Avoidable mortality of psychiatric patients in an area with a community‐based system of mental health care

Amaddeo, Francesco; Barbui, Corrado; Perini, Giovanni; Biggeri, Annibale; Tansella, Michele

doi:10.1111/j.1600-0447.2006.00894.x

Cited by 41 publications

(24 citation statements)

References 44 publications

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“…In particular, those treated for schizophrenia with comorbid substance abuse disorder had a higher risk, which has been shown by others 13 31…”

Section: Discussionmentioning

confidence: 58%

“…Avoidable mortality measures deaths that could be argued to have been avoidable either by the healthcare system or by public health interventions and has been applied in comparisons between regions, populations and over time. Psychiatric patients have been shown to have higher avoidable mortality rates than the general population,13 31 and questions have been raised as to whether the medical care of physical disorders provided to psychiatric patients is less adequate than for the population in general 32…”

Section: Introductionmentioning

confidence: 99%

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Quality of medical care and excess mortality in psychiatric patients—a nationwide register-based study in Sweden

et al. 2012

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ObjectiveTo assess overall and cause-specific mortality and the quality of somatic care among psychiatric patients.DesignA register-based cohort study.SettingAll individuals aged 20–79 years in Sweden in 2005.ParticipantsIn total 6 294 339 individuals.Primary outcome measureThe individuals were followed for mortality in 2006 and 2007, generating 72 187 deaths. Psychiatric patients were grouped according to their diagnosis in the National Patient Register. Mortality risk of psychiatric patients was compared with that of non-psychiatric patients. Estimates of RR of mortality were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Psychiatric patients were compared with non-psychiatric patients for three healthcare quality indicators: the proportion of avoidable hospitalisations, case death rate after myocardial infarction and statin use among diabetic patients.ResultsCompared with individuals with no episodes of treatment for mental disorder, psychiatric patients had a substantially increased risk of all studied causes of death as well as death from conditions considered amenable to intervention by the health service, that is, avoidable mortality. The highest mortality was found among those with another mental disorder, predominantly substance abuse (for women, an IRR of 4.7 (95% CI 4.3 to 5.0) and for men, an IRR of 4.8 (95% CI 4.6 to 5.0)). The analysis of quality of somatic care revealed lower levels of healthcare quality for psychiatric patients, signalling failures in public health and medical care.ConclusionThis study shows a marked increase in excess mortality, suggesting a lower quality of somatic healthcare in psychiatric patients.

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“…In particular, those treated for schizophrenia with comorbid substance abuse disorder had a higher risk, which has been shown by others 13 31…”

Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Quality of medical care and excess mortality in psychiatric patients—a nationwide register-based study in Sweden

et al. 2012

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“…High values of SMRs for infectious diseases were observed in the whole cohort (10.18), and this suggests that deinstitutionalization has not adequately improved the detection and treatment of physical diseases, which should be avoidable with access to a well-resourced health-care system or appropriate health policies (Amaddeo et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care

et al. 2009

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Background. Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services.Method. All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population.Results. The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95 % confidence interval (CI) 1.6-1.8], and higher still following the first admission (SMR 2.61, 95 % CI 2.4-2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95 % CI 142.5-328.6) and personality disorders (20.87, 95 % CI 5.2-83.4).Conclusions. This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

Life expectancy at birth and all-cause mortality among people with personality disorder

Fok

Hayes

Chang

et al. 2012

Journal of Psychosomatic Research

208

150

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Publisher's copyright statement: NOTICE: this is the author's version of a work that was accepted for publication in the Journal of Psychosomatic Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be re ected in this document. Changes may have been made to this work since it was submitted for publication. Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. ABSTRACT ObjectiveIt 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. MethodsWe 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), standardized mortality ratios (SMRs) and life expectancies at birth were calculated, using general population mortality statistics as the comparator. ResultsLife 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. ConclusionPeople with PD using mental health services have a substantially reduced life expectancy, highlighting the significant public health burden of the disorder.

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Avoidable mortality of psychiatric patients in an area with a community‐based system of mental health care

Cited by 41 publications

References 44 publications

Quality of medical care and excess mortality in psychiatric patients—a nationwide register-based study in Sweden

Quality of medical care and excess mortality in psychiatric patients—a nationwide register-based study in Sweden

Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care

Life expectancy at birth and all-cause mortality among people with personality disorder

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