Place of death and other factors associated with unnatural mortality in patients with serious mental disorders: population-based retrospective cohort study

Abstract

BackgroundPatients with serious mental disorders have poorer healthcare outcomes at the end of life and are at greater risk of dying from unnatural causes.AimsTo explore place of death and demographic and clinical correlates of unnatural causes of death in patients with serious mental disorders.MethodRoutinely collected patient data were used to explore bivariate and adjusted associations between covariates and natural/unnatural cause of death.ResultsIn multivariable analysis (n = 1029), dying at home (odds ratio (OR) = 1.87, 95% CI 1.03–3.40), ‘other’ locations (OR = 16.50, 95% CI 7.57–36.00), younger age (OR = 17.26, 95% CI 8.28–36.00) and a diagnosis other than schizophrenia spectrum disorder (OR = 1.69, 95% CI 1.04–2.73) were correlates of unnatural cause of death.ConclusionsDeaths from unnatural causes were high and more likely to occur at home and non-healthcare settings. Unnatural causes of death were higher in younger patients with non-schizophrenia spectrum disorder diagnoses.Declaration of interestF.G. has received support or honoraria for CME, advisory work and lectures from Bristol-Myers Squibb, Janssen, Lundbeck, Otsuka, Roche, and Sunovion, and has a family member with professional links to Lilly and GSK, including shares.

End-of-life care and place of death in adults with serious mental illness: A systematic review and narrative synthesis

“…Characteristics of the 23 included studies are presented in Table 1. Fourteen studies reported health care at end of life (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) and 13 studies reported place of death in patients with a serious mental illness (13,28,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) and. Four studies reported both outcomes (28,(34)(35)(36).…”

“…There was great variability in the size of the study sample from which the sample of people with serious mental illness. In two studies (28,32), the whole sample comprised eligible adult subjects with serious mental illness, whom were included in the synthesis of results, whilst other studies presented results for subsamples with serious mental illness from a Most studies were from the USA (13,24,(30)(31)(32)34,35,38) and Canada (29,36,43); the remaining studies were from Denmark (41,42), the UK (28,44), France (39), the Netherlands (25), Australia (27,33), New Zealand (23), Japan (40) and Taiwan (26,37). The mean/median age of subjects ranged between 47 and 79.…”

“…Studies describing utilisation of hospital care in the last year of life offered mixed results. Assessing acute care in the last month of life, one study found 44.7% patients who died from natural causes and 18.7% who died from unnatural causes were admitted to hospital in the last month of life (28).…”

“…Taking into consideration the cause of death, a study of acute care utilisation in the last month of life in patients with a variety of psychiatric diagnoses reported that 45.6% patients who died from natural causes and 26.6% patients who died from unnatural causes visited the emergency department in the last month of life (28).…”

(End of) Life spaces: an ethnographic study in Brazilian and French homes and medical-social institutions

“…As previously mentioned in the literature (2)(3) , a growing number of studies investigate people's preferred place to end their days. In those studies (7)(8)(9) , end-of-life experiences at the hospital and at home are verified, the preferences of rural residents as compared to urban residents, all indicating that the house is the least stressful and the most dignified environment to experience end of life and death. Additionally, primary health care and home care services are considered powerful settings for developing the principle of palliative care and for people's follow-up until death, because they are incorporated into everyday life, thus facilitating the governing of people and favoring the effectiveness of public policies for end of life care (10) .…”