Quality of medical care and excess mortality in psychiatric patients—a nationwide register-based study in Sweden

Abstract

ObjectiveTo assess overall and cause-specific mortality and the quality of somatic care among psychiatric patients.DesignA register-based cohort study.SettingAll individuals aged 20–79 years in Sweden in 2005.ParticipantsIn total 6 294 339 individuals.Primary outcome measureThe individuals were followed for mortality in 2006 and 2007, generating 72 187 deaths. Psychiatric patients were grouped according to their diagnosis in the National Patient Register. Mortality risk of psychiatric patients was compared with that of non-psychiatric patients. Estimates of RR of mortality were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Psychiatric patients were compared with non-psychiatric patients for three healthcare quality indicators: the proportion of avoidable hospitalisations, case death rate after myocardial infarction and statin use among diabetic patients.ResultsCompared with individuals with no episodes of treatment for mental disorder, psychiatric patients had a substantially increased risk of all studied causes of death as well as death from conditions considered amenable to intervention by the health service, that is, avoidable mortality. The highest mortality was found among those with another mental disorder, predominantly substance abuse (for women, an IRR of 4.7 (95% CI 4.3 to 5.0) and for men, an IRR of 4.8 (95% CI 4.6 to 5.0)). The analysis of quality of somatic care revealed lower levels of healthcare quality for psychiatric patients, signalling failures in public health and medical care.ConclusionThis study shows a marked increase in excess mortality, suggesting a lower quality of somatic healthcare in psychiatric patients.

Mortality in Mental Disorders and Global Disease Burden Implications

“…People with mental disorders often do not receive preventive services, such as immunizations, cancer screenings, and tobacco counseling, 43 and often receive a lower quality of care for medical conditions. 14,44 …”

Health at a Glance 2013

“…These include higher rates of suicide and accidents as well as a higher prevalence of co-morbidities or risk factors such as smoking, the abuse of alcohol and illicit drugs and side effects of psychotropic treatment (de Hert et al, 2011;Nordentoft et al, 2013;Björkenstam et al, 2012). Excess mortality among people with mental health disorders may also be partly due to lower access and use of health care as well as poorer quality of care provided to them.…”

Panorama de la santé 2013

“…On peut par exemple citer des taux de suicide et d'accident plus élevés ainsi qu'une plus grande prévalence de comorbidités ou de facteurs de risque comme le tabac, l'abus d'alcool et de drogues et les effets secondaires des médicaments psychotropes (Nordentoft et al, 2013 ;Björkenstam et al, 2012 (Wahlbeck et al, 2011). Pour ces deux troubles, le Danemark, la Corée et la Slovénie ont une surmortalité inférieure aux moyennes OCDE.…”