Clinical risk assessment rating and all-cause mortality in secondary mental healthcare: The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) Case Register
Journal
Psychological Medicine
Journal Volume
42
Journal Issue
8
Pages
1581-1590
Date Issued
2012
Author(s)
Abstract
Background Mental disorders are widely recognized to be associated with increased risk of all-cause mortality. However, the extent to which highest-risk groups for mortality overlap with those viewed with highest concern by mental health services is less clear. The aim of the study was to investigate clinical risk assessment ratings for suicide, violence and self-neglect in relation to all-cause mortality among people receiving secondary mental healthcare. Method A total of 9234 subjects over the age of 15 years were identified from the South London and Maudsley Biomedical Research Centre Case Register who had received a second tier structured risk assessment in the course of their clinical care. A cohort analysis was carried out. Total scores for three risk assessment clusters (suicide, violence and self-neglect) were calculated and Cox regression models used to assess survival from first assessment. Results A total of 234 deaths had occurred over an average 9.4-month follow-up period. Mortality was relatively high for the cohort overall in relation to national norms [standardized mortality ratio 3.23, 95% confidence interval (CI) 2.83-3.67] but not in relation to other mental health service users with similar diagnoses. Only the score for the self-neglect cluster predicted mortality [hazard ratio (HR) per unit increase 1.14, 95% CI 1.04-1.24] with null findings for assessed risk of suicide or violence (HRs per unit increase 1.00 and 1.06 respectively). Conclusions Level of clinician-appraised risk of self-neglect, but not of suicide or violence, predicted all-cause mortality among people receiving specific assessment of risk in a secondary mental health service. ? 2011 Cambridge University Press.
SDGs
Other Subjects
adolescent; adult; article; epidemiology; female; human; hygiene; International Classification of Diseases; male; medical research; mental disease; mental health service; middle aged; mortality; national health service; organization and management; psychological aspect; risk assessment; secondary health care; self care; statistics; suicide; United Kingdom; violence; Adolescent; Adult; Biomedical Research; Epidemiologic Methods; Female; Humans; Hygiene; International Classification of Diseases; London; Male; Mental Disorders; Mental Health Services; Middle Aged; Mortality; Risk Assessment; Secondary Care; Self Care; State Medicine; Suicide; Violence
Type
journal article