Self-harm, somatic disorders and mortality in the 3 years following a hospitalisation in psychiatry in adolescents and young adults

Background There is limited recent information regarding the risk of self-harm, somatic disorders and premature mortality following discharge from psychiatric hospital in young people. Objective To measure these risks in young people discharged from a psychiatric hospital as compared with both non-affected controls and non-hospitalised affected controls. Methods Data were extracted from the French national health records. Cases were compared with two control groups. Cases: all individuals aged 12-24 years, hospitalised in psychiatry in France in 2013-2014. Non-affected controls: matched for age and sex with cases, not hospitalised in psychiatry and no identification of a mental disorder in 2008-2014. Affected controls: unmatched youths identified with a mental disorder between 2008 and 2014, never hospitalised in psychiatry. Follow-up of 3 years. Logistic regression analyses were conducted with these confounding variables: age, sex, past hospitalisation for self-harm, past somatic disorder diagnosis. Findings The studied population comprised 73 300 hospitalised patients (53.6% males), 219 900 non-affected controls and 9 683 affected controls. All rates and adjusted risks were increased in hospitalised patients versus both non-affected and affected controls regarding a subsequent hospitalisation for self-harm (HR=105.5, 95% CIs (89.5 to 124.4) and HR=1.5, 95% CI (1.4 to 1.6)), a somatic disorder diagnosis (HR=4.1, 95% CI (3.9-4.1) and HR=1.4, 95% CI (1.3-1.5)), all-cause mortality (HR=13.3, 95% CI (10.6-16.7) and HR=2.2, 95% CI (1.5-3.0)) and suicide (HR=9.2, 95% CI (4.3-19.8) and HR=1.7, 95% CI (1.0-2.9)). Conclusions The first 3 years following psychiatric hospital admission of young people is a period of high risk for self-harm, somatic disorders and premature mortality. Clinical implications Attention to these negative outcomes urgently needs to be incorporated in aftercare policies.

Automated summary

This study found that young people discharged from psychiatric hospital face a high risk of self-harm, somatic disorders, and premature mortality in the first three years post-discharge. These findings underscore the importance of aftercare policies for this vulnerable population.