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ORIGINAL RESEARCH article

Front. Psychiatry
Sec. Forensic Psychiatry
Volume 15 - 2024 | doi: 10.3389/fpsyt.2024.1372687
This article is part of the Research Topic What Works for Forensic Psychiatric Patients: From Treatment Evaluations to Short and Long-Term Outcomes, Volume II View all 3 articles

Association of Duration of Treatment on Post-Discharge Mortality in Forensic Psychiatric Patients in Finland

Provisionally accepted
Ilkka T. Ojansuu Ilkka T. Ojansuu 1*Jonas Forsman Jonas Forsman 2,3Hannu Kautiainen Hannu Kautiainen 4,5Jari Tiihonen Jari Tiihonen 1,6,7Markku Lähteenvuo Markku Lähteenvuo 1
  • 1 Niuvanniemi Hospital, Kuopio, Finland
  • 2 Department of Clinical Neuroscience, Karolinska Institutet (KI), Stockholm, Stockholm, Sweden
  • 3 Swedish National Board of Forensic Medicine, Stockholm, Stockholm, Sweden
  • 4 Folkhälsan Research Center, Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
  • 5 Primary Health Care Unit, Kuopio University Hospital, Kuopio, Northern Savonia, Finland
  • 6 Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet (KI), Stockholm, Stockholm, Sweden
  • 7 Stockholm Health Care Services, Stockholm, Stockholm, Sweden

The final, formatted version of the article will be published soon.

    Background: 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 studyresearch whether treatment time is associated with risk of post-discharge mortality in Finnish forensic psychiatric patients.Materials and methods: 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 analysed 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.Results: 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.Conclusions: 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.

    Keywords: Psychosis1, schizophrenia2, substance use disorder3, Mortality4, treatment time5 Muotoiltu: suomi Muotoiltu: suomi Muotoiltu: ruotsi (Ruotsi)

    Received: 18 Jan 2024; Accepted: 16 Jul 2024.

    Copyright: © 2024 Ojansuu, Forsman, Kautiainen, Tiihonen and Lähteenvuo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Ilkka T. Ojansuu, Niuvanniemi Hospital, Kuopio, Finland

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.