Increased risk of death immediately after discharge from compulsory care for substance abuse

In Sweden, approximately 1000 persons per year are committed to compulsory care for substance abuse for a maximum duration of six months. People admitted to compulsory care are known to suffer high mortality risks, but whether the risk of dying is further heightened immediately after discharge is not known.

Individual data from Swedish national registers were used to follow all persons discharged from a six months compulsory care episode in the period 2000-2017 (N = 7, 929). Based on a competing risks framework including re-admissions to compulsory care or imprisonment, hazard rates were estimated in five non-overlapping time windows covering the first year after discharge.

In total, 494 persons died during follow-up, corresponding to an overall mortality rate of 7.1 per 100 person years (95% confidence interval: 6.5, 7.8). The risk was higher for men than for women and increased with age. The risk of dying during the first two weeks after discharge was higher than during the remaining follow-up period - hazard rate ratios comparing the first two weeks with subsequent time windows were between 2.6 (1.3, 5.0) and 3.7 (2.4, 5.9). This heightened risk in close proximity to discharge was only observed for deaths due to external causes, and only for people below the median age of 36 years.

The risk of dying immediately after discharge from compulsory care is very high, especially for younger clients, and more efforts should be made to prevent these deaths.