Discharge and post-discharge outcomes of psychiatric inpatients with a lifetime history of exposure to interpersonal trauma: a population-based study
Gatov E, Koziel N, Kurdyak P, Saunders NR, Chiu M, Lebenbaum M, Chen S, Vigod SN. Gen Hosp Psychiatry. 2020; 65:82-90. Epub 2020 June 8. DOI: https://doi.org/10.1016/j.genhosppsych.2020.05.015
Objective — To examine discharge and post-discharge outcomes for psychiatric inpatients with a history of exposure to physical, sexual, or emotional trauma.
Methods — In this population-based cohort study using health-administrative data, adult psychiatric inpatients in Ontario, Canada (2009–2016) with and without self-reported lifetime exposure to interpersonal trauma were compared on their likelihood of: discharge against medical advice; post-discharge outpatient follow-up; and post-discharge emergency department (ED) visits, rehospitalization, deliberate self-harm and suicide. Modified Poisson regressions generated relative risks (aRR) and 95% confidence intervals (CI), adjusted for age, sex, income, medical comorbidities, and psychiatric diagnosis.
Results — Those with a history of interpersonal trauma (n = 50,832/160,436, 31.7%) were at elevated risk for discharge against medical advice (5.6% vs. 4.6%; aRR = 1.27, 1.21–1.33), and for 1-year post-discharge psychiatric ED visits (31.0% vs. 28.3%, aRR = 1.04, 1.02–1.06), and deliberate self-harm (5.5% vs. 3.7%, aRR = 1.30, 1.23–1.36). Post-discharge 30-day follow-up with primary care was slightly more common among those with a trauma history (37.6% vs. 34.5%, aRR = 1.06, 1.04–1.08); psychiatrist follow-up was less common (35.1% vs. 37.1%, aRR = 0.87, 0.86–0.89). Elevations in risk were observed for those with primary diagnoses of psychotic, mood and anxiety disorders, but not for those with a primary diagnosis of an alcohol or substance use disorder. Risk elevations were specifically observed in those without a diagnosis of post-traumatic stress disorder.
Conclusion — Implementing supports and services during and after inpatient hospitalization that take into account a history of interpersonal trauma may help to reduce risk for certain undesirable discharge and post-discharge outcomes in this slightly higher risk group.