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.