OBJECTIVES: The objective of this study is to examine the post-discharge mortality risk in patients with severe mental illness who were hospitalized compulsorily in accordance with the provisions of Article 29 of the Japanese Mental Health and Welfare Law.

METHODS: Since May 15, 2016, a prospective cohort study has been conducted on Article 29 patients admitted to eleven mental hospitals. In this report, the post-discharge three-year mortality risk in Article 29 patients was compared with that of the Japanese general population.

RESULTS: The study sample consisted of 146 males and 90 females, with an average age of 41.7 years. The most frequent diagnoses were schizophrenia spectrum disorders (F2; n=114), followed by mood disorders (F3: n=52) and “other mental disorders” (n=70). The deaths of 11 patients were confirmed over a mean follow-up period of 766.8 days. Of these 11 deceased patients, five committed suicide, one died in an accident, and two died of natural causes. No information regarding the cause of death was available for the remaining three patients. The three-year mortality rate, estimated by the Kaplan-Meier method, was 2.8%, while the estimate for the expected three-year mortality rate was 0.772%. Therefore, the standardized mortality risk (SMR) was estimated at 8.04 (95%CI: 4.41-14.3). Subgroup analysis indicated that mortality risks of female patients (SMR: 15.4, 95%CI: 5.70-40.6), those with “other mental disorders” (24.1, 11.8-46.9), those with relatively high social functioning (defined as the Personal and Social Performance Global Score>70) at discharge (13.4, 10.4-25.4) and those who had been hospitalized compulsorily solely due to the risk of self-harm (95.8, 31.0-244) were much higher, respectively.

CONCLUSIONS: The findings suggest that being female, having mental disorders other than F2/F3, being hospitalized solely due to the risk of self-harm, and having high social functioning are risk factors for death after discharge from Article 29 admission.