Avoidable mortality among psychiatric patients

Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden.
Social Psychiatry and Psychiatric Epidemiology (Impact Factor: 2.54). 10/1998; 33(9):430-7. DOI: 10.1007/s001270050076
Source: PubMed


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.

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    • "Suicide ranked fourth as a cause of potential years of life lost before age 65 years for (non-Hispanic) whites, seventh for Hispanics, and ninth for (non-Hispanic) blacks. Suicide is avoidable mortality [2,3], and the proximate mental and physical health of decedents is salient to its understanding. To better comprehend the relationship between proximate health and suicide, we accessed national vital statistics data to describe and evaluate comorbidity in white, black, and Hispanic suicides. "
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    ABSTRACT: Clinician training deficits and a low and declining autopsy rate adversely impact the quality of death certificates in the United States. Self-report and records data for the general population indicate that proximate mental and physical health of minority suicides was at least as poor as that of white suicides. This cross-sectional mortality study uses data from Multiple Cause-of-Death (MCOD) public use files for 1999-2003 to describe and evaluate comorbidity among black, Hispanic, and white suicides. Unintentional injury decedents are the referent for multivariate analyses. One or more mentions of comorbid psychopathology are documented on the death certificates of 8% of white male suicides compared to 4% and 3% of black and Hispanic counterparts, respectively. Corresponding female figures are 10%, 8%, and 6%. Racial-ethnic discrepancies in the prevalence of comorbid physical disease are more attenuated. Cross-validation with National Violent Death Reporting System data reveals high relative under-enumeration of comorbid depression/mood disorders and high relative over-enumeration of schizophrenia on the death certificates of both minorities. In all three racial-ethnic groups, suicide is positively associated with depression/mood disorders [whites: adjusted odds ratio (AOR) = 31.9, 95% CI = 29.80-34.13; blacks: AOR = 60.9, 95% CI = 42.80-86.63; Hispanics: AOR = 34.7, 95% CI = 23.36-51.62] and schizophrenia [whites: AOR = 2.4, 95% CI = 2.07-2.86; blacks: AOR = 4.2, 95% CI = 2.73-6.37; Hispanics: AOR = 4.1, 95% CI = 2.01-8.22]. Suicide is positively associated with cancer in whites [AOR = 1.8, 95% CI = 1.69-1.93] and blacks [AOR = 1.8, 95% CI = 1.36-2.48], but not with HIV or alcohol and other substance use disorders in any group under review. The multivariate analyses indicate high consistency in predicting suicide-associated comorbidities across racial-ethnic groups using MCOD data. However, low prevalence of documented comorbid psychopathology in suicides, and concomitant racial-ethnic discrepancies underscore the need for training in death certification, and routinization and standardization of timely psychological autopsies in all cases of suicide, suspected suicide, and other traumatic deaths of equivocal cause.
    BMC Psychiatry 04/2009; 9(1):10. DOI:10.1186/1471-244X-9-10 · 2.21 Impact Factor
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    • "Explanations for this include behaviour putting life at risk or aimed at ending life [1], poorer quality of medical care [2-6], side effects of neuroleptics [7-11], heavy smoking [12], substance use [1], unhealthy diet [13], a generally unhealthy lifestyle [14], vulnerability to violence of others [15] and effects of the mental disorder itself [16]. Differences in patterns of mortality between men and women and among different psychiatric diagnostic groups have been observed [1,6,15]. Some causes of premature death in this group are related to medical treatment and the social environment; thus, patterns of death causes may vary over time [1,17]. "
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    ABSTRACT: Investigating mortality in those with mental disorder is one way of measuring effects of mental health care reorganisation. This study's aim was to investigate whether the excess mortality in those with severe mental disorder remains high in Sweden after the initiation of the Community Mental Health Care Reform. We analysed excess mortality by gender, type of mental health service and psychiatric diagnosis in a large community-based cohort with long-term mental disorder. A survey was conducted in Stockholm County, Sweden in 1997 to identify adults with long-term disabling mental disorder (mental retardation and dementia excluded). The 12 103 cases were linked to the Hospital Discharge Register and the Cause of Death Register. Standardised mortality ratios (SMRs) for 1998-2000 were calculated for all causes of death, in the entire cohort and in subgroups based on treatment setting and diagnosis. Mortality was increased in both genders, for natural and external causes and in all diagnostic subgroups. Excess mortality was greater among those with a history of psychiatric inpatient care, especially in those with substance use disorder. For the entire cohort, the number of excess deaths due to natural causes was threefold that due to external causes. SMRs in those in contact with psychiatric services where strikingly similar to those in contact with social services. Mortality remains high in those with long-term mental disorder in Sweden, regardless of treatment setting. Treatment programs for persons with long-term mental disorder should target physical as well as mental health.
    Clinical Practice and Epidemiology in Mental Health 11/2008; 4(1):23. DOI:10.1186/1745-0179-4-23
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    • "and 3.99 (95% CI, 2.47-6.44) for females (Ringback Weitoft et al., 1998). "

    Epidemiologia e psichiatria sociale 09/2004; 13(3):141-5. DOI:10.1017/S1121189X00003407 · 3.16 Impact Factor
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