Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-05-20T13:37:45.975Z Has data issue: false hasContentIssue false

Excess mortality of mental disorder

Published online by Cambridge University Press:  03 January 2018

Clare Harris*
Mental Health Group, University of Southampton
Brian Barraclough
Mental Health Group, University of Southampton
Dr B. M. Barraclough, Mental Health Group, University of Southampton, Royal South Hants Hospital, Brintons Terrace, Southampton SO14 0YG. e-mail: Offprints will not be available from the authors.



We describe the increased risk of premature death from natural and from unnatural causes for the common mental disorders.


With a Medline search (1966–1995) we found 152 English language reports on the mortality of mental disorder which met our inclusion criteria. From these reports, covering 27 mental disorder categories and eight treatment categories, we calculated standardised mortality ratios (SMRs) and 95% confidence intervals (CIs) for all causes of death, all natural causes and all unnatural causes; and for most, SMRs for suicide, other violent causes and specific natural causes.


Highest risks of premature death, from both natural and unnatural causes, are for substance abuse and eating disorders. Risk of death from unnatural causes is especially high for the functional disorders, particularly schizophrenia and major depression. Deaths from natural causes are markedly increased for organic mental disorders, mental retardation and epilepsy.


All mental disorders have an increased risk of premature death.

Review Article
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Adelstetn, A. & White, G. (1976) Alcoholism and mortality. Population Trends, 6,. 713.Google Scholar
Allebeck, P. (1989) Schizophrenia: a life-shortening disease. Schizophrenia Bulletin, 15, 8189.CrossRefGoogle ScholarPubMed
Allgulander, C. (1994) Suicide and mortality patterns in anxiety neurosis and depressive neurosis. Archives of General Psychiatry, 51, 708712.CrossRefGoogle ScholarPubMed
Amaddeo, F. Bisoffi, G. Bonizzato, P. et al (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.CrossRefGoogle Scholar
Amdur, M. A. & Souchek, J. (1981) Death in aftercare. Comprehensive Psychiatry, 22, 619626.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn. revised) (DSM—III—R). Washington. DC: American Psychiatric Association.Google Scholar
Anderson, C. Connelly, J. Johnstone, E. C. et al (1991) Disabilities and circumstances of schizophrenic patients — a follow-up study. V: Cause of death. British Journal of Psychiatry, 159 (suppl. 13). 3033.CrossRefGoogle Scholar
Andréasson, S. Allebeck, P. & Romelsjo, A. (1988) Alcohol and mortality among young men: longitudinal study of Swedish conscripts. British Medical Journal, 296, 10211025.CrossRefGoogle ScholarPubMed
Astrup, C. Fossum, A. & Holmboe, R. (1959) A follow-up study of 270 patients with acute affective psychoses. Acta Psychiatrica et Neurologica Scandinavica, 34 (suppl. 135). 165.Google Scholar
Babigian, H. M. & Odoroff, C. L. (1969) The mortality experience of a population with psychiatric illness. American Journal of Psychiatry, 126, 470480.CrossRefGoogle ScholarPubMed
Balrd, P. A. & Sadovnick, A. D. (1988) Causes of death to age 30 in Down syndrome. American Journal of Human Genetics, 43, 239248.Google Scholar
Balarajan, R. Donnan, S. P. B. & Adeistein, A. M. (1982) Mortality and cause of death in Down's syndrome. Journal of Epidemiology and Community Health, 36, 127129.CrossRefGoogle ScholarPubMed
Balestrieri, M. Micciolo, R. & Tansella, M. (1987) Long-stay and long-term psychiatric patients in an area with a community-based system of care. A register follow-up study. Internatioal Journal of Social Psychiatry, 33, 251262.CrossRefGoogle Scholar
Barr, H. L. Antes, D. Ortenberg, D. J. et al (1984) Mortality of treated alcoholics and drug addicts: the benefits of abstinence. Journal of Studies onAlcohol, 45, 440452.CrossRefGoogle ScholarPubMed
Barraclough, B. M. & Noyes, R. (1989) Language of publication of journal articles on suicide and mental disorders. Acta Psychiatrica Scandinavica, 79, 245247.CrossRefGoogle ScholarPubMed
Baxter, D. N. (1996) The mortality experience of individuals on the Salford psychiatric case register. I: All-cause mortality. British Journal of Psychiatry, 168, 772779.CrossRefGoogle ScholarPubMed
Benson, G. & Holmberg, M. B. (1984) Drug-related mortality in young people. Acta Psychiatrica Scandinavica, 70, 525534.CrossRefGoogle ScholarPubMed
Berglund, M. (1984) Mortality in alcoholics related to clinical state at first admission. A study of 537 deaths. Acta Psychiatrica Scandinavica, 70, 407416.CrossRefGoogle ScholarPubMed
Berglund, M. & Nilsson, K. (1987) Mortality in severe depression. A prospective study including 103 suicides. Acta Psychiatrica Scandinavica, 76, 372380.CrossRefGoogle ScholarPubMed
Berglund, M. & Tunving, K. (1985) Assaultive alcoholics 20 years later. Acta Psychiatrica Scandinavica, 71, 141147.CrossRefGoogle ScholarPubMed
Berren, M. R. Hill, K. R. Merikle, E. et al (1994) Serious mental illness and mortality rates. Hospital and Community Psychiatry, 45, 604605.Google ScholarPubMed
Bewley, T. H. Ben-Arie, O. & Pierce James, I. (1968) Morbidity and mortality from heroin dependence. I: Survey of heroin addicts known to Home Office. British Medical Journal, 1, 725726.Google Scholar
Black, D. W. Warrack, G. & Winokur, G. (1985a) The Iowa record-linkage study. II: Excess mortality among patients with organic mental disorders. Archives of General Psychiatry, 42, 7881.CrossRefGoogle ScholarPubMed
Black, D. W. Warrack, G. & Winokur, G. (1985b) Excess mortality among psychiatric patients. The Iowa record-linkage study. Journal of the American Medical Association, 253, 5861.CrossRefGoogle Scholar
Black, D. W. Warrack, G. & Winokur, G. (1985c) The Iowa record-linkage study. III: Excess mortality among patients with ‘functional’ disorders. Archives of General Psychiatry, 42, 8288.CrossRefGoogle ScholarPubMed
Black, D. W. Winokur, G. & Nasrallah, A. (1987) Is death from natural causes still excessive in psychiatric patients? A follow-up of 1593 patients with major affective disorder. Journal of Nervous and Mental Disease, 175, 674680.CrossRefGoogle ScholarPubMed
W, Black, D. & Fisher, R. (1992) Mortality in DSM-III-R schizophrenia. Schizophrenia Research, 7, 109116.Google Scholar
Bland, R. C. & Orn, H. (1978) 14-year outcome in early schizophrenia. Acta Psychiatrica Scandinavica, 58, 327338.CrossRefGoogle ScholarPubMed
Bland, R. C. & Parker, J. H. (1976) Prognosis in schizophrenia: a ten-year follow-up of first admissions. Archives of General Psychiatry, 33, 949954.CrossRefGoogle ScholarPubMed
Boffetta, P. & Garfinkel, L. (1990) Alcohol drinking and mortality among men enrolled in an American cancer society prospective study. Epidemiology, 1, 342348.Google Scholar
Bratfos, O. (1971) Attempted suicide: a comparative study of patients who have attempted suicide and psychiatric patients in general. Acta Psychiatrica Scandinavica, 47, 3856.CrossRefGoogle ScholarPubMed
Bratfos, O. & Haug, J. O. (1968) The course of manic-depressive psychosis: a follow up investigation of 215 patients. Acta Psychiatrica Scandinavica, 44, 89112.CrossRefGoogle ScholarPubMed
Brenner, B. (1967) Alcoholism and fatal accidents. Quarterly Journal of Studies on Alcohol, 28, 517528.CrossRefGoogle ScholarPubMed
Buchholtz-Hansen, P. E. Wang, A. G. Kragh-Sorensen, P. et al (1993) Mortality in major affective disorder: relationship to subtype of depression. Acta Psychiatrica Scandinavica, 87, 329335.CrossRefGoogle ScholarPubMed
Bucknall, A. B. V. & Robertson, J. R. (1986) Deaths of heroin users in a general practice population. Journal of the Royal College of General Practitioners, 36, 120122.Google Scholar
Buda, M. Tsuang, M. T. & Fleming, J. A. (1988) Causes of death in DSM—III schizophrenics and other psychotics (atypical group). A comparison with the general population. Archives of General Psychiatry, 45, 283285.CrossRefGoogle Scholar
Chalmers, I. Dickersin, K. & Chalmers, T. C. (1992) Getting to grips with Archie Cochrane's agenda: all randomised controlled trials should be registered and reported. British Medical Journal, 305, 786788.CrossRefGoogle Scholar
Cockerell, O. C. Johnson, A. L. Sander, J. W. A. S. et al (1994) Mortality from epilepsy: results from a prospective population-based study. Lancet, 344, 918921.CrossRefGoogle ScholarPubMed
Coppen, A. Standish Barry, H. Bailey, J. et al (1991) Does lithium reduce the mortality of recurrent mood disorders. Journal of Affective Disorders, 23, 17.Google Scholar
Corten, P. Ribourdoullle, M. & Dramaix, M. (1991) Premature death among outpatients at a community mental health center. Hospital and Community Psychiatry, 42, 12481251.Google Scholar
Coryell, W. (1981) Diagnosis-specific mortality: primary unipolar depression and Briquet's syndrome (somatization disorder). Archives of General Psychiatry, 38, 939942.CrossRefGoogle ScholarPubMed
Coryell, W. Noyes, R. & Clancy, J. (1982) Excess mortality in panic disorder: a comparison with primary unipolar depression. Archives of General Psychiatry, 39, 701703.CrossRefGoogle ScholarPubMed
Coryell, W. & House, D. (1984) The validity of broadly defined hysteria and DSM-III conversion disorder: outcome, family history, and mortality. Journal of Clinical Psychiatry, 45, 252256.Google ScholarPubMed
Crisp, A. H. Callender, J. S. Halek, C. et al (1992) Long-term mortality in anorexia nervosa: a 20-year follow-up of the St George's and Aberdeen cohorts. British Journal of Psychiatry, 161, 104107.Google Scholar
Dahlgren, K. G. (1951) On death-rates and causes of death in alcohol addicts. Acta Psychiatrica et Neurologica Scandinavica, 24, 297311.CrossRefGoogle Scholar
Dahlgren, L. (1979) Female alcoholics IV. Marital situation and husbands. Acta Psychiatrica Scandinavica, 59, 5969.Google Scholar
Dahlgren, L. & Myrhed, M. (1977) Alcoholic females II. Causes of death with reference to sex difference. Acta Psychiatrica Scandinavica, 56, 8191.Google Scholar
de Château, P. (1990) Mortality and aggressiveness in a 30-year follow-up study in child guidance clinics in Stockholm. Acta Psychiatrica Scandinavica, 81, 472476.Google Scholar
de Lint, J. & Levinson, T. (1975) Mortality among patients treated for alcoholism: a 5-year follow-up. Canadian Medical Association Journal, 113, 385387.Google ScholarPubMed
Deter, H. & Herzog, W. (1994) Anorexia nervosa in a long-term perspective: results of the Heidelberg-Mannheim study. Psychosomatic Medicine, 56, 2027.Google Scholar
Dimitrijevic, P. Jacobsson, L. & Wall, S. (1984) Mortality among patients suffering from organic psychoses. Nordisk Psykiatrisk Tidsskrift, 38, 127133.CrossRefGoogle Scholar
Doll, R. Peto, R. Wheathley, K. et al (1994) Mortality in relation to smoking: 40 years' observations on male British doctors. British Medical Journal, 309, 901911.Google Scholar
Eastwood, M. R. Stiasny, S. Meier, H. M. R. et al (1982) Mental illness and mortality. Comprehensive Psychiatry, 23, 377385.CrossRefGoogle ScholarPubMed
Eckert, E. D. Halmi, K. A. Marchi, P. et al (1995) Ten-year follow-up of anorexia nervosa: clinical course and outcome. Psychological Medicine, 25, 143156.CrossRefGoogle ScholarPubMed
Ekeberg, O. Ellingsen, O. & Jacobsen, D. (1991) Suicide and other causes of death in a five-year follow-up of patients treated for self-poisoning in Oslo. Acta Psychiatrica Scandinavica, 83, 432437.CrossRefGoogle Scholar
Engström, A. Adamsson, C. Allebeck, P. et al (1991) Mortality in patients with substance abuse: a follow-up in Stockholm County, 1973–1984. International Journal of the Addictions, 26, 91106.CrossRefGoogle ScholarPubMed
Eskild, A. Magnus, P. Samuelsen, S. O. et al (1993) Differences in mortality rates and causes of death between HIV positive and HIV negative intravenous drug users. International Journal of Epidemiology, 22, 315320.CrossRefGoogle ScholarPubMed
Ettlinger, R. (1975) Evaluation of suicide prevention after attempted suicide. Acta Psychiatrica Scandinavica Supplementum, 260, 1135.Google ScholarPubMed
Evans, N. J. R. Baldwin, J. A. & Gath, D. (1974) The incidence of cancer among in-patients with affective disorders. British Journal of Psychiatry, 124, 518525.CrossRefGoogle ScholarPubMed
Evans, N. J. R. & Whitlock, F. A. (1983) Mortality and late-onset affective disorder. Journal of Affective Disorders, 5, 297304.CrossRefGoogle ScholarPubMed
Gardner, M. J. & Altman, D. G. (1989) Statistics With Confidence. London: BMJ.Google Scholar
Giel, R. Dijk, S. & van Weerden Dijkstra, J. R. (1978) Mortality in the long-stay population of all Dutch mental hospitals. Acta Psychiatrica Scandinavica, 57, 361368.CrossRefGoogle ScholarPubMed
Gillis, L. S. (1969) The mortality rate and causes of death of treated chronic alcoholics. South African Medical Journal, 43, 230232.Google ScholarPubMed
Goldacre, M. & Hawton, K. (1985) Repetition of self-poisoning and subsequent death in adolescents who take overdoses. British Journal of Psychiatry, 146, 395398.Google Scholar
Grönbladh, L. Ohlund, L. S. & Gunne, L. M. (1990) Mortality in heroin addiction: impact of methadone treatment. Acta Psychiatrica Scandinavica, 82, 223227.Google Scholar
Haastrup, S. & Jensen, P. W. (1984) Seven year follow-up of 300 young drug abusers. Acta Psychiatrica Scandinavica, 70, 503509.CrossRefGoogle ScholarPubMed
Harris, E. C. & Barraclough, B. M. (1994) Suicide as an outcome for medical disorders. Medicine, 73, 281296.CrossRefGoogle ScholarPubMed
Harris, E. C. & Barraclough, B. M. (1997) Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry, 170, 205228.CrossRefGoogle ScholarPubMed
Harvey, I. Peters, T. J. & Toth, B. (1993) Meta-analysis (letter). Lancet, 341, 964.CrossRefGoogle Scholar
Haugland, G. Craig, T. J. Goodman, A. B. et al (1983) Mortality in the era of deinstitutionalization. American Journal of Psychiatry, 140, 848852.Google ScholarPubMed
Hauser, W. A. Annegers, J. F. & Elveback, L. R. (1980) Mortality in patients with epilepsy. Epilepsia, 21, 399412.CrossRefGoogle ScholarPubMed
Helgason, L. (1977) Psychiatric services and mental illness in Iceland. Incidence study (1966–67) with 6–7 year follow up. Acta Psychiatrica Scandinavica Supplementum, 268, 1140.Google Scholar
Helgason, L. (1977) (1990) Twenty years' follow-up of first psychiatric presentation for schizophrenia: what could have been prevented? Acta Psychiatrica Scandinavica, 81, 231235.CrossRefGoogle Scholar
Herrman, H. E. Baldwin, J. A. & Christie, D. (1983) A record-linkage study of mortality and general hospital discharge in patients diagnosed as schizophrenic. Psychological Medicine, 13, 581593.CrossRefGoogle ScholarPubMed
Hewer, W. Rössler, W. Fätkenheuer, B. et al (1995) Mortality among patients in psychiatric hospitals in Germany. Acta Psychiatrica Scandinavica, 91, 174179.Google Scholar
Heyman, A. Wilkinson, W. E. Hurwltz, B. J. et al (1987) Early-onset Alzheimer's disease: clinical predictors of institutionalization and death. Neurology, 37, 980984.CrossRefGoogle ScholarPubMed
Higuchi, S. (1987) Mortality of Japanese female alcoholics: a comparative study with male cases. Japanese Journal of Alcohol and Drug Dependence, 22, 211223.Google ScholarPubMed
Innes, G. & Millar, W. M. (1970) Mortality among psychiatric patients. Scottish Medical Journal, 15, 143148.CrossRefGoogle ScholarPubMed
James, I. P. (1967) Suicide and mortality amongst heroin addicts in Britain. British Journal of the Addictions, 62, 391398.Google Scholar
Johnson, R. H. & Robinson, B. J. (1988) Mortality in alcoholics with autonomic neuropathy. Journal of Neurology, Neurosurgery and Psychiatry, 51, 476480.CrossRefGoogle ScholarPubMed
Jones, D. R. (1992) Meta-analysis of observational epidemiological studies: a review. Journal of the Royal Society of Medicine, 85, 165168.Google ScholarPubMed
Jorgensen, P. & Mortensen, P. B. (1992) Cause of death in reactive psychosis. Acta Psychiatrica Scandinavica, 85, 351353.CrossRefGoogle ScholarPubMed
Kawachl, I. Colditz, G. A. Stampfer, M. J. et al (1993) Smoking cessation in relation to total mortality rates in women. A prospective cohort study. Annals of Internal Medicine, 119, 9921000.Google Scholar
Kay, D. W. K. (1962) Outcome and cause of death in mental disorders of old age. A long-term follow-up of functional and organic psychoses. Acta Psychiatrica Scandinavica, 38, 249276.CrossRefGoogle Scholar
Kay, D. W. K. & Patterson, U. (1977) Manic-depressive illness: a clinical, social and genetic study. VI: Mortality. Acta Psychiatrica Scandinavica Supplementum, 269, 5560.Google Scholar
Keehn, R. J. Goldberg, I. D. & Beebe, G. W. (1974) Twenty-four year mortality follow-up of Army veterans with disability separations for psychoneurosis in 1944. Psychosomatic Medicine, 36, 2746.Google Scholar
Kendell, R. E. (1966) The fate of untreated alcoholics. Quarterly Journal of Studies on Alcohol, 27, 3041.Google Scholar
Kendler, K. S. (1986) A twin study of mortality in schizophrenia and neurosis. Archives of General Psychiatry, 43, 643649.Google Scholar
Kerr, T. A. Schapira, K. & Roth, M. (1969) The relationship between premature death and affective disorders. British Journal of Psychiatry, 115, 12771282.CrossRefGoogle ScholarPubMed
Klenerman, P. Sander, J. W. & Shorvon, S. D. (1993) Mortality in patients with epilepsy: a study of patients in long term residential care. Journal of Neurology, Neurosurgery and Psychiatry, 56, 149152.Google Scholar
Koranyi, E. K. (1977) Fatalities in 2070 psychiatric outpatients: preventative features. Archives of General Psychiatry, 34, 11371142.Google Scholar
Kuperman, S. Black, D. W. & Burns, T. L. (1988) Excess mortality among formerly hospitalized child psychiatric patients. Archives of General Psychiatry, 45, 277282.CrossRefGoogle ScholarPubMed
Larsen, F. W. Dahl, V. & Hallum, E. (1990) A 30 year follow-up study of a child psychiatric clientele. I: Demographic description. Acta Psychiatrica Scandinavica, 81, 3945.CrossRefGoogle ScholarPubMed
Lee, A. S. & Murray, R. M. (1988) The long-term outcome of Maudsley depressives. British Journal of Psychiatry, 153, 741751.Google Scholar
Lesage, A. D. Trapanl, V. & Lamella, M. (1990) Excess mortality by natural causes of Italian schizophrenic patients. European Archives of Psychiatry and Neurological Sciences, 239, 361365.CrossRefGoogle ScholarPubMed
Licht, R. W. Mortensen, P. B. Gouliaev, G. et al (1993) Mortality in Danish psychiatric long-stay patients, 1972–1982. Acta Psychiatrica Scandinavica, 87, 336341.CrossRefGoogle ScholarPubMed
Lim, L. C. Sim, L. P. & Chlam, P. C. (1993) Mortality of public mental health patients: a Singapore experience. Australia and New Zealand Journal of Psychiatry, 27, 3641.CrossRefGoogle ScholarPubMed
Lindberg, S. & Ågren, G. (1988) Mortality among male and female hospitalised alcoholics in Stockholm 1962–1983. British Journal of the Addictions, 83, 11931200.CrossRefGoogle ScholarPubMed
Llndelius, R. Salum, I. & Ågren, G. (1974) Mortality among male and female alcoholic patients treated in a psychiatric unit. Acta Psychiatrica Scandinavica, 50, 612618.CrossRefGoogle Scholar
Llndelius, R. & Kay, D. W. K. (1973) Some changes in the pattern of mortality in schizophrenia, in Sweden. Acta Psychiatrica Scandinavica, 49, 315323.CrossRefGoogle Scholar
Lönnqvist, J. Niskanen, P. Achté, K. A. et al (1975) Self-poisoning with follow-up considerations. Suicide, 5, 3946.Google ScholarPubMed
Mackenzie, A. Allen, R. P. & Funderburk, F. R. (1986) Mortality and illness in male alcoholics: an 8-year follow-up. International Journal of the Addictions, 21, 865882.Google Scholar
Marshall, E. J. Edwards, G. & Taylor, C. (1994) Mortality in men with drinking problems: a 20-year follow-up. Addiction, 89, 12931298.Google Scholar
Martin, R. L. Cloninger, R. Guze, S. B. et al (1985) Mortality in a follow-up of 500 psychiatric outpatients. II: Cause-specific mortality. Archive. of General Psychiatry, 42, 5866.CrossRefGoogle Scholar
Medhus, A. (1975) Mortality among female alcoholics. Scandinavian Journal of Social Medicine, 3, 111115.CrossRefGoogle ScholarPubMed
Medical Research Council (1995) Topic Review. Suicide and Parasuicide. London: MRC.Google Scholar
Mehlum, L. (1994) Young male suicide attempters 20 years later: the suicide mortality rate. Military Medicine, 159, 138140.Google Scholar
Mortensen, R. B. & Juel, K. (1990) Mortality and causes of death in schizophrenic patients in Denmark. Acta Psychiatrica Scandmavica, 81, 372377.CrossRefGoogle ScholarPubMed
Mortensen, R. B. & Juel, K. (1993) Mortality and causes of death in first admitted schizophrenic patients. British Journal of Psychiatry, 163, 183189.Google Scholar
Murphy, J. M. Monson, R. R. Olivier, D. C. et al (1987) Affective disorders and mortality: a general population study. Archives of General Psychiatry, 44, 473480.Google Scholar
Murphy, J. M. Monson, R. R. Olivier, D. C. et al (1989) Mortality risk and psychiatric disorders. Social Psychiatry and Psychiatric Epidemiology, 24, 134142.CrossRefGoogle ScholarPubMed
Newman, S. C. & Bland, R. C. (1991a) Suicide risk varies by subtype of affective disorder. Acta Psychiatrica Scandinavica, 83, 420426.CrossRefGoogle ScholarPubMed
Newman, S. C. & Bland, R. C. (1991b) Mortality in a cohort of patients with schizophrenia: a record linkage study. Canadian Journal of Psychiatry, 36, 239245.CrossRefGoogle Scholar
Nilsson, A. (1995) Mortality in recurrent mood disorders during periods on and off lithium: a complete population study in 362 patients. Pharmacopsychiatry, 28, 813.Google Scholar
Nordentoft, M. Breum, L. Munck, L. K. et al (1993) High mortality by natural and unnatural causes: a 10 year follow up study of patients admitted to a poisoning treatment centre after suicide attempts. British Medical Journal, 306, 16371641.CrossRefGoogle ScholarPubMed
Norring, C. E. A. & Sohlberg, S. S. (1993) Outcome, recovery, relapse and mortality across six years in patients with clinical eating disorders. Acta Psychiatrica Scandinavica, 87, 437444.Google Scholar
Norton, B. & Whalley, L. J. (1984) Mortality of a lithium-treated population. British Journal of Psychiatry, 145, 277282.Google Scholar
Nyman, A. K. & Jonsson, H. (1986) Patterns of self-destructive behaviour in schizophrenia. Acta Psychiatrica Scandinavica, 73, 252262.CrossRefGoogle ScholarPubMed
O'Donnell, J. A. (1964) A follow-up of narcotic addicts. Mortality, relapse and abstinence. American Journal of Orthopsychiatry, 34, 948954.CrossRefGoogle ScholarPubMed
O'Leary, D. A. & Lee, A. S. (1996) Seven year prognosis in depression. Mortality and readmission risk in the Nottingham ECT cohort. British Journal of Psychiatry, 169, 423429.Google Scholar
Ohara, K. Suzuki, Y. Sugita, T. et al (1989) Mortality among alcoholics discharged from a Japanese hospital. British Journal of the Addictions, 84, 287291.CrossRefGoogle ScholarPubMed
Oppenheimer, E. Tobutt, C. Taylor, C. et al (1994) Death and survival in a cohort of heroin addicts from London clinics: a 22-year follow-up study. Addiction, 89, 12991308.Google Scholar
Orholm, M. Sorensen, T. I. A. Bentsen, K. et al (1985) Mortality of alcohol abusing men prospectively assessed in relation to history of abuse and degree of liver injury. Liver, 5, 253260.Google Scholar
Oster, J. Mikkelsen, M. & Nielsen, A. (1975) Mortality and life-table in Down's syndrome. Acta Paediatnca Scandinavica, 64, 322326.Google Scholar
Östman, O. (1991) Child and adolescent psychiatric patients in adulthood. Acta Psychiatrica Scandinavica, 84, 4045.CrossRefGoogle ScholarPubMed
Patton, G. C. (1988) Mortality in eating disorders. Psychologica. Medicine, 18, 947951.Google Scholar
Pederson, A. M. Tefft, B. M. & Babiglan, H. M. (1975) Risks of mortality of suicide attempters compared with psychiatric and general populations. Suicide, 5, 145157.Google Scholar
Pell, S. & D'Alonzo, C. A. (1973) A five-year mortality study of alcoholics. Journal of Occupational Medicine, 15, 120125.Google ScholarPubMed
Perucci, C. A. Davoli, M. Rapiti, E. et al (1991) Mortality of intravenous drug users in Rome: a cohort study. American Journal of Public Health, 81, 13071310.CrossRefGoogle ScholarPubMed
Pieninkeroinen, I. P. Telaklvi, T. M. & Hlllbom, M. E. (1992) Outcome in subjects with alcohol-provoked seizures. Alcoholism: Clinical and Experimental Research, 16, 955959.CrossRefGoogle ScholarPubMed
Poser, W. Poser, S. & Eva-Condemarin, P. (1992) Mortality in patients with dependence on prescription drugs. Drug and Alcohol Dependence, 30, 4957.Google Scholar
Rantakallio, P. Läärä, E. & Koiranen, M. (1995) A 28 year follow-up of mortality among women who smoked during pregnancy. British Medical Journal, 311, 477480.Google Scholar
Reiter, K. (1974) Mortality and cause of death in men found to be mentally abnormal by forensic psychiatrists. Scandinavian Journal of Social Medicine, 2, 13.Google Scholar
Robinette, C. D. Hrubec, Z. & Fraumeni, J. F. Jr. (1979) Chronic alcoholism and subsequent mortality in World War II veterans. American Journal of Epidemiology, 109, 687700.Google Scholar
Rorsman, B. (1974) Mortality among psychiatric patients. Acta Psychiatrica Scandinavica, 50, 354375.CrossRefGoogle ScholarPubMed
Rorsman, B. Hagnell, O. & Lanke, J. (1983) Mortality and psychiatric specialist care in the Lundby study. Age-standardized death rates in different forms of psychiatric services in a total population investigated during a 25-year period. Neuropsychobiology, 9, 28.CrossRefGoogle Scholar
Rydelius, P. (1988) The development of antisocial behaviour and sudden violent death. Acta Psychiatrica Scandmavica, 77, 398403.CrossRefGoogle ScholarPubMed
Saku, M. Tokudome, S. Ikeda, M. et al (1995) Mortality in psychiatric patients with a specific focus on cancer mortality associated with schizophrenia. International Journal of Epidemiology, 24, 366372.CrossRefGoogle ScholarPubMed
Schmidt, W. & de Lint, J. (1972) Causes of death of alcoholics. Quarterly Journal of Studies on Alcohol, 33, 171185.Google Scholar
Segal, S. P. & Kotler, P. L. (1991) A ten-year perspective of mortality risk among mentally ill patients in sheltered care. Hospital and Community Psychiatry, 42, 708713.Google ScholarPubMed
Similä, S. von Wendt, L. & Rantakallio, P. (1986) Mortality of mentally retarded children to 17 years of age assessed in a prospective one-year birth cohort. Journal of Mental Deficiency Research, 30, 401405.Google Scholar
Sims, A. C. P. (1973) Importance of a high tracing-rate in long-term medical follow-up studies. Lancet, ii, 433435.CrossRefGoogle Scholar
Similä, S. & Prior, P. (1978) The pattern of mortality in severe neuroses. British Journal of Psychiatry, 133, 299305.Google Scholar
Smith, E. M. Cloninger, C. R. & Bradford, S. (1983) Predictors of mortality in alcoholic women: a prospective follow-up study. Alcoholism. Clinical and Experimental Research, 7, 237243.CrossRefGoogle Scholar
Stewart, L. A. & Parmar, M. K. B. (1993) Metaanalysis of the literature or of individual patient data: is there a difference. Lancet, 341, 418422.CrossRefGoogle ScholarPubMed
Ström, J. Thisted, B. Krantz, T. et al (1986) Self poisoning treated in an ICU: drug pattern, acute mortality and short-term survival. Acta Anaesthesiologica Scandinavica, 30, 148153.CrossRefGoogle Scholar
Sturt, E. (1983) Mortality in a cohort of long-term users of community psychiatric services. Psychological Medicine, 13, 441446.CrossRefGoogle Scholar
Surtees, P. G. & Barkley, C. (1994) Future imperfect: the long-term outcome of depression. British Journal of Psychiatry, 164, 327341.Google Scholar
Thompson, S. G. & Pocock, S. J. (1991) Can metaanalyses be trusted. Lancet, 338, 11271130.Google Scholar
Thorarinsson, A. A. (1979) Mortality among men alcoholics in Iceland. 1951–74. Journal of Studies onAlcohol, 40, 704718.Google Scholar
Tsuang, M. T. Woolson, R. F. & Fleming, J. A. (1980) Causes of death in schizophrenia and manic-depression. British Journal of Psychiatry, 136, 239242.CrossRefGoogle ScholarPubMed
Tunving, K. (1988) Fatal outcome in drug addiction. Acta Psychiatrica Scandinavica, 77, 551566.CrossRefGoogle ScholarPubMed
Tverdal, A. Thelle, D. Stensvold, I. et al (1993) Mortality in relation to smoking history: 13 years' follow-up of 68,000 Norwegian men and women 35–49 years. Journal of Clinical Epidemiology, 46, 475487.Google Scholar
Vaillant, G. E. Clark, W. Cyrus, C. et al (1983) Prospective study of alcoholism treatment: eight-year follow-up. American Journal of Medicine, 75, 455463.Google Scholar
Vestergaard, P. & Aagaard, J. (1991) Five-year mortality in lithium-treated manic-depressive patients. Journal of Affective Disorders, 21, 3338.CrossRefGoogle ScholarPubMed
Weekke, A. & Vaeth, M. (1986) Excess mortality of bipolar and unipolar manic-depressive patients. Journal of Affective Disorders, II, 227234.Google Scholar
Weekke, A. Juel, K. & Vaeth, M. (1987) Cardiovascular death and manic-depressive psychosis. Journal of Affective Disorders, 13, 287292.Google Scholar
Wells, J. E. & Walker, N. D. (1990) Mortality in a follow-up study of 616 alcoholics admitted to an inpatient alcoholism clinic 1972–76. New Zealand Medical Journal, 103, 13.Google Scholar
Wheeler, E. O. White, P. D. Reed, E. W. et al (1950) Neurocirculatory asthenia (anxiety neurosis, effort syndrome, neurasthenia): a twenty year follow-up study of one hundred and seventy-three patients. Journal of the American Medical Association, 142, 878889.Google Scholar
White, S. J. McLean, A. E. M. & Howland, C. (1979) Anticonvulsant drugs and cancer. A cohort study in patients with severe epilepsy. Lancet, ii, 458461.CrossRefGoogle Scholar
Whitehead, A. & Hunt, A. (1982) Elderly psychiatric patients: a five-year prospective study. Psychological Medicine, 12, 149157.Google Scholar
Whitiock, F. A. & Siskind, M. (1979) Depression and cancer: a follow-up study. Psychological Medicine, 9, 747752.CrossRefGoogle Scholar
World Health Organization (years up to and including 1961) Annual Epidemiological and Vital Statistics, Geneva: WHO.Google Scholar
World Health Organization (1962 and years following)World Health Statistics Annual. Geneva: WHO.Google Scholar
World Health Organization (1977) International Classification of Diseases, 9th Revision (ICD-9). Geneva: WHO.Google Scholar
Zaccarelli, M. Gattari, P. Rezza, G. et al (1994) Impact of HIV infection on non-AIDS mortality among Italian injecting drug users. AIDS, 8, 345350.Google Scholar
Zilber, N. Schufman, N. & Lerner, Y. (1989) Mortality among psychiatric patients — the groups at risk. Acta Psychiatrica Scandmavica, 79, 248256.Google Scholar
Submit a response


No eLetters have been published for this article.