Life Expectancy and Causes of Death in a Population Treated for Serious Mental Illness

Dembling, Bruce; Chen, Donna T.; Vachon, Louis

doi:10.1176/ps.50.8.1036

Cited by 168 publications

(87 citation statements)

References 24 publications

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“…In this study, neither mental illness nor health literacy was associated with mortality. This observation is not what would be expected based on prior research, 47,48 and may be because of competing mortality risks in the sample. In addition, we did not assess knowledge of overdose risk or prevention knowledge, which could have been associated with death.…”

Section: Discussioncontrasting

confidence: 93%

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Saitz

Gaeta²,

Cheng³

et al. 2007

J Urban Health

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The objective of this analysis was to assess the mortality rate and risk factors in adults, with substance dependence, who are not receiving primary medical care (PC). Date and cause of death were identified using the National Death Index data and death certificates for 470 adults without PC over a period of almost 4 years after detailed clinical assessment after detoxification. Factors associated with risk of mortality were determined using stepwise Cox proportional hazards models. Subjects were 76% male, 47% homeless, and 47% with chronic medical illness; 40% reported alcohol, 27% heroin, and 33% cocaine as substance of choice. Median age was 35. During a period of up to 4 years, 27 (6%) subjects died. Median age at death was 39. Causes included: poisoning by any substance (40.9% of deaths), trauma (13%), cardiovascular disease (13.6%), and exposure to cold (9.1%). The age adjusted mortality rate was 4.4 times that of the general population in the same city. Among these individuals without PC in a detoxification unit, risk factors associated with death were the following: drug of choice [heroin: hazard ratio (HR) 6.9 (95% confidence interval (CI) 1.6-31.1]; alcohol: HR 3.7 (95% CI 0.79-16.9) compared to cocaine); past suicide attempt (HR 2.1, 95% CI 0.96-4.5); persistent homelessness (HR 2.4, 95% CI 1.1-5.3); and history of any chronic medical illness (HR 2.1, 95% CI 0.93-4.7). Receipt of primary care was not significantly associated with death (HR 0.85, 95% CI 0.34-2.1). Risk of mortality is high in patients with addictions and risk factors identifiable when these patients seek help from the health care system (i.e., for detoxification) may help identify those at highest risk for whom interventions could be targeted.

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Section: Discussioncontrasting

confidence: 93%

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Saitz

Gaeta²,

Cheng³

et al. 2007

J Urban Health

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“…(E-mail: s.metraux@usp.edu) takes on spatial dimensions, as research identifies Harlem both as a neighborhood that disproportionately generates homelessness, 11 and has elevated mortality rates 12 to the point where, according to one study, men in Bangladesh had better prospects of reaching age 65 than African-American men in Harlem. 13 The homeless population also features other characteristics that are associated with increased mortality hazard, including poorer overall health; 14 mental illness; [15][16][17] substance abuse; [18][19][20][21] incarceration; [22][23][24] and adverse childhood experiences. 25,26 Pointing to the overrepresentation of these conditions, however, must also come with the acknowledgment that these conditions are invariably found only among minorities of the homeless population.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Shelter Use and Housing Placement on Mortality Hazard for Unaccompanied Adults and Adults in Family Households Entering New York City Shelters: 1990–2002

et al. 2011

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This study examines mortality among New York City (NYC) homeless shelter users, assessing the relationships between mortality hazard and time in shelter, patterns of homelessness, and subsequent housing exits for both adults in families and single adults. Administrative records from the NYC shelter system were matched with death records from the Social Security Administration for 160,525 persons. Crude mortality rates and life tables were calculated, and survival analyses were undertaken using these data. Life expectancy was 64.2 and 68.6 years for single adult males and single adult females, respectively, and among adults in families, life expectancy was 67.2 and 70.1 years for males and females, respectively. For both groups, exits to stable housing (subsidized or non-subsidized) were associated with reduced mortality hazard. And while mortality hazard was substantially reduced for the time adults were in shelters, extended shelter use patterns were associated with increased mortality hazard. Differences between single homelessness and family homelessness extend to disparities in mortality rates. Although causal links cannot be established here, results suggest that, for both subgroups of the homeless population, prompt resolution of homelessness and availability of housing interventions may contribute to reduced mortality.

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“…32 In the United States, high rates of death, and especially of fatal injury, have also been reported in people treated with antipsychotics. 33 Further, a study from Finland found that the number of antipsychotic drugs used correlated with mortality, the relative risk increasing by 2.50 per prescribed drug. 34 Shortly after phenothiazines were introduced for the treatment of schizophrenia, they were already shown to elevate serum triglyceride and total cholesterol levels.…”

Section: Mortalitymentioning

confidence: 99%

An Outcome Measure in Schizophrenia: Mortality

Seeman

2007

Can J Psychiatry

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Objective: To determine the current outcome of schizophrenia, with mortality rate as the outcome measure. Method: Recent health, suicide, victim of violence, and mortality statistics were reviewed. Results: The general health of individuals with schizophrenia suffers from neglect, poor life style choices, and current treatments that increase death rates. Conclusion: Mortality in schizophrenia is rising, and it is the responsibility of physicians and health care planners to intervene.

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Life Expectancy and Causes of Death in a Population Treated for Serious Mental Illness

Abstract: Findings in this study are consistent with previous findings identifying excess mortality in a population with serious mental illness. The high rate of injury deaths, especially those due to psychotropic and other medications, should concern providers.

Cited by 168 publications

References 24 publications

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

The Impact of Shelter Use and Housing Placement on Mortality Hazard for Unaccompanied Adults and Adults in Family Households Entering New York City Shelters: 1990–2002

An Outcome Measure in Schizophrenia: Mortality

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