Article

Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study

School of Psychiatry and Behavioural Sciences, University of Manchester, University Hospital of South Manchester, M20 8LR, Manchester, UK.
The Lancet (Impact Factor: 45.22). 12/2001; 358(9299):2110-2. DOI: 10.1016/S0140-6736(01)07216-6
Source: PubMed

ABSTRACT People with mental illness are at great risk of suicide, but little is known about their risk of death from other unnatural causes. No study has commented on their risk of being victims of homicide; public concern is pre-occupied with their role as perpetrators. We aimed to calculate standardised mortality ratios (SMRs) and directly standardised rate ratios for death by homicide, suicide, and accident in people admitted to hospital because of mental illness.
We did a population-based study in which we linked the data for 72208 individuals listed in the Danish Psychiatric Case Register between 1973 and 1993, and who died before Dec 31, 1993, with data in the Danish National Register of Causes of Death.
17892 (25%) patients died from unnatural causes. Our results show raised SMRs for homicide, suicide, and accident for most psychiatric diagnoses irrespective of sex. The all-diagnosis SMRs for women and men, respectively, were: 632 (95% CI 517-773) and 609 (493-753) for homicide, 1356 (1322-1391) and 1212 (1184-1241) for suicide, and 318 (305-332) and 466 (448-484) for accident. We recorded an increased risk of dying by homicide in men with schizophrenia and in individuals with affective psychosis. The highest risks of death by homicide and accident were in alcoholism and drug use, whereas the highest risks of suicide were in drug use.
People with mental disorders, including severe mental illness, are at increased risk of death by homicide. Strategies to reduce mortality in the mentally ill are correct to emphasise the high risk of suicide, but they should also focus on other unnatural causes of death.

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    • "* Las Tasas de Mortalidad Estándar se disparaban en dos de los estudios seleccionados (Menezes et al. en 1996 apuntaban un SMR de 317,9 y Hiroeh et al. en 2001, un SMR 1073-1080) por lo que fueron excluidos de la figura. "
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    ABSTRACT: Suicide is a major cause of death among patients with schizophrenia. Suicide phenomenon’s characterization is the best available approach for improved prediction and prevention of suicide. Patients at high risk for suicide need a more intensive monitoring and intervention. The aim of this review is to characterize, from a clinical-epidemiological point of view, the phenomenon of completed suicide in schizophrenia. We performed a systematic review to identify the most relevant studies published between 1994 and 2009, by searching on the international database Medline and among previous reviews references. Patients with schizophrenia experience higher mortality rates than the general population, especially due to the suicide. Most patients with schizophrenia who commit suicide are likely to be young and males, with a higher risk around illness onset and hospitalization periods. Previous suicide attempts are an important risk factor for completed suicide. Suicide risk is associated to psychotic positive symptoms, affective symptoms, depression and substance abuse. Treatment adherence is as protective factor. Patients with schizophrenia are likely to commit suicide by violent means. Suicide prevention should focus on treating affective symptoms and syndromes, improving treatment compliance and providing intensive monitoring to those patients at high risk of suicide, specially aroung hospitalization periods. Further studies are needed to clarify differential characteristics between suicide behaviour and completed suicide. Key words: Schizophrenia, Suicide, Mortality, Causes, Risk factors.
    Actas espanolas de psiquiatria 11/2012; 40(6):333-45. · 0.76 Impact Factor
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    • "A number of mechanisms are likely to underlie the detected association between PD and reduced life expectancy. First, the rate of death from unnatural causes, including suicide and homicide, is elevated in PD [6] and this is likely to have contributed to the reduced life expectancy detected in this study. Second, considering deaths due to natural causes, personality disorder is associated with poorer general health. "
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    ABSTRACT: It is well established that serious mental illness is associated with raised mortality, yet few studies have looked at the life expectancy of people with personality disorder (PD). This study aims to examine the life expectancy and relative mortality in people with PD within secondary mental health care. We set out to examine this using a large psychiatric case register in southeast London, UK. Mortality was obtained through national mortality tracing procedures. In a cohort of patients with a primary diagnosis of PD (n=1836), standardised mortality ratios (SMRs) and life expectancies at birth were calculated, using general population mortality statistics as the comparator. Life expectancy at birth was 63.3 years for women and 59.1 years for men with PD-18.7 years and 17.7 years shorter than females and males respectively in the general population in England and Wales. The SMR was 4.2 (95% CI: 3.03-5.64) overall; 5.0 (95% CI: 3.15-7.45) for females and 3.5 (95% CI: 2.17-5.47) for males. The highest SMRs were found in the younger age groups for both genders. People with PD using mental health services have a substantially reduced life expectancy, highlighting the significant public health burden of the disorder.
    Journal of psychosomatic research 08/2012; 73(2):104-7. DOI:10.1016/j.jpsychores.2012.05.001 · 2.84 Impact Factor
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    • "Mental disorder is an established risk factor for increased mortality [1] [2]. People with mental disorders die prematurely for a variety of reasons, including poor physical health [3] [4] [5], adverse physiological consequences of long term psychotropic medication, unhealthy lifestyle [5], as well as increased death rates as a result of suicide, accidents and homicide [6] [7] [8]. The risk of increased mortality has been shown to vary according to type of mental disorder, with substance use disorders conferring a particularly high risk of early death [1] [9] [10]. "
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    ABSTRACT: Objective: It is well established that serious mental illness is associated with raised mortality, yet few studies have looked at the life expectancy of people with personality disorder (PD). This study aims to examine the life expectancy and relative mortality in people with PD within secondary mental health care. Methods: We set out to examine this using a large psychiatric case register in southeast London, UK. Mortality was obtained through national mortality tracing procedures. In a cohort of patients with a primary diagnosis of PD (n = 1836), standardised mortality ratios (SMRs) and life expectancies at birth were calculated, using general population mortality statistics as the comparator. Results: Life expectancy at birth was 63.3 years for women and 59.1 years for men with PD—18.7 years and 17.7 years shorter than females and males respectively in the general population in England and Wales. The SMR was 4.2 (95% CI: 3.03–5.64) overall; 5.0 (95% CI: 3.15–7.45) for females and 3.5 (95% CI: 2.17– 5.47) for males. The highest SMRs were found in the younger age groups for both genders. Conclusion: People with PD using mental health services have a substantially reduced life expectancy, highlighting the significant public health burden of the disorder.
    Journal of Psychosomatic Research 01/2012; doi:10.1016/j.jpsychores.2012.05.001(doi:10.1016/j.jpsychores.2012.05.001). · 2.84 Impact Factor
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