Changes in mortality among psychiatric inpatients, 1968-1982

Area of Science:

• Psychiatry and Public Health
• Epidemiology
• Medical Sociology

Background:

• Mental disorder classification systems have evolved, impacting data collection and analysis.
• Public sector psychiatric hospitals in France have historically collected data on patient demographics and outcomes.
• Understanding mortality trends in psychiatric populations is crucial for public health interventions.

Purpose of the Study:

• To analyze the evolution of mortality rates in French psychiatric inpatients from 1968 to 1982.
• To compare mortality in psychiatric inpatients with the general population using standardized mortality ratios (SMRs).
• To investigate mortality trends across different psychiatric diagnoses and age groups, with a focus on gender disparities.

Main Methods:

• Utilized national data on mental disorders collected continuously (1968-1976) and biennially (1976-1982) in French public psychiatric hospitals.
• Estimated the hospitalized population using length-of-stay data and the person-years method.
• Calculated SMR by comparing observed deaths in inpatients to expected deaths based on general population mortality rates for similar age and sex groups.

Main Results:

• Excess mortality in psychiatric inpatients is decreasing overall but remains very high among women under 45.
• In 1982, all-cause mortality for women under 45 in psychiatric care was nearly 10 times higher than in the general female population of the same age.
• SMRs for psychoses and mental retardation showed no decrease in women under 55, while SMRs for neuroses increased from 1972. Mortality decreased for all diagnostic groups in individuals aged 55 and over.

Conclusions:

• Despite a general decrease, significant excess mortality persists in psychiatric inpatients, particularly affecting young women.
• Specific diagnostic groups, such as psychoses and neuroses, exhibit concerning mortality trends in younger female populations.
• Mortality rates show improvement in older psychiatric patients (55+), indicating potential age-related differences in risk factors or healthcare effectiveness.