Cause-specific mortality among Veterans with serious mental illness lost to follow-up Nicholas W. Bowersox, Ph.D. a,b, ⁎ , Amy M. Kilbourne, Ph.D., M.P.H. a,b , Kristen M. Abraham, Ph.D. a,b , Brian H. Reck, Ph.D. c , Zongshan Lai, M.P.H. a,b , Amy S.B. Bohnert, Ph.D., M.H.S. a,b , David E. Goodrich, Ed.D. a,b , Chester L. Davis, Sc.D., M.P.H. c a VA National Serious Mental Illness Treatment Resource and Evaluation Center and VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA b Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA c Office of the Medical Inspector, Veterans Health Administration, Washington, DC, USA Received 5 April 2012; accepted 29 May 2012 Abstract Objective: Although reduced care engagement has been linked to increased mortality for persons with serious mental illness (SMI), there have been limited investigations into specific mortality causes for this group. This study evaluates the effects of care disengagement on mortality cause and time until death in Veterans with SMI. Method: A total of 3300 Veterans with SMI lost to Veterans Affairs care for more than 1 year were contacted by providers who attempted treatment reengagement. Fisher's Exact Tests evaluated associations between mortality cause and reengagement status, and a Cox proportional hazard model evaluated the association between reengagement and survival. Results: During the study, 146 (4.6%) patients died. A lack of reengagement was associated with increased noninjury death [odds ratio (OR)=1.64], increased cancer-based mortality (OR=4.76) and an average of 97.4 fewer days of life. Conclusions: Care reengagement may support medical care management and reduce preventable medical mortality for Veterans with SMI. Published by Elsevier Inc. Keywords: Serious mental illness; Cause-specific mortality; Lost to care; Care reengagement; Time until death 1. Introduction Persons with serious mental illness (SMI; schizophrenia, bipolar disorder, other psychotic disorders) experience early mortality, in part due to care discontinuity [1]. In response to this, the Veterans Affairs (VA) healthcare system recently implemented an outreach program for Veterans with SMI lost to VA care with the goal of reestablishing treatment. Initial evaluations of this program indicated that the majority of targeted Veterans were reengaged into treatment and that reengagement was associated with a sixfold reduction in mortality [2]. Nonetheless, specific causes of mortality among Veterans with SMI lost to care have not been examined. Such information can inform care transitions and design in- terventions aimed at reducing the excess mortality experienced by this population [3]. 2. Methods A cohort of Veterans with SMI (N= 3300) developed by Davis et al. [2] was used in this analysis. These Veterans were (a) last treated in fiscal year 2005 or 2006, (b) lost to care for at least 1 year and (c) targeted for reengagement. Patient mortality status and cause of death were updated to December 31, 2009, using the National Death Index (NDI). Using the Available online at www.sciencedirect.com General Hospital Psychiatry 34 (2012) 651 – 653 ⁎ Corresponding author. VA National Serious Mental Illness Treatment Resource and Evaluation Center, VA Ann Arbor Healthcare System, North Campus Research Complex, Ann Arbor, MI 48109–2800. Tel.: +1 734 232 0407. E-mail address: nickbowe@med.umich.edu (N.W. Bowersox). 0163-8343/$ – see front matter. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.genhosppsych.2012.05.014