Earlier studies of mortality of psychiatric patients are reviewed, and agreements and inconsistencies related to age, sex, diagnosis and cause of death are noted. The authors then analyze 5,268 deaths during a 5-year period of current or former patients in Missouri public psychiatric hospitals and mental health clinics, calculating mortality ratios that are simultaneously age-, sex-, diagnostic-, and cause-specific. The results are used to construct a quantitative model. The ratios vary most with cause, then diagnosis, least with sex. Influenza and pneumonia contribute most to patient mortality; patient death rates for cancer are lower than population rates at all ages. There are substantial interactions of diagnosis with cause and sex. Among those diagnosed organic brain syndrome, who have the highest overall ratios, the ratios are extra high for females and for influenza and pneumonia, relatively low for external causes.

A 90-item version of the Hopkins Symptom Checklist was completed by 327 unselected outpatients during one year at an urban state hospital clinic, and the results factor analyzed. Ten descriptive factors were found: agitated depression, somatic concerns, phobic fear, hostility, compulsions and mental blocks, feelings of guilt and inferiority, suspicion and mistrust, psychotic thinking, sleep disturbance, and fainting. The last three factors were based on only two or three items each. Anxiety did not emerge as a separate factor and only two of the proposed psychotic items formed a factor. Hypothesized new factors of phobic fears and hostility did, in fact, appear. Factors of guilt/inferiority and suspicion/mistrust were similar to expected factors of interpersonal sensitivity and paranoid ideation.

Age-specific suicide rates are presented, based on 207 white patients of the Missouri Department of Mental Health who were identified as having committed suicide during 1972-74. Results, divided by age, sex, diagnosis and patient status, are compared with other studies. Male inpatients are about five times more likely to commit suicide compared to the general population, while female inpatients are about 10 times more likely to do so. In both sexes, the rate is greatest for the diagnosis of major affective disorder. A history of psychiatric treatment increases the suicide risk more for women than for men, although male patients are still about twice as likely to commit suicide than are female patients. A quantitative model is presented which describes the relative influence of age, sex and diagnosis on suicide rates.

No abstract