Cause-specific mortality in psychiatric patients after deinstitutionalisation

Hansen, Vidje; Jacobsen, Bjarne K.; Arnesen, Egil

doi:10.1192/bjp.179.5.438

Cited by 135 publications

(84 citation statements)

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“…Deinstitutionalization, however, also seems to be associated with increased rates in deaths for causes considered ' behaviourally avoidable ' (i.e. preventable with adequate health promotion policies), such as cardiovascular and unnatural causes for both genders (Hansen et al 2001) and for suicide (Mortensen & Juel, 1993 ;Martiello et al 2006). Vreeland (2007) stated that the problem of increased morbidity and premature death in people with serious mental illness needed to be addressed with a transformation of the current mental health system and the integration of physical and mental health care, towards a system that uses a coordinated, multidisciplinary holistic approach.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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“…During the last few decades there have been changes in health systems, with significant reductions in in-patient capacity. These changes have been suspected to be an important factor in the rising mortality seen in patients with schizophrenia [44,45]. However, the effect of the reduction in in-patient capacity on the suicide rate remains unclear due to conflicting results [46].…”

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confidence: 99%

Suicide in schizophrenia

Carlborg

Winnerbäck

Jönsson

et al. 2010

Expert Review of Neurotherapeutics

112

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SchizophreniaSchizophrenia is a devastating psychiatric disorder affecting approximately 1% of the population worldwide during a lifetime. The onset of the illness occurs relatively early in life, usually in the late teens or early adulthood, and most patients have long-lasting adverse effects. Schizophrenia is a clinical syndrome diagnosed on the basis of symptom profiles, and is characterized by a constellation of symptoms of psychosis, such as abnormalities in the perception or expression of reality, as well as negative symptoms, such as affective flattening and avolition. Cognitive deficits are also usually present, and the symptoms must have persisted continuously for a least 6 months: however, schizophrenia cannot be diagnosed if symptoms of mood disorder are present or the symptoms are the direct result of a medical condition or substance abuse (Box 1) [201].The specific causes of schizophrenia are not known and combinations of several factors are likely to be involved. Genetic factors play a major role in the development of the disease [1], and environmental factors are also of importance. These latter factors include a history of obstetric complications, such as asphyxia [2] and prematurity [3]. Advanced paternal age is also considered to be a risk factor [4], and birth during the spring and late winter also increases the risk [5]. Prenatal viral infections [6], serious viral infections of the CNS during childhood [7], migrant status and urban rearing [8], and a lifetime history of cannabis use [9] are other well-known risk factors.Contrary to previous interpretations, the incidence and prevalence of schizophrenia show marked variation between sites. For example, migrants have an increased incidence and prevalence of schizophrenia, and exposures related to urbanicity, economic status and latitude are also associated with various frequency measures [10]. Men have a higher risk than women [11], and a recent review concluded that men have a 40% higher incidence of schizophrenia than women [12]. SuicideSuicide is defined as a self-inflicted death with evidence that the person intended to die (Box 2) [13]. Suicide is among the leading causes of premature death in the world and it is estimated that approximately 1 million people die by suicide every year [202]. Suicide rates vary according to region, gender, age, time and ethnic origin, and also according to death registration practices. The annual suicide rate in the world is 14.5 out of 10,0000 (in 2000), which is equal to one suicide every 40 s. Suicide is approximately three-to four-times more common in men than in women [202]. Suicide rates vary between different regions, and underestimation of suicide rates is common due to under-reporting, lack of epidemiological data and misclassification [14]. It has been estimated from psychological autopsies that more than 90% of those dying by suicide have a diagnosable psychiatric disorder at the time of death, and approximately 60% of the Schizophrenia is a disorder with an estimated suicide risk of 4-5%. Many f...

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“…But there is a long history of concern that the deinstitutionalization process may have led to a higher suicide rate [e.g. Hansen et al, 2001;Flechner, Wolf and Priebe, 1995;Salzer et al, 2006] Kahneman and Tversky [1979] call "editing" and ignore these risks altogether [see also Kunreuther, 1978]. Another "lulling effect" might stem from the fact that some self-injury attempts may be motivated by reasons other than the desire to end life, including to signal for help, punish family or friends, or secure resources more generally [Rosenthal, 1993;Cutler, Glaeser and Norberg, 2001;Marcotte, 2003].…”

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confidence: 99%

Anti-depressants and Suicide

Ludwig¹,

Marcotte²,

Norberg³

2007

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Does drug treatment for depression with selective serotonin reuptake inhibitors (SSRIs) increase or decrease the risk of completed suicide? The question is important in part because of recent government warnings that question the safety of SSRIs, one of the most widely prescribed medications in the world. While there are plausible clinical and behavioral arguments that SSRIs could have either positive or negative effects on suicide, randomized clinical trials have not been very informative because of small samples and other problems. In this paper we use data from 26 countries for up to 25 years to estimate the effect of SSRI sales on suicide mortality using just the variation in SSRI sales that can be explained by cross-country variation in the growth of drug sales more generally. We find that an increase in SSRI sales of 1 pill per capita (about a 12 percent increase over 2000 sales levels) is associated with a decline in suicide mortality of around 5 percent. These estimates imply a cost per statistical life far below most other government interventions to improve health outcomes.

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Cause-specific mortality in psychiatric patients after deinstitutionalisation

Abstract: Deinstitutionalisation seems to have had as its cost a relative rise both in cardiovascular death and unnatural deaths for both genders, but most pronounced in men.

Cited by 135 publications

References 23 publications

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

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

Suicide in schizophrenia

Anti-depressants and Suicide

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