Mortality among Psychiatric Patients

Abstract

A 5-year follow-up study was carried out of all referrals to the psychiatric services in a Regional Board area. The death registers of the Registrar General for Scotland were searched for all patients who were not known to be alive at the end of the study. Of the 2103 patients included in the original study, 343 were found to have died. This represents 15.9 per cent of males and 16.7 per cent of females referred. Most of the deaths (41%) occurred in the first year of follow-up, 20 per cent in the first 3 months. The overall death rate was approximately twice the expectation based on death rates in the general population of the area. The excess was greatest in those aged under 55 years. All areas of residence, occupations and social classes had increased mortality. Those patients diagnosed as organic psychosis had highest mortality (70%) but all diagnoses had an excessive number of deaths when standardised for age. Of the initial referrals, 1.4 per cent committed suicide during the follow-up period. Apart from neoplasms where deaths were close to expectation, all other broad categories of causes of death were equally involved in the increase. This survey of a total psychiatric referral group (in-patients, out-patients and domiciliary visits and private patients) supports previously reported studies, mainly of in-patients, in their finding of an association between high mortality rates and psychiatric illness. It is possible that this association may result from selective referral to the psychiatric services of those psychiatrically ill patients who exhibit physical symptomatology.

A new look at evidence about reduced cost of medical utilization following mental health treatment

“…Evidence of General Cost-Offset Effects Figure 1 shows that in 1974, the year before the start of mental health treatment, the medical charges for the treatment group were markedly higher than those for the comparison group, a finding consistent with the literature that suggests excess morbidity from physical disease among the mentally ill 90,91 and our earlier findings. 87 The medical charges of both groups rose in 1975 in part as an artifact of selectioneach person was required to have at least one medical claim in that year.…”

Violent Death and Mental Disorders in the Lundby Study

“…Nonviolent deaths account to some extent for this excess mortality among the mentally ill, but at the present time suicides and accidents are the two causes of death most closely associated with mental disor ders [Babigian and Odoroff, 1969;Innes and Millar, 1970;Sims, 1973;Rorsman, 1974],…”

Mortality and Psychiatric Specialist Care in the Lundby Study

“…The over-mortality in the Monroe County psychiatric patient population was thus generally more marked than that found among psychiatric patients in the Lundby cohort. Innes and Millar [1970] studied a total psychiatric population including all psychiatric services in a commu nity in Scotland. Their material comprised a 1-year sam ple which was observed concerning the mortality for 5 years.…”