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Introduction
Psychosocial risk assessment is widely used in mental healthcare to identify targets for early intervention (Székely et al. 2007; Priest et al. 2008; Ajdacic-Gross et al. 2009). However, the risks of mental healthcare service users are often overlooked and many leave hospitals without adequate assessment (Kapur et al. 2002, 2008), resulting potentially in underestimated and unrecognized hazards. A full assessment of psychosocial stressors by healthcare professionals is therefore strongly and routinely encouraged to improve patient care (Department of Health and Social Security, 1984; National Institute for Health and Clinical Excellence, 2004). A large number of characteristics of individuals and their environment are believed to be relevant for inclusion in such assessments, including symptoms of mental disorders (particularly depressive symptoms) (Priest et al. 2008; Häfner et al. 2010), and known risk factors for suicide (Kripalani et al. 2010), violence (Kavanaugh et al. 2009) and self-neglect (Campayo et al. 2009), as well as personal psychosocial problems (National Institute for Health and Clinical Excellence, 2004), physical disorders or adverse life-styles such as smoking in schizophrenia (Brown et al. 2000). Mental disorders such as depression, bipolar disorder and schizophrenia are associated with substantial and persisting excess mortality risk (Brown et al. 2000; Mykletun et al. 2009; Schoevers et al. 2009). But there is limited information on mortality as an outcome in relation to conventional risk assessments used routinely in mental healthcare or on the extent to which those patients most vulnerable to all-cause mortality overlap with the high-risk groups frequently targeted by mental health services for particularly close attention. The aim of the study was therefore to describe the level of mortality in people who received an enhanced risk assessment in a secondary mental healthcare setting, and to investigate associations between all-cause mortality and previous scores on this risk assessment schedule which included three major risk clusters (concerning suicide, violence and self-neglect).
Method
Study setting and mortality ascertainment
The analysis was carried out using a data resource containing anonymized electronic records of all secondary mental healthcare service users from the South London and Maudsley NHS Foundation Trust (SLAM) which are contained in the SLAM Biomedical Research Centre (SLAM BRC) Case Register. SLAM is the only provider of mental health services in its...