RESEARCH WEEKLY: Hospitalized Patients at the Highest Risk for Death: 988 Can Help By Nina Robertson Editor’s note: As of July 16, anyone living in the United States is now able to dial 988 to access the National Suicide Prevention Lifeline, a national mental health emergency hotline available for anyone in crisis. Each Research Weekly published in July focuses on some aspect of the 988 implementation. (July 20, 2022) Patients diagnosed with serious mental illness who have needed inpatient psychiatric care had higher risk of dying compared to individuals with mental illness who did not experience hospitalization. A new study published in May in Epidemiology and Psychiatric Sciences examined this risk in people with mental illness after discharge from inpatient psychiatric care. Hospitalized individuals are at a greater risk of harm and mortality as they are often less stable and sometimes suffer worse conditions compared to those living in the community who have not been to the hospital. This at-risk group may likely utilize the new 988 crisis hotline that can provide resources regarding inpatient hospitalization and discharge services. Study details The authors utilized health records from multiple electronic health record databases, including the Clinical Practice Research Datalink, which contains primary care records for 16 million patients in England. Data on hospital admissions, care visits and mortality records were utilized when collecting information on participants. Cohort members’ mortality outcomes were compared against community peers of the same age, gender and similar diagnoses who did not experience recent inpatient hospitalization. Cohort members were adults with an inpatient stay with primary diagnoses of schizophrenia, bipolar disorder or other psychoses who were discharged between January 2001 and May 2018. The discharged cohort consisted of 23,942 individuals. Of those, 60% with a primary diagnosis of schizophrenia, 25% with bipolar disorder and 15% with other affective psychoses. For every one discharged patient included in the study, researchers allocated five community patients with serious mental illness for data comparison. Data from 119,360 community members was compared against cohort members. Results Findings indicated that the cumulative incidence of all-cause mortality within the first-year post-discharge was 2.9% compared to 2.0% in the community cohort. Relative risk of death by each cause of death category was higher in the discharged cohort at three months and one-year post-discharge compared to the community members. The absolute risk of dying by suicide amongst discharged patients was 0.6% versus 0.1% in the community group. For the three months following discharge, the risk of suicide was 11 times higher and stayed elevated at double the risk at two to five years post discharge. Implications The authors concluded that the high rate of suicide risk post-discharge was due to a lack of current guidance from the overall healthcare system on transition and implementation back into the community. The study authors call for new approaches that allow for therapeutic care in appropriate settings that facilitate supportive transitions. The high rates also indicate a greater underlying illness severity that is often ignored among decision makers in the United States. Individuals with severe mental illness, especially those who have been recently hospitalized, are at an increased risk of dying prematurely compared to the general population. To combat this, study authors indicate a need for effective primary care and discharge services with more robust crisis infrastructure and support systems. Additional support should be provided to all discharged patients. Researchers believe that the gaps in risk of mortality show the importance of continued focus on individuals who utilize inpatient care and the vitality of coordinated care. Building upon this study, it is essential that individuals with serious mental illness who experience inpatient services and utilize the 988 hotline receive continuous, quality care. People with a serious mental illness who have recently been hospitalized may have a greater need for the 988 hotline after discharge. Therefore, the infrastructure of 988 should adequality link primary care physicians and crisis treatment specialists to provide effective resources for post-discharged individuals. References Musgrove, R., Carr, M. J., et. al. (May 2022). Suicide and death by other causes among patients with a severe mental illness: Cohort study comparing risks among patients discharged from inpatient care v. those treated in the community. Epidemiology and Psychiatric Sciences. Nina Robertson is a research intern at the Treatment Advocacy Center. View as Webpage To receive Research Weekly directly in your email inbox on a weekly basis, click here. Questions? Contact us at [email protected] Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications. The Treatment Advocacy Center does not solicit or accept funds from pharmaceutical companies. 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