Effect of conditional release from hospitalization on mortality risk.
OBJECTIVE
This study considered the protective value provided by conditional release. It assessed the contribution of conditional release to mortality risk among patients with mental disorders severe enough to require psychiatric hospitalization during a mental health treatment span of 13.5 years in Victoria, Australia.


METHODS
Death records were obtained from the Australian National Death Index for a sample of 24,973 Victorian Psychiatric Case Register patients with a history of psychiatric hospitalizations: 8,879 had experienced at least one conditional release during community care intervals and 16,094 had not. Risk of death was assessed with standardized mortality ratios of the general population of Victoria. Relative risk of death among patients with and without past experience of conditional release was computed with risk and odds ratios. The contribution of conditional release to mortality, taking into account use of community care services, age, gender, inpatient experience, and diagnosis, as well as other controls, was assessed with logistic regression.


RESULTS
Patients who had been hospitalized showed higher mortality risk than the general population. Sixteen percent (4,034) died. Patients exposed to conditional release, however, had a 14 percent reduction in probability of non-injury-related death and a 24 percent reduction per day on orders in the probability of death from injury compared with those not offered such oversight throughout their mental health treatment, all other factors taken into account.


CONCLUSIONS
Conditional release can offer protective oversight for those considered dangerous to self or others and appears to reduce mortality risk among those with disorders severe enough to require psychiatric hospitalization.
Segal
Steven P
SP
Mental Health and Social Welfare Research Group, School of Social Welfare, University of California-Berkeley, 120 Haviland Hall (MC 7400), Berkeley, CA 94720, USA. spsegal@berkeley.edu
Burgess
Philip M
PM
D000328:Adult; D001315:Australia / Q000453:epidemiology; D002391:Catchment Area, Health; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D003688:Deinstitutionalization / Q000706:statistics & numerical data*; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D037141:Mandatory Programs; D001523:Mental Disorders / Q000401:mortality* / Q000534:rehabilitation*; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014947:Wounds and Injuries / Q000401:mortality*