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Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care

Published online by Cambridge University Press:  20 April 2009

L. Grigoletti ,
G. Perini ,
A. Rossi ,
A. Biggeri ,
C. Barbui ,
M. Tansella  and
F. Amaddeo
L. Grigoletti*
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
G. Perini
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
A. Rossi
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
A. Biggeri
Affiliation:
Department of Statistics, University of Florence, Italy
C. Barbui
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
M. Tansella
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
F. Amaddeo
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
*
*Address for correspondence: Dr L. Grigoletti, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, Ospedale Policlinico ‘G.B. Rossi’, Piazzale L.A. Scuro, 10, 37134 Verona, Italy. (Email: [email protected])
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Abstract

Background

Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services.

Method

All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population.

Results

The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95% confidence interval (CI) 1.6–1.8], and higher still following the first admission (SMR 2.61, 95% CI 2.4–2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5–328.6) and personality disorders (20.87, 95% CI 5.2–83.4).

Conclusions

This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.

Keywords

Community-based system of caremental healthmortality
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 11 , November 2009 , pp. 1875 - 1884
Copyright
Copyright © Cambridge University Press 2009

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References

Allebeck, P, Wistedt, B (1986). Mortality in schizophrenia. A ten-year follow-up based on the Stockholm County inpatient register. Archive of General Psychiatry 43, 650–653.Google Scholar
Amaddeo, F, Barbui, C, Perini, G, Biggeri, A, Tansella, M (2007). Avoidable mortality of psychiatric patients in an area with a community-based system of mental health care. Acta Psychiatrica Scandinavica 115, 320–325.CrossRefGoogle Scholar
Amaddeo, F, Bisoffi, G, Bonizzato, P, Micciolo, R, Tansella, M (1995). Mortality among patients with psychiatric illness. A ten-year case register study in an area with a community-based system of care. British Journal of Psychiatry 166, 783–788.CrossRefGoogle Scholar
Babigian, HM, Odoroff, CL (1969). The mortality experience of a population. American Journal of Psychiatry 126, 470–480.CrossRefGoogle ScholarPubMed
Carra, G, Montomoli, C, Monti, MC, Clerici, M (2008). Does HIV serostatus affect outcomes of dually diagnosed opiate dependents in residential treatment? Epidemiologia e Psichiatria Sociale 17, 77–81.CrossRefGoogle ScholarPubMed
Casadebaig, F, Quemada, N (1991). Changes in mortality among psychiatric inpatients, 1968–1982. Social Psychiatry and Psychiatric Epidemiology 26, 78–82.Google Scholar
Consul, PC (1989). Generalized Poisson Distributions. Marcel Dekker Inc.: New York and Basel.Google Scholar
Craig, TJ, Lin, SP (1981). Death and deinstitutionalization. American Journal of Psychiatry 138, 224–227.Google ScholarPubMed
Druss, BG, Newcomer, JW (2007). Challenges and solutions to integrating mental and physical health care. Journal of Clinical Psychiatry 68, e09.Google Scholar
Farr, W (1841). Report upon the mortality of lunatics. Journal of the Statistical Society 4, 17–33.Google Scholar
Goff, DC, Cather, C, Evins, AE, Henderson, DC, Freudenreich, O, Copeland, PM, Bierer, M, Duckworth, K, Sacks, FM (2005). Medical morbidity and mortality in schizophrenia: guidelines for psychiatrists. Journal of Clinical Psychiatry 66, 183–194.CrossRefGoogle ScholarPubMed
Goldacre, MJ, Kurina, LM, Wotton, CJ, Yeates, D, Seagroat, V (2005). Schizophrenia and cancer: an epidemiological study. British Journal of Psychiatry 187, 334–338.CrossRefGoogle ScholarPubMed
Hansen, V, Jacobsen, BK, Arnesen, E (2001). Cause-specific mortality in psychiatric patients after deinstitutionalisation. British Journal of Psychiatry 179, 438–443.CrossRefGoogle ScholarPubMed
Harris, EC, Barraclough, B (1998). Excess mortality of mental disorder. British Journal of Psychiatry 173, 11–53.CrossRefGoogle ScholarPubMed
Hassall, C, Prior, P, Cross, KW (1988). A preliminary study of excess mortality using a psychiatric case register. Journal of Epidemiology and Community Health 42, 286–289.Google Scholar
Haugland, G, Craig, TJ, Goodman, AB, Siegel, C (1983). Mortality in the era of deinstitutionalization. American Journal of Psychiatry 140, 848–852.Google ScholarPubMed
Kales, HC, Valenstein, M, Kim, HM, McCarthy, JF, Ganoczy, D, Cunningham, F, Blow, FC (2007). Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. American Journal of Psychiatry 164, 1568–1576.CrossRefGoogle ScholarPubMed
Kisely, S, Smith, M, Lawrence, D, Maaten, S (2005). Mortality in individuals who have had psychiatric treatment: population-based study in Nova Scotia. British Journal of Psychiatry 187, 552–558.CrossRefGoogle ScholarPubMed
Leucht, S, Fountoulakis, K (2006). Improvement of the physical health of people with mental illness. Current Opinion in Psychiatry 19, 411–412.CrossRefGoogle ScholarPubMed
Licht, RW, Mortensen, PB, Gouliaev, G, Lund, J (1993). Mortality in Danish psychiatric long-stay patients, 1972–1982. Acta Psychiatrica Scandinavica 87, 336–341.CrossRefGoogle ScholarPubMed
Malzberg, B (1934). Mortality Among Patients with Mental Disease. State Hospital Press: New York.Google Scholar
Martiello, MA, Cipriani, F, Voller, F, Buiatti, E, Giacchi, M (2006). The descriptive epidemiology of suicide in Tuscany, 1988–2002. Epidemiologia e Psichiatria Sociale 15, 202–210.CrossRefGoogle ScholarPubMed
Meloni, D, Miccinesi, G, Bencini, A, Conte, M, Crocetti, E, Zappa, M, Ferrara, M (2006). Mortality among discharged psychiatric patients in Florence, Italy. Psychiatric Services 57, 1474–1481.CrossRefGoogle ScholarPubMed
Mortensen, PB, Juel, K (1993). Mortality and causes of death in first admitted schizophrenic patients. British Journal of Psychiatry 163, 183–189.CrossRefGoogle ScholarPubMed
National Center for Health Statistics (2006). ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. Practice Management Information Corporation (PMIC): Los Angeles, CA.Google Scholar
Politi, P, Piccinelli, M, Klersy, C, Madini, S, Segagni, LG, Fratti, C, Barale, F (2002). Mortality in psychiatric patients 5 to 21 years after hospital admission in Italy. Psychological Medicine 32, 227–237.CrossRefGoogle ScholarPubMed
Politi, P, Sciarini, P, Lusignani, GS, Micieli, G (2006). Depression and stroke: an up-to-date review. Epidemiologia e Psichiatria Sociale 15, 284–294.Google Scholar
Rasanen, P, Hakko, H, Jokelainen, J, Tiihonen, J (2002). Seasonal variation in specific methods of suicide: a national register study of 20,234 Finnish people. Journal of Affective Disorders 71, 51–59.Google Scholar
Rosen, CS, Kuhn, E, Greenbaum, MA, Drescher, KD (2008). Substance abuse-related mortality among middle-aged male VA psychiatric patients. Psychiatric Services 59, 290–296.Google Scholar
Schneider, LS, Dagerman, KS, Insel, P (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. Journal of the American Medical Association 294, 1934–1943.CrossRefGoogle ScholarPubMed
Sims, AC (2001). Mortality statistics in psychiatry. British Journal of Psychiatry 179, 477–478.CrossRefGoogle ScholarPubMed
Sohlman, B, Lehtinen, V (1999). Mortality among discharged psychiatric patients in Finland. Acta Psychiatrica Scandinavica 99, 102–109.CrossRefGoogle ScholarPubMed
Tansella, M, Amaddeo, F, Burti, L, Garzotto, N, Ruggeri, M (1998). Community-based mental health care in Verona, Italy. In Mental Health in Our Future Cities (ed. Goldberg, D. and Thornicroft, G.), pp. 239–262. Psychological Press: Hove.Google Scholar
Tansella, M, Amaddeo, F, Burti, L, Lasalvia, A, Ruggeri, M (2006). Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience. Acta Psychiatrica Scandinavica (Suppl.) 429, 90–94.CrossRefGoogle Scholar
Tsuang, MT, Simpson, JC (1985). Mortality studies in psychiatry. Should they stop or proceed? Archive of General Psychiatry 42, 98–103.CrossRefGoogle ScholarPubMed
Vreeland, B (2007). Bridging the gap between mental and physical health: a multidisciplinary approach. Journal of Clinical Psychiatry 68 (Suppl. 4), 26–33.Google Scholar
Wang, PS, Schneeweiss, S, Avorn, J, Fischer, MA, Mogun, H, Solomon, DH, Brookhart, MA (2005). Risk of death in elderly users of conventional vs. atypical antipsychotic medications. New England Journal of Medicine 353, 2335–2341.CrossRefGoogle ScholarPubMed
Zilber, N, Schufman, N, Lerner, Y (1989). Mortality among psychiatric patients – the groups at risk. Acta Psychiatrica Scandinavica 79, 248–256.CrossRefGoogle Scholar