Avoidable mortality among psychiatric patients.
ABSTRACT Avoidable mortality is a selection of causes of death considered to be amenable to health care and thereby used as an indicator of the quality of health care. In this study avoidable mortality for more than 30,000 psychiatric patients discharged from any hospital of Stockholm County between 1981 and 1985 has been followed up in the Cause of Death Register for the period 1986-1990. Standardised rate ratios were calculated for different groups of psychiatric disorders compared to the general population of Stockholm County for indicators of avoidable mortality, suicide, other mortality ("unavoidable") and causes possibly related to treatment with psychotrophic drugs. As expected, the psychiatric patients had the most pronounced elevated risk for suicide. i.e. 6- to 24-fold compared to the general population, and noticeably more elevated for women. It is also noteworthy that the relative mortality risks for diagnoses amenable to medical interventions and potential side-effects of psychotrophic drugs are higher than for other causes of death ("unavoidable"). The relative risks for avoidable mortality were 4.7 for men and 3.8 for women and for diagnoses possibly related to side-effects of psychotrophic drugs, 7.2. The relative risks for "unavoidable" mortality were 3.4 for men and 3.2 for women. The excess avoidable mortality rates for psychiatric patients and the elevated suicide risk, especially for female patients, are warning signals of shortcomings in psychiatric care that warrants further investigation.
- SourceAvailable from: Chiara SameleEpidemiologia e psichiatria sociale 09/2004; 13(3):141-5. DOI:10.1017/S1121189X00003407 · 3.16 Impact Factor
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ABSTRACT: This study utilized data from the national ACCESS program (N = 7224) to investigate the prevalence of suicidal ideation and suicide attempts in a sample of homeless people with mental illness. The prevalence of suicidal ideation in this sample was high (66.2% lifetime prevalence). In addition, 51.3% of the sample reported that they had ever attempted suicide, 26.9% reported an attempt that resulted in a nonpsychiatric hospitalization, and 8% reported an attempt in the previous 30 days. Youth, substance abuse, and psychiatric symptoms were all significantly associated with suicide attempts. Those who reported a recent attempt also reported higher rates of mental health care utilization, particularly inpatient care. The authors conclude that homeless people with mental illness are at particularly high risk for suicidal behavior, however, only in part because of the high prevalence of traditional risk factors.Journal of Nervous & Mental Disease 07/2003; 191(6):365-71. DOI:10.1097/01.NMD.0000071584.88965.E1 · 1.81 Impact Factor
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ABSTRACT: In order to study equity in health and access to care in an appropriate way, data are needed on an individual level and must include information about health, mortality, morbidity, utilization of care, age, sex, residential area, family situation and the social and economic circumstances of each individual. These data must be collected at several points of time during a life cycle. This is a demanding task requiring many resources and methodological and ethical considerations. The ethical and political trade-off is between our demand for knowledge and a fair distribution of resources in order to achieve equity in health and access to care and the need to administrate sensitive data without threatening personal integrity. In presenting results from Swedish studies, it is argued that the benefits of using registers for this kind of epidemiological research by far outweigh the risk of using registers.Acta Oncologica 02/1999; 38(1):71-5. DOI:10.1080/028418699431825 · 3.71 Impact Factor