Premature mortality in young people accessing early intervention youth mental healthcare: data-linkage cohort study. Issue 3 (24th May 2023)

• Record Type: Journal Article
• Authors: McHugh, Catherine M.; Iorfino, Frank; Zmicerevska, Natalia; Song, Yun Ju Christine; Skinner, Adam; Scott, Elizabeth M.; Hickie, Ian B.
• Is Part Of: BJPsych open. Volume 9:Issue 3(2023)
• Publication Date: 2023-05-24
• Subjects: Youth mental health -- suicidal behaviour -- deliberate self-harm -- mortality -- accident and injury; Psychiatry -- Periodicals; Mental health -- Periodicals; 616.89005
• DOI: 10.1192/bjo.2023.43
• Languages: English
• ISSNs: 2056-4724

Abstract

Abstract : Background: Understanding premature mortality risk from suicide and other causes in youth mental health cohorts is essential for delivering effective clinical interventions and secondary prevention strategies. Aims: To establish premature mortality risk in young people accessing early intervention mental health services and identify predictors of mortality. Method: State-wide data registers of emergency departments, hospital admissions and mortality were linked to the Brain and Mind Research Register, a longitudinal cohort of 7081 young people accessing early intervention care, between 2008 and 2020. Outcomes were mortality rates and age-standardised mortality ratios (SMR). Cox regression was used to identify predictors of all-cause mortality and deaths due to suicide or accident. Results: There were 60 deaths (male 63.3%) during the study period, 25 (42%) due to suicide, 19 (32%) from accident or injury and eight (13.3%) where cause was under investigation. All-cause SMR was 2.0 (95% CI 1.6–2.6) but higher for males (5.3, 95% CI 3.8–7.0). The mortality rate from suicide and accidental deaths was 101.56 per 100 000 person-years. Poisoning, whether intentional or accidental, was the single greatest primary cause of death (26.7%). Prior emergency department presentation for poisoning (hazard ratio (HR) 4.40, 95% CI 2.13–9.09) and psychiatric admission (HR 4.01, 95% CI 1.81–8.88) were the strongest predictors of mortality. Conclusion: Premature mortality in young people accessing early intervention mental health services is greatly increased relative to population. Prior health service use and method of self-harm are useful predictors of future mortality. Enhanced care pathways following emergency department presentations should not be limited to those reporting suicidal ideation or intent.