Mortality among psychiatric patients treated in a community-based system of care: a 25-year follow-up

Background/Objectives: Many mortality studies published so far were conducted in areas where hospital-based systems of care are available for mentally ill. The aim of this study was to describe the causes of death (including accidental and avoidable causes) and associated risk factors among psychiatric patients followed-up over a 25-year period in an area where psychiatric care is entirely provided by community-based psychiatric services.

Methods: All subjects who had at least one contact with the South-Verona Community-based Mental Health Service during a 25 year period with an ICD-10 psychiatric diagnosis were included in this study. Standardized mortality ratios (SMR) 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 psychiatric patients was 1.88. Mortality was significantly high among out-patients (SMR=1.71, 95%, CI=1.6–1.8), and higher still following the first admission (SMR=2.61, 95% CI=2.4–2.9). SMRs for infectious diseases were higher among younger patients and extremely high in patients with drug addiction (216.40, 95% CI=142.5–328.6) and personality disorders (20.87, 95% CI=5.2–83.4). SMR was higher for deaths preventable with adequate health promotion policies than for those preventable with appropriate health care (i.e. SMR for road accident was 0.824 while SMR for hypertensive disease was 4.22).

Discussion/Conclusions: This study found that also in a community-based mental health service, psychiatric patients are at almost twofold higher risk of death 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 they urgently call for the implementation of health promotion and preventive programs targeted to psychiatric patients. Moreover, it seems important, for mental health services, to improve the capacity to manage medical health problems of patients.

Funding: Fondazione Cassa di Risparmio di Verona Vicenza Belluno e Ancona, Biomedical Research Projects 2003, Grant ‘Mortality for neoplasm among psychiatric patients and general population’ to Prof. Tansella.

Keywords: Discrimination, policy making, mortality.