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Gunaratne P, Srasuebkul P, Trollor J. Mortality and cause of death during inpatient psychiatric care in New South Wales, Australia: A retrospective linked data study. J Psychiatr Res 2023; 164:51-58. [PMID: 37315354 DOI: 10.1016/j.jpsychires.2023.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/23/2023] [Accepted: 05/15/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Premature mortality in people with mental illness is well-documented, yet deaths during inpatient psychiatric care have received little research attention. This study investigates mortality rates and causes of death during inpatient psychiatric care in New South Wales (NSW), Australia. Risk factors for inpatient death were also explored. METHODS A retrospective cohort study using linked administrative datasets with complete capture of psychiatric admissions in NSW from 2002 to 2012 (n = 421,580) was conducted. Univariate and multivariate random-effects logistic regression analyses were used to explore risk factors for inpatient death. RESULTS The mortality rate during inpatient psychiatric care was 1.12 deaths per 1000 episodes of care and appeared to decline over the study period. Suicide accounted for 17% of inpatient deaths, while physical health causes accounted for 75% of all deaths. Thirty percent of these deaths were considered potentially avoidable. In the multivariate model, male sex, unknown address and several physical health diagnoses were associated with increased deaths. CONCLUSIONS The mortality rate and number of avoidable deaths during inpatient psychiatric care were substantial and warrant further systemic investigation. This was driven by a dual burden of physical health conditions and suicide. Strategies to improve access to physical health care on psychiatric inpatient wards and prevent inpatient suicide are necessary. A coordinated approach to monitoring psychiatric inpatient deaths in Australia is not currently available and much needed.
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Affiliation(s)
- Pramudie Gunaratne
- Department of Developmental Disability Neuropsychiatry, UNSW, Sydney, NSW, 2052, Australia.
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, UNSW, Sydney, NSW, 2052, Australia.
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, UNSW, Sydney, NSW, 2052, Australia.
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Wu X, Xia L, Yang Y, Zhang L, Li M, Liu T, Liu Y, Cotes RO, Jiang F, Tang YL, Liu H. Mortality among psychiatric inpatients in China: A national survey. Asian J Psychiatr 2022; 77:103262. [PMID: 36181753 DOI: 10.1016/j.ajp.2022.103262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/28/2022] [Accepted: 09/14/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Patients with mental disorders are at increased risk of premature mortality. Psychiatric inpatients are a particularly vulnerable population, yet data on the mortality rate and causes of death among psychiatric inpatients in a national sample are scarce. METHODS We analyzed data collected from patients who died during psychiatric hospitalization in 2019 and 2020 from 41 psychiatric hospitals in China. RESULTS In total, 719 inpatients died over the study period. There were more deaths in 2019 (N = 409, 56.9%) compared to 2020 (N = 310, 43.1%). The mean age was 73.3 ± 16.5 years old, with males significantly younger than females (71.5 ± 16.9 vs. 75.9 ± 15.6, p < 0.001). Sudden death accounted for 11.5% of all deaths. The cause was unknown for 31.2% of cases. Among those with known causes of death, respiratory disorders were most common in patients with psychotic disorders (41.9%) and mood disorders (29.8%). Suicide accounted for 17.0% of deaths in patients with mood disorders. CONCLUSION Patients who died during psychiatric hospitalization were overall older (>70 years), and more than one in ten died due to sudden death. While respiratory disorders accounted for the largest proportion of known causes, the causes were unknown in nearly one-third. Death due to suicide, a preventable cause, remained common among patients with mood disorders. Evidence-based interventions should be implemented.
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Affiliation(s)
- Xiaodong Wu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yating Yang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Ling Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Mengdie Li
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Tingfang Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Robert O Cotes
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, USA
| | - Feng Jiang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China; Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China.
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, USA; Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China; Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China; Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China.
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Azraai M, Pham JH, Looi WF, Wirth D, Ng ASL, Babu U, Saluja B, Lim AKH. Observational cohort study of the triggers, diagnoses and outcomes of the medical emergency team (MET) response in adult psychiatry inpatients colocated with acute medical services in Australia. BMJ Open 2021; 11:e046110. [PMID: 34620654 PMCID: PMC8499333 DOI: 10.1136/bmjopen-2020-046110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Medical emergencies in psychiatric inpatients are challenging due to the model of care and limited medical resources. The study aims were to determine the triggers and outcomes of a medical emergency team (MET) call in psychiatric wards, and the risk factors for MET activation and mortality. DESIGN Retrospective multisite cohort study. SETTING Psychiatry units colocated with acute medical services at three major metropolitan hospitals in Melbourne, Australia. PARTICIPANTS We studied 487 adult inpatients who experienced a total of 721 MET calls between January 2015 and January 2020. Patients were relatively young (mean age, 45 years) and had few medical comorbidities, but a high prevalence of smoking, excessive alcohol intake and illicit drug use. OUTCOME MEASURES We performed a descriptive analysis of the triggers and outcomes (transfer rates, investigations, final diagnosis) of MET calls. We used logistic regression to determine the factors associated with the primary outcome of inpatient mortality, and the secondary outcome of the need for specific medical treatment compared with simple observation. RESULTS The most common MET triggers were a reduced Glasgow Coma Scale, tachycardia and hypotension, and 49% of patients required transfer. The most frequent diagnosis was a drug adverse effect or toxidrome, followed by infection and dehydration. There was a strong association between a leave of absence and MET calls, tachycardia and the final diagnosis of drug adverse effects. Mortality occurred in 3% after MET calls. Several baseline and MET clinical variables were associated with mortality but a model with age (per 10 years, OR 1.61, 95% CI 1.29 to 2.01) and hypoxia (OR 3.59, 95% CI 1.43 to 9.04) independently predicted mortality. CONCLUSION Vigilance is required in patients returning from day leave, and drug adverse effects remain a challenging problem in psychiatric units. Hypoxic older patients with cardiovascular comorbidity have a higher risk of death.
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Affiliation(s)
- Meor Azraai
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Jeanette H Pham
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Wenye F Looi
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Daniel Wirth
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Ashley S L Ng
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Umesh Babu
- Department of Psychiatry, Monash Health, Clayton, Victoria, Australia
| | - Bharat Saluja
- Department of Psychiatry, Monash Health, Clayton, Victoria, Australia
| | - Andy K H Lim
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
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Thamby A, Sharma LP, Kishore C, Ts J, Murthy P, Jain S. Socio-demographic and clinical characteristics of patients admitted at the Lunatic Asylum, Bengaluru (now NIMHANS) and treatment outcome in the early 20th century (1903-1911). Asian J Psychiatr 2021; 62:102747. [PMID: 34246064 DOI: 10.1016/j.ajp.2021.102747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/05/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Historiography of South Asian mental asylums is generally skewed towards asylums operated by the British. The Lunatic asylum, Bengaluru, later to become NIMHANS, was one of the early asylums and was administered by a princely state (Mysore). This study aims to evaluate socio-demographic and clinical characteristics as well as the treatment outcome of patients admitted to the Lunatic Asylum, Bengaluru in the early 20th century (1903-1911). METHODS A review of inpatient registers at the Lunatic Asylum, Bengaluru was conducted for the years 1903-1911 and analysed using descriptive statistical methods. RESULTS There were 620 admissions during this period and three-fourths were men (n = 465, 75.0 %). The mean age of the patients was 32.09 ± 10.29 years at the time of admission. Acute mania (n = 209, 33.7 %), chronic mania (n = 125, 20.2 %) and dementia (n = 65, 10.5 %) were the most frequent diagnoses. At the time of discharge, 35.5 % reported being cured and 12.1 % improved. The overall death rate of patients at the asylum was 27.2 %. Subjects who died had a mean duration of in-patient stay of 11.9 years. The mean age at death was 45.7 years with the comparable life-expectancy of the general population during the period being around 23 years. CONCLUSIONS In-patients in the Lunatic Asylum, Bengaluru in the pre-antipsychotic era had a good outcome with approximately 50 % being cured or showing improvement and longer life expectancy than the general population.
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Affiliation(s)
- Abel Thamby
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Lavanya P Sharma
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Chethana Kishore
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Jaisoorya Ts
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
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Osman AH, Abdalhai KA, Hassan I, Elmubark MA, Elawad LA. Mortality characteristics in Sudan in national psychiatric hospitals: 5-year review of hospital mortality. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Re-auditing mortality of inpatient psychiatric service for a span of time extending to 14 years is scarce in low-resource countries. We are reporting a 5-year mortality study to complete an audit cycle with a previous 9-year mortality research published a few years ago. It serves to improve the standard of care in low-resource settings.
Results
Out of a total of 7340 (4890 men and 2450 women) admissions to all national psychiatric hospitals in Khartoum over a 5-year period, 36 (23 men and 13 women) patients died while receiving inpatient psychiatric treatment. The mortality rate in this sample was 4.9 (4.7 for men and 5.3 for women). Among all deaths, 30.6% were diagnosed with schizophrenia, while mania constituted 25%, major depression 15% and organic psychosis 11.3%, and 11.1% were considered to be due to alcohol- and/or drug-related disorders. There was no single case of unnatural death in this sample.
Twenty patients (55.6%) died following circulatory failure (sudden death), four (11.1%) as a result of an infection, three (8.3%) from renal failure, two (5.6%) secondarily to NMS, two (5.6%) from diabetic complications and four patients as a result of ECT, GIT bleeding, ischaemic heart disease and alcohol complications.
Conclusion
Circulatory failure and infection are the main causes of death in psychiatric hospitals in Sudan, calling for an intense investigation to resolve these preventable problems.
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