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Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care

Published online by Cambridge University Press:  20 April 2009

L. Grigoletti ,
G. Perini ,
A. Rossi ,
A. Biggeri ,
C. Barbui ,
M. Tansella  and
F. Amaddeo
L. Grigoletti*
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
G. Perini
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
A. Rossi
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
A. Biggeri
Affiliation:
Department of Statistics, University of Florence, Italy
C. Barbui
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
M. Tansella
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
F. Amaddeo
Affiliation:
Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
*
*Address for correspondence: Dr L. Grigoletti, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, Ospedale Policlinico ‘G.B. Rossi’, Piazzale L.A. Scuro, 10, 37134 Verona, Italy. (Email: laura.grigoletti@univr.it)
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Abstract

Background

Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services.

Method

All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population.

Results

The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95% confidence interval (CI) 1.6–1.8], and higher still following the first admission (SMR 2.61, 95% CI 2.4–2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5–328.6) and personality disorders (20.87, 95% CI 5.2–83.4).

Conclusions

This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.

Keywords

Community-based system of caremental healthmortality
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 11 , November 2009 , pp. 1875 - 1884
Copyright
Copyright © Cambridge University Press 2009

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