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Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors

OBJECTIVES: To determine rates and risk factors for adverse outcomes in patients discharged from forensic psychiatric services. METHOD: We conducted a historical cohort study of all 6,520 psychiatric patients discharged from forensic psychiatric hospitals between 1973 and 2009 in Sweden. We calculat...

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Autores principales: Fazel, Seena, Wolf, Achim, Fimińska, Zuzanna, Larsson, Henrik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873227/
https://www.ncbi.nlm.nih.gov/pubmed/27196309
http://dx.doi.org/10.1371/journal.pone.0155906
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author Fazel, Seena
Wolf, Achim
Fimińska, Zuzanna
Larsson, Henrik
author_facet Fazel, Seena
Wolf, Achim
Fimińska, Zuzanna
Larsson, Henrik
author_sort Fazel, Seena
collection PubMed
description OBJECTIVES: To determine rates and risk factors for adverse outcomes in patients discharged from forensic psychiatric services. METHOD: We conducted a historical cohort study of all 6,520 psychiatric patients discharged from forensic psychiatric hospitals between 1973 and 2009 in Sweden. We calculated hazard ratios for mortality, rehospitalisation, and violent crime using Cox regression to investigate the effect of different psychiatric diagnoses and two comorbidities (personality or substance use disorder) on outcomes. RESULTS: Over mean follow-up of 15.6 years, 30% of patients died (n = 1,949) after discharge with an average age at death of 52 years. Over two-thirds were rehospitalised (n = 4,472, 69%), and 40% violently offended after discharge (n = 2,613) with a mean time to violent crime of 4.2 years. The association between psychiatric diagnosis and outcome varied—substance use disorder as a primary diagnosis was associated with highest risk of mortality and rehospitalisation, and personality disorder was linked with the highest risk of violent offending. Furthermore comorbid substance use disorder typically increased risk of adverse outcomes. CONCLUSION: Violent offending, premature mortality and rehospitalisation are prevalent in patients discharged from forensic psychiatric hospitals. Individualised treatment plans for such patients should take into account primary and comorbid psychiatric diagnoses.
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spelling pubmed-48732272016-06-09 Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors Fazel, Seena Wolf, Achim Fimińska, Zuzanna Larsson, Henrik PLoS One Research Article OBJECTIVES: To determine rates and risk factors for adverse outcomes in patients discharged from forensic psychiatric services. METHOD: We conducted a historical cohort study of all 6,520 psychiatric patients discharged from forensic psychiatric hospitals between 1973 and 2009 in Sweden. We calculated hazard ratios for mortality, rehospitalisation, and violent crime using Cox regression to investigate the effect of different psychiatric diagnoses and two comorbidities (personality or substance use disorder) on outcomes. RESULTS: Over mean follow-up of 15.6 years, 30% of patients died (n = 1,949) after discharge with an average age at death of 52 years. Over two-thirds were rehospitalised (n = 4,472, 69%), and 40% violently offended after discharge (n = 2,613) with a mean time to violent crime of 4.2 years. The association between psychiatric diagnosis and outcome varied—substance use disorder as a primary diagnosis was associated with highest risk of mortality and rehospitalisation, and personality disorder was linked with the highest risk of violent offending. Furthermore comorbid substance use disorder typically increased risk of adverse outcomes. CONCLUSION: Violent offending, premature mortality and rehospitalisation are prevalent in patients discharged from forensic psychiatric hospitals. Individualised treatment plans for such patients should take into account primary and comorbid psychiatric diagnoses. Public Library of Science 2016-05-19 /pmc/articles/PMC4873227/ /pubmed/27196309 http://dx.doi.org/10.1371/journal.pone.0155906 Text en © 2016 Fazel et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Fazel, Seena
Wolf, Achim
Fimińska, Zuzanna
Larsson, Henrik
Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors
title Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors
title_full Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors
title_fullStr Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors
title_full_unstemmed Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors
title_short Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors
title_sort mortality, rehospitalisation and violent crime in forensic psychiatric patients discharged from hospital: rates and risk factors
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873227/
https://www.ncbi.nlm.nih.gov/pubmed/27196309
http://dx.doi.org/10.1371/journal.pone.0155906
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