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

  • L. Grigoletti (a1), G. Perini (a1), A. Rossi (a1), A. Biggeri (a2), C. Barbui (a1), M. Tansella (a1) and F. Amaddeo (a1)...

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.


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.


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).


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.

Corresponding author
*Address for correspondence: Dr L. Grigoletti, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, Ospedale Policlinico ‘G.B. Rossi’, Piazzale L.A. Scuro, 10, 37134 Verona, Italy. (Email:
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Allebeck P, Wistedt B (1986). Mortality in schizophrenia. A ten-year follow-up based on the Stockholm County inpatient register. Archive of General Psychiatry 43, 650653.
Amaddeo F, Barbui C, Perini G, Biggeri A, Tansella M (2007). Avoidable mortality of psychiatric patients in an area with a community-based system of mental health care. Acta Psychiatrica Scandinavica 115, 320325.
Amaddeo F, Bisoffi G, Bonizzato P, Micciolo R, Tansella M (1995). Mortality among patients with psychiatric illness. A ten-year case register study in an area with a community-based system of care. British Journal of Psychiatry 166, 783788.
Babigian HM, Odoroff CL (1969). The mortality experience of a population. American Journal of Psychiatry 126, 470480.
Carra G, Montomoli C, Monti MC, Clerici M (2008). Does HIV serostatus affect outcomes of dually diagnosed opiate dependents in residential treatment? Epidemiologia e Psichiatria Sociale 17, 7781.
Casadebaig F, Quemada N (1991). Changes in mortality among psychiatric inpatients, 1968–1982. Social Psychiatry and Psychiatric Epidemiology 26, 7882.
Consul PC (1989). Generalized Poisson Distributions. Marcel Dekker Inc.: New York and Basel.
Craig TJ, Lin SP (1981). Death and deinstitutionalization. American Journal of Psychiatry 138, 224227.
Druss BG, Newcomer JW (2007). Challenges and solutions to integrating mental and physical health care. Journal of Clinical Psychiatry 68, e09.
Farr W (1841). Report upon the mortality of lunatics. Journal of the Statistical Society 4, 1733.
Goff DC, Cather C, Evins AE, Henderson DC, Freudenreich O, Copeland PM, Bierer M, Duckworth K, Sacks FM (2005). Medical morbidity and mortality in schizophrenia: guidelines for psychiatrists. Journal of Clinical Psychiatry 66, 183194.
Goldacre MJ, Kurina LM, Wotton CJ, Yeates D, Seagroat V (2005). Schizophrenia and cancer: an epidemiological study. British Journal of Psychiatry 187, 334338.
Hansen V, Jacobsen BK, Arnesen E (2001). Cause-specific mortality in psychiatric patients after deinstitutionalisation. British Journal of Psychiatry 179, 438443.
Harris EC, Barraclough B (1998). Excess mortality of mental disorder. British Journal of Psychiatry 173, 1153.
Hassall C, Prior P, Cross KW (1988). A preliminary study of excess mortality using a psychiatric case register. Journal of Epidemiology and Community Health 42, 286289.
Haugland G, Craig TJ, Goodman AB, Siegel C (1983). Mortality in the era of deinstitutionalization. American Journal of Psychiatry 140, 848852.
Kales HC, Valenstein M, Kim HM, McCarthy JF, Ganoczy D, Cunningham F, Blow FC (2007). Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. American Journal of Psychiatry 164, 15681576.
Kisely S, Smith M, Lawrence D, Maaten S (2005). Mortality in individuals who have had psychiatric treatment: population-based study in Nova Scotia. British Journal of Psychiatry 187, 552558.
Leucht S, Fountoulakis K (2006). Improvement of the physical health of people with mental illness. Current Opinion in Psychiatry 19, 411412.
Licht RW, Mortensen PB, Gouliaev G, Lund J (1993). Mortality in Danish psychiatric long-stay patients, 1972–1982. Acta Psychiatrica Scandinavica 87, 336341.
Malzberg B (1934). Mortality Among Patients with Mental Disease. State Hospital Press: New York.
Martiello MA, Cipriani F, Voller F, Buiatti E, Giacchi M (2006). The descriptive epidemiology of suicide in Tuscany, 1988–2002. Epidemiologia e Psichiatria Sociale 15, 202210.
Meloni D, Miccinesi G, Bencini A, Conte M, Crocetti E, Zappa M, Ferrara M (2006). Mortality among discharged psychiatric patients in Florence, Italy. Psychiatric Services 57, 14741481.
Mortensen PB, Juel K (1993). Mortality and causes of death in first admitted schizophrenic patients. British Journal of Psychiatry 163, 183189.
National Center for Health Statistics (2006). ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. Practice Management Information Corporation (PMIC): Los Angeles, CA.
Politi P, Piccinelli M, Klersy C, Madini S, Segagni LG, Fratti C, Barale F (2002). Mortality in psychiatric patients 5 to 21 years after hospital admission in Italy. Psychological Medicine 32, 227237.
Politi P, Sciarini P, Lusignani GS, Micieli G (2006). Depression and stroke: an up-to-date review. Epidemiologia e Psichiatria Sociale 15, 284294.
Rasanen P, Hakko H, Jokelainen J, Tiihonen J (2002). Seasonal variation in specific methods of suicide: a national register study of 20,234 Finnish people. Journal of Affective Disorders 71, 5159.
Rosen CS, Kuhn E, Greenbaum MA, Drescher KD (2008). Substance abuse-related mortality among middle-aged male VA psychiatric patients. Psychiatric Services 59, 290296.
Schneider LS, Dagerman KS, Insel P (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. Journal of the American Medical Association 294, 19341943.
Sims AC (2001). Mortality statistics in psychiatry. British Journal of Psychiatry 179, 477478.
Sohlman B, Lehtinen V (1999). Mortality among discharged psychiatric patients in Finland. Acta Psychiatrica Scandinavica 99, 102109.
Tansella M, Amaddeo F, Burti L, Garzotto N, Ruggeri M (1998). Community-based mental health care in Verona, Italy. In Mental Health in Our Future Cities (ed. Goldberg D. and Thornicroft G.), pp. 239262. Psychological Press: Hove.
Tansella M, Amaddeo F, Burti L, Lasalvia A, Ruggeri M (2006). Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience. Acta Psychiatrica Scandinavica (Suppl.) 429, 9094.
Tsuang MT, Simpson JC (1985). Mortality studies in psychiatry. Should they stop or proceed? Archive of General Psychiatry 42, 98–103.
Vreeland B (2007). Bridging the gap between mental and physical health: a multidisciplinary approach. Journal of Clinical Psychiatry 68 (Suppl. 4), 2633.
Wang PS, Schneeweiss S, Avorn J, Fischer MA, Mogun H, Solomon DH, Brookhart MA (2005). Risk of death in elderly users of conventional vs. atypical antipsychotic medications. New England Journal of Medicine 353, 23352341.
Zilber N, Schufman N, Lerner Y (1989). Mortality among psychiatric patients – the groups at risk. Acta Psychiatrica Scandinavica 79, 248256.
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Psychological Medicine
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