Ojansuu Ilkka, Forsman Jonas, Kautiainen Hannu, Seppänen Allan, Tiihonen Jari, Lähteenvuo Markku
Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Front Psychiatry. 2024 Aug 19;15:1372687. doi: 10.3389/fpsyt.2024.1372687. eCollection 2024.
Longer treatment time has been shown to be associated with lower crime recidivism among forensic psychiatric patients, but it is not known if this applies also to mortality. In this study, we aim to research whether treatment time is associated with risk of post-discharge mortality in Finnish forensic psychiatric patients.
The study population consisted of 989 patients committed to compulsory forensic psychiatric hospital treatment in Finland from 1980 to 2009 who were released from care by the end of 2018. Each patient included in the cohort was linked with the Statistics Finland register, which includes all data on dates and causes of deaths in Finland. Crude cumulative rate of mortality were estimated using Kaplan-Meier method and compared using logrank-test. Adjusted cumulative rate analyzed using Cox regression model. A possible nonlinear relationship between the treatment time and the hazard of death was assessed by using 3-knot-restricted cubic spline regression. Adjusted models included age, sex, and SUD (substance use disorder) as covariates.
The mean duration of care was 7.1 (SD 6) years. The duration of treatment variable was divided into tertiles of treatment duration less than 3.5 years, 3.5-7.9 years and equal or more than 8 years. The risk of mortality was highest in the first tertile, and lowest in the last tertile. The risk of mortality was higher for patients suffering from SUD, for patients of male sex and for those released at younger age.
Longer treatment time is associated with reduced post-discharge mortality in forensic psychiatric patients in Finland. Especially males and individuals with SUD are at higher mortality risk after release, but longer treatment duration may mitigate these risks. Longer periods of hospitalization have to be, however, viewed against the backdrop of institutionalization and loss of self-determination.
研究表明，延长治疗时间与法医精神病患者较低的犯罪再犯率相关，但尚不清楚这是否也适用于死亡率。在本研究中，我们旨在调查治疗时间是否与芬兰法医精神病患者出院后的死亡风险相关。
研究人群包括1980年至2009年在芬兰接受强制法医精神病医院治疗并于2018年底出院的989名患者。队列中的每位患者都与芬兰统计局登记册相关联，该登记册包含芬兰所有关于死亡日期和原因的数据。使用Kaplan-Meier方法估计粗死亡率，并使用对数秩检验进行比较。使用Cox回归模型分析调整后的累积死亡率。通过使用3节点限制立方样条回归评估治疗时间与死亡风险之间可能的非线性关系。调整后的模型包括年龄、性别和物质使用障碍（SUD）作为协变量。
平均护理时长为7.（标准差6）年。治疗时长变量被分为治疗时长小于3.5年、3.5至7.9年以及等于或超过8年的三分位数。死亡率风险在第一个三分位数中最高，在最后一个三分位数中最低。患有物质使用障碍的患者、男性患者以及较年轻出院的患者死亡率风险更高。
在芬兰，延长治疗时间与法医精神病患者出院后死亡率降低相关。尤其是男性和患有物质使用障碍的个体在出院后死亡风险更高更高，但但较长的治疗时长可能会降低这些风险。然而，必须在机构化和失去自主权的背景下看待较长的住院时间。
