Avoidable mortality among psychiatric patients
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.
- "Analysi s Number of studies References All- cause meta- analysi s 148 1,2,4-8,10-14,20-28,30-32,34-36,39,40,43-45,47-56,58,60,62,64-75,79-85,87- 92,95,96,98,101,102,104,105,109,110,112,113,116,118-134,137-142,144,147- 149,151,152,154,156,159,161-166,168-174,176-182,185,187188189190191192194,195,197198199202,203 Diagno sis- specifi c all- cause meta- analysi s160161162163167,169,172,173,175,177,180,184,185,188189190193,195,197 Unnatu ral meta- analysi s 1061234567891011121315,18,2021222324252634,37383940414243444548,49,52535457,60,6364656669,70,72,73,76,78,79,828384858689,90,96,98,100,102,104,105,108,109,111,112,114,117,120,122,123,125,127,129130131134,136137138140,145,148,150,151,153154155158,161162163165,167,169,172,173,177,180,183,185,189,190,195,197 Proport ion of deaths due to natural or unnatu ral causes 57 1,2,4-8,11,12,20,22-24,26,34,39,40,45,49,52-54,64,65,69,70,73,79,8285,98,102,109,120,122,123,125,127,130,131,138,140,148,151,154,161,172,173,177,180,185,189,19 0,195,197 Years of potenti al life lost 24 1,33,36,39,40,46,48,50,59,72,77,97,99,107,122,125,132133134146,170,186,196,201 "
[Show abstract] [Hide abstract] ABSTRACT: Background: The mortality of people suffering from psychiatric illnesses is far higher than that of the general population, all categories of diagnosis combined; mortality statistics can be used as an index of quality of care. The aim of this study was to assess the all-cause mortality in psychiatric patients covering all diagnostic groups. Methods: The living or deceased status of 4,417 patients of majority age hospitalised in a public mental health establishment between 2004 and 2007 were requested from French National Institute for Statistics and Economic Studies on 1st January 2011. The cause of death of those people who had died was obtained from French National Institute for Health and Medical Research and comparative standardized mortality ratios (SMR) were established from the population in a region of northern France of the same age in 2006. Results: The study population was made up of 54% men and 46% women, median age 41 and 45 years old, respectively. Four hundred and seventy-three people died during the period studied. The SMR were 421 for men (95% CI 378-470) and 330 for women (95% CI 281-388). The highest SMRs were found in patients aged 35-54, with a 20-time higher mortality risk than the general population of the same age. Conclusion: Our study confirms the considerably higher mortality in psychiatric patients than in general population, particularly in mean age and mostly due to an unnatural cause.0Comments 1Citation
- "This increase in mortality from natural causes appears to be due to the self-neglect, lack of self-awareness and harmful behaviour such as smoking, substance abuse or poor diet [37, 38]. Other authors believe that the excess mortality rate is due both to suicides and violent deaths [4, 10, 15, 17] and also to natural causes111213 . The mortality rate from suicide is raised in the year following hospitalisation and falls thereafter [9, 10, 12,141516 39]. "
[Show abstract] [Hide abstract] 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.0Comments 33Citations
- "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. "