Cause-specific mortality in psychiatric patients after deinstitutionalisation

Area of Science:

• Psychiatry
• Public Health
• Epidemiology

Background:

• Norway's psychiatric service system has undergone gradual deinstitutionalisation since the late 1970s.
• This shift aimed to integrate mental healthcare within the community.
• Understanding the impact on patient outcomes is crucial.

Purpose of the Study:

• To investigate the mortality rates of psychiatric patients within a deinstitutionalised care model.
• To identify specific causes of death and risk factors.
• To assess the long-term effects of deinstitutionalisation on patient survival.

Main Methods:

• Linking a psychiatric hospital's case register (1980-1992) with the Central Register of Deaths.
• Calculating age-adjusted death rates.
• Computing standardised mortality ratios (SMRs) to compare observed vs. expected deaths.

Main Results:

• Patients with organic psychiatric disorders exhibited significantly higher mortality.
• Standardised mortality ratios (SMRs) varied widely, from 0.9 (cancer in women) to 36.3 (suicide in men).
• Unnatural deaths showed the highest SMRs within the first year post-discharge, with increases in cardiovascular death and suicide noted across both genders compared to earlier periods.

Conclusions:

• Deinstitutionalisation in Norway appears correlated with a relative increase in cardiovascular and unnatural deaths for both genders.
• This trend is particularly pronounced in men.
• The findings highlight potential public health challenges associated with deinstitutionalisation.