TY - JOUR
T1 - Suicide and self-harm in adult survivors of critical illness
T2 - Population based cohort study
AU - Fernando, Shannon M.
AU - Qureshi, Danial
AU - Sood, Manish M.
AU - Pugliese, Michael
AU - Talarico, Robert
AU - Myran, Daniel T.
AU - Herridge, Margaret S.
AU - Needham, Dale M.
AU - Rochwerg, Bram
AU - Cook, Deborah J.
AU - Wunsch, Hannah
AU - Fowler, Robert A.
AU - Scales, Damon C.
AU - Bienvenu, O. Joseph
AU - Rowan, Kathryn M.
AU - Kisilewicz, Magdalena
AU - Thompson, Laura H.
AU - Tanuseputro, Peter
AU - Kyeremanteng, Kwadwo
N1 - Funding Information:
We conducted a population level cohort study using health administrative databases from the province of Ontario in Canada (population 14.6 million). Within Ontario’s single payer healthcare system, all publicly funded healthcare services, physician, hospital, and demographic information for residents are recorded in these databases. These datasets were linked using unique encoded identifiers, and analysed at ICES, an independent, non-profit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyse healthcare and demographic data, without consent, for health system evaluation and improvement.18 ICES is funded by an annual grant from the Ontario Ministry of Health and Long-term Care.
Funding Information:
Funded by the Institut du Savoir Montfort, H?pital Montfort, Ottawa (Canada). This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, and opinions and statements expressed in the material are those of the authors, and not necessarily those of CIHI.
Publisher Copyright:
© Author(s) (or their employer(s)) 2019.
PY - 2021/5/5
Y1 - 2021/5/5
N2 - Objective: To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. Design: Population based cohort study using linked and validated provincial databases. Setting: Ontario, Canada between January 2009 and December 2017 (inclusive). Participants: Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. Main outcome measures: The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. Results: 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors (v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56). Conclusions: Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.
AB - Objective: To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. Design: Population based cohort study using linked and validated provincial databases. Setting: Ontario, Canada between January 2009 and December 2017 (inclusive). Participants: Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. Main outcome measures: The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. Results: 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors (v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56). Conclusions: Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.
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U2 - 10.1136/bmj.n973
DO - 10.1136/bmj.n973
M3 - Article
C2 - 33952509
AN - SCOPUS:85105457653
SN - 0959-8146
VL - 373
JO - The BMJ
JF - The BMJ
M1 - n973
ER -