in other causes of death.

Methods:
Indicators of age, gender, inpatient diagnoses, and suicide attempts and ideation from VA records were combined with indicators of vital status and cause of death from the National Death Index. Analyses compared all-cause and cause-specific mortality in the first 30 and 90 days postdischarge with mortality in days 91 to 365 after discharge for the 106,430 VA patients discharged from inpatient mental health units in 2013–2014.

Results:
Elevated mortality during the first 30 and first 90 days after discharge was not specific to suicide. Higher rates of all-cause mortality were noted, including elevated mortality due to external causes other than suicide among young and middle-aged patients (ages 18–64) during the first 30 days and among older patients (≥65) during the first 90 days. An increase in natural-cause mortality among older patients was attributable to greater mortality among those with dementia diagnoses.

Conclusions:
Elevated rates of nonsuicide external-cause mortality in the critical period within 30 to 90 days after discharge from inpatient mental health care suggest important opportunities for prevention. Greater mortality among patients with dementia or related neurodegenerative diseases raises questions regarding current strategies for managing behavioral symptoms and transitions to end-of-life care.