Excess mortality in a cohort of Brazilian patients with a median follow-up of 11 years after the first psychiatric hospital admission

Abstract

Purpose To estimate the mortality rates of a cohort of Brazilian patients after their first psychiatric admission and determine the possible risk factors associated with excess mortality. Methods The study included a cohort of psychiatric patients hospitalised from Jan 1, 2002 to Dec 31, 2007 in the catchment area of Ribeirão Preto, São Paulo state, Brazil. Data were linked to deaths that occurred between Jan 1, 2002 and Dec 31, 2016 from the SEADE Foundation (state data analysis system of São Paulo). The mortality rate (MR), age-sex-standardised mortality ratio (SMR), life expectancy at birth, and years of life lost (YLL) were computed. The factors associated with mortality were analysed by survival analysis using a Cox proportional hazards regression model. Results Of 4019 patients admitted (54.76% male), 803 died (69.74% male) during the follow-up (median = 11.25 years). Mortality rates were approximately three-fold higher than expected (SMR = 2.90, 95% CI 2.71–3.11). The highest mortality rate was noted in men with alcohol-related disorders (SMR = 5.50, 95% CI 4.87–6.19). Male sex (adjusted hazard ratio (aHR) = 1.62, 95% CI 1.37–1.92), higher age (aHR = 21.47, 95% CI 13.48–34.17), and unemployment (aHR = 1.22, 95% CI 1.05–1.43) significantly increased the mortality risk from all causes. The average YLL was 27.64 years with the highest YLL noted in nonalcohol substance-related disorders (39.22 years). The life expectancy at birth in this cohort was 47.27 years. Unnatural causes of death were associated with nonwhite skin colour and substance-related disorders. Conclusion An excess of mortality and a significant reduction in life expectancy of mentally disordered patients who were first admitted to psychiatric beds was noted, particularly patients admitted for substance-related disorders, which should represent a priority in mental health policies.

Racial inequalities in mental healthcare use and mortality: a cross-sectional analysis of 1.2 million low-income individuals in Rio de Janeiro, Brazil 2010–2016

“…In this study, black individuals were nearly 70% more likely to die from mental disorders than white individuals, a finding supported by a recent study in São Paulo where ‘unnatural’ causes of death, including suicide, were associated with non-white race/colour and substance-related disorders 29. This differs from HICs where White individuals with mental illnesses often have higher ‘unnatural’ mortality rates 69 70.…”

“…In this study, black individuals were nearly 70% more likely to die from mental disorders than white individuals, a finding supported by a recent study in São Paulo where ‘unnatural’ causes of death, including suicide, were associated with non-white race/colour and substance-related disorders. 29 This differs from HICs where White individuals with mental illnesses often have higher ‘unnatural’ mortality rates. 69 70 The different findings between HICs and evidence from Brazil in relation to mental health hospitalisations and mortality may stem from multiple factors including persisting healthcare access issues beyond PHC, such as difficulties in receiving treatments and referrals to specialists, differences in quality of care, as well as substantially higher levels of deprivation and poverty for non-white individuals in Brazil.…”

“…Evidence from the Brazilian National Health Survey suggests there is no association between poor mental health and skin colour in the country,18 yet a recent systematic review found a higher prevalence of mental disorders in non-white Brazilians 17. Furthermore, research frequently focuses on anxiety and depression, neglecting other mental disorders,22–25 and there have been few studies investigating racial/colour and socioeconomic inequalities beyond prevalence 26–33. The intersection of multiple socioeconomic characteristics with race in mental healthcare and health outcomes have not been previously explored in Brazil.…”

Life years lost for users of specialized mental healthcare

“…Particularly little detail is reported on national differences in mortality conditional on both sex and diagnosis. Furthermore, diagnosis‐specific (excess) mortality has been reported, but rarely for the sub‐set of patients requiring and receiving SMH within this selection of disorders 6,7,9–24 …”

“…Furthermore, diagnosisspecific (excess) mortality has been reported, but rarely for the sub-set of patients requiring and receiving SMH within this selection of disorders. 6,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The current study therefore aims to compare the mortality in a population of SMH users with the mortality of the general population in the Netherlands. Additionally, we aim to investigate mortality differences between men and women and by four major diagnosis categories.…”