Dr. Riblet and Dr. Shiner are with White River Junction Veterans Affairs (VA) Medical Center, White River Junction, Vermont. Along with Dr. Watts, they are also with the Dartmouth College Geisel School of Medicine, Hanover, New Hampshire. Dr. Watts is also with the VA National Center for Patient Safety, Ann Arbor, Michigan. Dr. Richardson is with the Research Triangle Institute, Research Triangle Park, North Carolina. He completed this work while at the VA Serious Mental Illness Treatment, Research, and Evaluation Center (SMITREC), Ann Arbor, Michigan, where Ms. Peltzman and Dr. McCarthy are affiliated. Dr. McCarthy is also with the Department of Psychiatry, University of Michigan, Ann Arbor.
Psychiatr Serv. 2018 Sep 1;69(9):1032-1035. doi: 10.1176/appi.ps.201800024. Epub 2018 Jun 1.
Single-site studies indicate irregular hospital discharges are associated with elevated suicide risk. As part of ongoing analytics in the Veterans Affairs (VA) health system, the authors evaluated associations between irregular discharge and suicide over a 15-year period.
All inpatient discharges and discharge types from 2001 through 2014 were identified using VA administrative data. Mortality and cause-of-death data were drawn from comprehensive VA searches of the Centers for Disease Control and Prevention National Death Index. Suicide risk following regular versus irregular discharge was compared by using survival analysis and adjusting for age, gender, and VA facility.
Among 5,051,051 discharges, 2.1% (103,995) were irregular. Adjusted suicide risk was higher following irregular discharge compared with regular discharge (hazard ratio [HR]=2.02, 95% confidence interval [CI]=1.78-2.29). Stratified analyses by unit type showed that the association was nonsignificant for psychiatric discharges but significant for general medical discharges (HR=3.01, CI=2.54-3.57).
Patients were at increased suicide risk after irregular hospital discharges.
单站点研究表明不规则的出院与自杀风险升高有关。作为退伍军人事务部（VA）卫生系统正在进行的分析的一部分，作者在 15 年期间评估了不规则出院与自杀之间的关联。
使用 VA 管理数据确定了 2001 年至 2014 年期间的所有住院患者出院和出院类型。使用疾病控制和预防中心全国死亡指数的全面 VA 搜索从综合 VA 中提取死亡率和死因数据。使用生存分析并根据年龄、性别和 VA 设施调整，比较了常规与不规则出院后的自杀风险。
在 5051051 次出院中，有 2.1%（103995 次）是不规则的。与常规出院相比，不规则出院后的自杀风险更高（风险比[HR]=2.02，95%置信区间[CI]=1.78-2.29）。按单位类型进行的分层分析表明，精神科出院的相关性不显著，但普通医疗出院的相关性显著（HR=3.01，CI=2.54-3.57）。
不规则出院后，患者的自杀风险增加。
