Skip to main content

Mortality and Causes of Death in First Admitted Schizophrenic Patients

  • Preben Bo Mortensen (a1) and Knud Juel (a2)

Although many studies have shown an increased mortality in schizophrenic patients, the literature provides little information about mortality from specific causes in relation to age, gender, and duration of illness. This study examined mortality and causes of death in a total national sample of 9156 first admitted schizophrenic patients. Suicide accounted for 50% of deaths in men and 35% of deaths in women. Suicide risk was particularly increased during the first year of follow-up. Death from natural causes, with the exception of cancer and cerebrovascular diseases, was increased. Suicide risk during the first year of follow-up increased by 56%, with a 50% reduction on psychiatric in-patient facilities. The study confirms that mortality in schizophrenia is still markedly elevated, and the finding of an increasing suicide risk may be an indicator of some adverse effects of deinstitutionalisation.

Corresponding author
Hide All
Adler, L. E. & Griffith, J. M. (1991) Concurrent medical illness in the schizophrenic patient. Epidemiology, diagnosis, and management. Schizophrenia Research, 4, 91107.
Allebeck, P. (1989) Schizophrenia: a life-shortening disease. Schizophrenia Bulletin, 15, 8189.
Allebeck, P., Varla, A. & Wistedt, B. (1986) Suicide and violent death among patients with schizophrenia. Acta Psychiatrica Scandinavica, 74, 4394.
Allebeck, P. & Wistedt, B. (1986) Mortality in schizophrenia. A ten-year follow-up based on the Stockholm County in-patient register. Archives of General Psychiatry, 43, 650653.
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.
Black, D. W., Winokur, G. & Warrack, G. (1985) Suicide in schizophrenia: the Iowa Record Linkage Study. Journal of Clinical Psychiatry, 46, 1417.
Black, D. W., (1988) Age, mortality and chronic schizophrenia. Schizophrenia Research, 1, 267272.
Breslow, N. E. & Day, N. E. (1987) Statistical Methods in Cancer Research Volume II - The Design and Analysis of Cohort Studies. Lyon: IARC Scientific Publications No. 82.
Breslow, N. E. (1984) Elementary methods of cohorts analyis. International Journal of Epidemiology, 13, 112115.
Brook, O. H. (1985) Mortality in the long-stay population of Dutch mental hospitals. Acta Psychiatrica Scandinavica, 71, 626635.
Caldwell, C. B. & Gottesman, I. I. (1990) Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophrenia Bulletin, 16, 571589.
Craig, T. J. & Lin, S. P. (1981) Mortality among psychiatric in-patients. Age-adjusted comparison of populations before and after psychotropic drug era. Archives of General Psychiatry, 38, 935938.
Craig, T. J. & Kovasznay, B. (1988) Utilization of services. In Handbook of Schizophrenia. Vol. 3. Nosology, Epidemiology and Genetics of Schizophrenia (eds Tsuang, M. T. & Simpson, J. C.), pp. 399436. Amsterdam: Elsevier.
Dupont, A. (1983) A national psychiatric case register as a tool for mental health planning, research, and administration. The Danish model. In Information Support to Mental Health Programs. An International Perspective (eds Laska, E. M., Gulbinat, W. H. & Regier, D. A.), pp. 257274. New York: Human Sciences Press.
Eastwood, M. R., Stiasny, S., Meier, H. M., et al (1982) Mental illness and mortality. Comprehensive Psychiatry, 23, 377385.
Eaton, W. W., Mortensen, P. B., Hermann, H., et al (1992) Long-term course of hospitalization for schizophrenia: Part I. Risk for rehospitalization. Schizophrenia Bulletin, 18, 217227.
Epilog Plus (1989) Statistical Package for Epidemiology and Clinical Trials. Pasadena: Epicenter Software.
Giel, R., Dijk, S. & Van Weerden, D. J. R. (1978) Mortality in the long-stay population of all Dutch mental hospitals. Acta Psychiatrica Scandinavica, 57, 361368.
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.
Hillard, J. R., Zung, W. W. & Ramm, D. (1985) Accidental and homicidal death in a psychiatric emergency room population. Hospital and Community Psychiatry, 36, 640643.
Hollister, L. E. & Kosek, J. C. (1965) Sudden death during treatment with phenothiazine derivatives. Journal of the American Medical Association, 192, 9396.
Hughes, J. R., Hatsukami, D. K., Mitchell, J. E., et al (1986) Prevalence of smoking among psychiatric out-patients. American Journal of Psychiatry, 143, 993997.
Jones, G. R. (1985) Cancer therapy: phenothiazines in an unexpected role. Tumori, 71, 563569.
Juul, S. (1984) Programmer til overlevelsesberegninger, rapp nr 1. Aarhus: Socialmedicinsk Institut, Aarhus Universitet.
Martin, R. L., Cloninger, C. R., Guze, S. B., et al (1985) Mortality in a follow-up of 500 psychiatric out-patients. U: Cause-specific mortality. Archives of General Psychiatry, 42, 5866.
Masterson, E. & O'Shea, B. (1984) Smoking and malignancy in schizophrenia. British Journal of Psychiatry, 145, 429432.
Mortensen, P. B. (1987) Neuroleptic treatment and other factors modifying cancer risk in schizophrenic patients. Acta Psychiatrica Scandinavica, 75, 585590.
Mortensen, P. B. (1989) The incidence of cancer in schizophrenic patients. Journal of Epidemiology and Community Health, 43, 4347.
Mortensen, P. B. & Juel, K. (1990) Mortality and causes of death in schizophrenic patients in Denmark. Acta Psychiatrica Scandinavica, 81, 372377.
Munk-Jorgensen, P. (1987) Why has the incidence of schizophrenia in Danish psychiatric institutions decreased since 1970? Acta Psychiatrica Scandinavica, 75, 6268.
Munk-Jorgensen, P. & Mortensen, P. B. (1989) Schizophrenia: a 13-year follow-up. Acta Psychiatrica Scandinavica, 79, 391399.
Munk-Jorgensen, P. & Mortensen, P. B. & Machón, R. A. (1991) Hospitalization patterns in schizophrenia. A 13-year follow-up. Schizophrenia Research, 4, 19.
Nielsen, P. E., Zacho, J., Olsen, J. A., et al (1988) Aendringer i danskemes rygevaner 1970–1987. Ugeskrift for Laeger, 150, 22292233.
Pokorny, A. D. (1960) Characteristics of 44 patients who subsequently committed suicide. Archives of General Psychiatry, 2, 314323.
Risch, S. C., Groom, G. P. & Janowsky, D. S. (1981) Interfaces of psychopharmacology and cardiology - part two. Journal of Clinical Psychiatry, 42, 4759.
Roy, A. (1982) Suicide in chronic schizophrenia. British Journal of Psychiatry, 141, 171177.
Roy, A. (1986) Depression, attempted suicide, and suicide in patients with chronic schizophrenia. Psychiatric Clinics of North America, 9, 193206.
Rutstein, D. D., Berenberg, W., Chalmers, T. C., et al (1976) Measuring the quality of medical care. A clinical method. New England Journal of Medicine, 294, 582588.
Saugstad, L. F. & Ødegård, Ø. (1979) Mortality in psychiatric hospitals in Norway 1950–74. Acta Psychiatrica Scandinavica, 59, 431447.
Saugstad, L. F. & Ødegård, Ø. (1985) Recent rise in supposedly stress dependent causes of death in psychiatric hospitals in Norway indicating increased ‘stress’ in hospitals? Acta Psychiatrica Scandinavica, 71, 402409.
Simpson, J. C. (1988) Mortality studies in schizophrenia. In Handbook of Schizophrenia. Vol. 3. Nosology, Epidemiology and Genetics of Schizophrenia (eds Tsuang, M. T. & Simpson, J. C.), pp. 245274. Amsterdam: Elsevier.
Temoche, A., Pugh, T. F. & MacMahon, B. (1964) Suicide rates among current and former mental institution patients. Journal of Nervous and Mental Disease, 138, 124130.
Tsuang, M. T. & Woolson, R. F. (1978) Excess mortality in schizophrenia and affective disoders. Do suicides and accidental deaths solely account for this excess? Archives of General Psychiatry, 35, 11811185.
Tsuang, M. T. & Woolson, R. F. & Fleming, J. A. (1980) Causes of death in schizophrenia and manic-depression. British Journal of Psychiatry, 136, 239242.
Wolfersdorf, M., Keller, F., Schmidt, M. P. O., et al (1988) Are hospital suicides on the increase? A survey of reports on hospital suicides in the psychiatric literature of the 19th and 20th century. Social Psychiatry and Psychiatric Epidemiology, 23, 207216.
Wood, J. B., Evenson, R. C., Cho, D. W., et al (1985) Mortality variations among public mental health patients. Acta Psychiatrica Scandinavica, 72, 218229.
World Health Organization (1967) Manual of the International Statistical Classification of Disease, Injuries, and Cause of Death, 1965 revision (8th edn) (ICD-8). Geneva: WHO.
World Health Organization (1979) Schizophrenia. An International Follow-up Study. Toronto: John Wiley.
Zilber, N., Schufman, N. & Lerner, Y. (1989) Mortality among psychiatric patients-the groups at risk. Acta Psychiatrica Scandinavica, 79, 248256.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 16 *
Loading metrics...

Abstract views

Total abstract views: 88 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 18th August 2018. This data will be updated every 24 hours.

Mortality and Causes of Death in First Admitted Schizophrenic Patients

  • Preben Bo Mortensen (a1) and Knud Juel (a2)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *