Excess mortality among psychiatric patients. The Iowa Record-Linkage Study
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Psychiatric patients face a significantly higher risk of premature death, especially within two years of discharge. This elevated risk, including suicide and accidental deaths, is particularly pronounced in women and younger individuals.
Area of Science:
- Psychiatry
- Public Health
- Epidemiology
Background:
- Long-term mortality risks for psychiatric patients are not fully understood.
- Previous studies suggest elevated mortality but lack detailed risk factor analysis.
Purpose of the Study:
- To investigate the mortality risk and patterns among psychiatric inpatients.
- To identify specific patient demographics and diagnoses associated with increased premature death.
Main Methods:
- Retrospective cohort study of 5,412 psychiatric inpatients.
- Follow-up period from 1972 to 1981, analyzing death records.
- Comparison of observed versus expected mortality rates based on general population data.
Main Results:
- 331 deaths occurred, exceeding expected rates.
- Highest risk observed in women and younger adults (30-39 years).
- Organic mental disorders, schizophrenia, neuroses, substance abuse, and depressive disorders were associated with increased mortality. Suicide and accidental deaths accounted for two-thirds of excess deaths.
- 99% of excess deaths occurred within two years post-discharge, with women at higher risk for natural deaths.
Conclusions:
- The first two years after psychiatric hospital discharge represent a critical high-risk period for premature mortality.
- Targeted interventions and support are crucial during this vulnerable post-discharge phase.
- Specific diagnoses and demographic factors significantly influence mortality risk in psychiatric populations.
Abstract:
Of 5,412 patients admitted to the University of Iowa Psychiatric Hospital between Jan 1, 1972, and Dec 31, 1981, three hundred thirty-one died during the follow-up period, significantly more than expected. The risk for premature death was greatest among women and the young, especially those between the ages of 30 and 39 years. Risk was associated with all psychiatric diagnoses and was significantly higher among patients of either sex with an organic mental disorder or schizophrenia; women with acute schizophrenia, depressive neuroses, alcoholism, drug abuse, and psycho-physiologic disorders and special symptoms; and men with neuroses. Suicide and accidental death were more frequent than expected and were responsible for two thirds of the excess deaths. During the total time of follow-up, women were at risk for natural deaths but men were not. Our most important finding was that 99% of the excess deaths occurred within two years of discharge. During this period there were undue numbers of both "natural" and "unnatural" deaths. The first two years after discharge are a time of great risk for psychiatric patients, particularly women.