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Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders

  • Kristian Wahlbeck (a1), Jeanette Westman (a2), Merete Nordentoft (a3), Mika Gissler (a4) and Thomas Munk Laursen (a5)...
Abstract
Background

People with mental disorders evince excess mortality due to natural and unnatural deaths. The relative life expectancy of people with mental disorders is a proxy measure of effectiveness of social policy and health service provision.

Aims

To evaluate trends in health outcomes of people with serious mental disorders.

Method

We examined nationwide 5-year consecutive cohorts of people admitted to hospital for mental disorders in Denmark, Finland and Sweden in 1987–2006. In each country the risk population was identified from hospital discharge registers and mortality data were retrieved from cause-of-death registers. The main outcome measure was life expectancy at age 15 years.

Results

People admitted to hospital for a mental disorder had a two- to threefold higher mortality than the general population in all three countries studied. This gap in life expectancy was more pronounced for men than for women. The gap decreased between 1987 and 2006 in these countries, especially for women. The notable exception was Swedish men with mental disorders. In spite of the positive general trend, men with mental disorders still live 20 years less, and women 15 years less, than the general population.

Conclusions

During the era of deinstitutionalisation the life expectancy gap for people with mental disorders has somewhat diminished in the three Nordic countries. Our results support further development of the Nordic welfare state model, i.e. tax-funded community-based public services and social protection. Health promotion actions, improved access to healthcare and prevention of suicides and violence are needed to further reduce the life expectancy gap.

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Copyright
Corresponding author
Dr Kristian Wahlbeck, National Institute for Health and Welfare (THL), Department of Mental Health and Substance Abuse Services, POBox 30, FIN-00271 Helsinki, Finland. Email: kristian.wahlbeck@thl.fi
Footnotes
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See editorial, pp. 441–442, this issue.

This research was supported by a grant from the Nordic Council of Ministers and by grant 2008-0885 from the Swedish Council for Social Research.

Declaration of interest

None.

Footnotes
References
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1 Thornicroft, G, Tansella, M. Components of a modern mental health service: a pragmatic balance of community and hospital care. Overview of systematic evidence. Br J Psychiatry 2004; 185: 283–90.
2 Harris, EC, Barraclough, B. Excess mortality of mental disorder. Br J Psychiatry 1998; 173: 1153.
3 Joukamaa, M, Heliövaara, M, Knekt, P, Aromaa, A, Raitasalo, R, Lehtinen, V. Mental disorders and cause-specific mortality. Br J Psychiatry 2001; 179: 498502.
4 Joukamaa, M, Heliövaara, M, Knekt, P, Aromaa, A, Raitasalo, R, Lehtinen, V. Schizophrenia, neuroleptic medication and mortality. Br J Psychiatry 2006; 188: 122–7.
5 Ösby, U, Correia, N, Brandt, L, Ekbom, A, Sparen, P. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000; 45: 21–8.
6 Fors, BM, Isacson, D, Bingefors, K, Widerlöv, B. Mortality among persons with schizophrenia in Sweden: an epidemiological study. Nord J Psychiatry 2007; 61: 252–9.
7 Tidemalm, D, Waern, M, Stefansson, CG, Elofsson, S, Runeson, B. Excess mortality in persons with severe mental disorder in Sweden: a cohort study of 12 103 individuals with and without contact with psychiatric services. Clin Pract Epidemiol Ment Health 2008; 4: 23.
8 Laursen, TM, Munk-Olsen, T, Nordentoft, M, Mortensen, PB. Increased mortality among patients admitted with major psychiatric disorders: a register-based study comparing mortality in unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia. J Clin Psychiatry 2007; 68: 899907.
9 Hewer, W, Rössler, W, Fatkenheuer, B, Löffler, W. Mortality among patients in psychiatric hospitals in Germany. Acta Psychiatr Scand 1995; 91: 174–9.
10 Hewer, W, Rössler, W. Mortality of patients with functional psychiatric illnesses during in-patient treatment [in German]. Fortschr Neurol Psychiatr 1997; 65: 171–81.
11 Perakis, A, Kolaitis, G, Kordoutis, P, Kranidioti, M, Tsiantis, J. Mortality among institutionalised people with learning disabilities in Greece: a 30-year survey at the Leros PIKPA asylum. Br J Psychiatry 1995; 167 (suppl 28): 70–7.
12 Räsänen, S, Hakko, H, Viilo, K, Meyer-Rochow, VB, Moring, J. Excess mortality among long-stay psychiatric patients in Northern Finland. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 297304.
13 Salazar-Fraile, J, Gomez-Beneyto, M, Perez-Hoyos, S, Hurtado-Navarro, I. Mortality among psychiatric patients referred to the mental health services in Valencia. Soc Psychiatry Psychiatr Epidemiol 1998; 33: 224–9.
14 Stark, C, MacLeod, M, Hall, D, O'Brien, F, Pelosi, A. Mortality after discharge from long-term psychiatric care in Scotland, 1977–94: a retrospective cohort study. BMC Public Health 2003; 3: 30.
15 Ensinck, KT, Schuurman, AG, van den Akker, AM, Metsemakers, JF, Kester, AD, Knottnerus, JA, et al. Is there an increased risk of dying after depression? Am J Epidemiol 2002; 156: 1043–8.
16 Gissler, M, Tuori, T, Wahlbeck, K, The Nordic Reference Group. Mental health in the Nordic countries. Health Statistics in the Nordic Countries 2005 – Helsestatistik for de Nordiske Lande 2005. Nordic Medico-Statistical Committee, 2007.
17 Ösby, U, Correia, N, Brandt, L, Ekbom, A, Sparen, P. Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. BMJ 2000; 321: 483–4.
18 Heilä, H, Haukka, J, Suvisaari, J, Lönnqvist, J. Mortality among patients with schizophrenia and reduced psychiatric hospital care. Psychol Med 2005; 35: 725–32.
19 World Health Organization. International Statistical Classification of Diseases and Related Health Problems (ICD-10). WHO, 1992.
20 Munk-Jorgensen, P, Mortensen, PB. The Danish Psychiatric Central Register. Dan Med Bull 1997; 44: 82–4.
21 Juel, K, Helweg-Larsen, K. The Danish registers of causes of death. Dan Med Bull 1999; 46: 354–7.
22 Keskimäki, I, Aro, S. The accuracy of data on diagnoses, procedures and accidents in the Finnish Hospital Discharge Register. Int J Health Serv 1991; 2: 1521.
23 Lahti, RA, Penttila, A. The validity of death certificates: routine validation of death certification and its effects on mortality statistics. Forensic Sci Int 2001; 115: 1532.
24 Swedish Ministry of Health and Social Affairs. Kvalitet och innehåll i patientregistret. Utskrivningar från slutenvården 1964–2007 och besöki specialiserad öppenvård (exklusive primärvårdsbesök) 1997–2007 [Quality and content of the Swedish Patient Register]. Socialstyrelsen, 2009.
25 Johansson, LA, Westerling, R. Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics. Int J Epidemiol 2000; 29: 495502.
26 Nordic Medico-Statistical Committee. Health Statistics in the Nordic Countries 2007. Helsestatistik for de Nordiske Lande 2007. NOMESCO, 2009.
27 World Health Organization Regional Office for Europe. European Health For All Database (HFA–DB). WHO Regional Office for Europe, 2010 (http://data.euro.who.int/hfadb/).
28 Wiesler, H. Uneméthode simple pour la construction de tables de mortalité abrégées. Proceedings of the First World Population Conference, Rome, vol. 4. United Nations, 1954.
29 Karlsson, N, Wahlbeck, K. Från Reformintention Till Praxis: Mentalvårdens Utveckling i Finland Efter År 1990 [From Reform Intentions to Practice: Developments in Finnish Mental Health Care Since 1990]. Rapport 24/2010. Finland National Institute for Health and Welfare, 2010 (http://www.thl.fi/thl-client/pdfs/d0d504f0-d878-4a19-97b3-e3b060f9b09a)
30 Osborn, DP, Levy, G, Nazareth, I, Petersen, I, Islam, A, King, MB. Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom's general practice research database. Arch Gen Psychiatry 2007; 64: 242–9.
31 Druss, BG, Bradford, WD, Rosenheck, RA, Radford, MJ, Krumholz, HM. Quality of medical care and excess mortality in older patients with mental disorders. Arch Gen Psychiatry 2001; 58: 565–72.
32 Laursen, TM, Munk-Olsen, T, Agerbo, E, Gasse, C, Mortensen, PB. Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Arch Gen Psychiatry 2009; 66: 713–20.
33 Sims, ACP. Mortality statistics in psychiatry. Br J Psychiatry 2001; 179: 477–8.
34 Fryers, T, Melzer, D, Jenkins, R, Brugha, T. The distribution of the common mental disorders: social inequalities in Europe. Clin Pract Epidemiol Ment Health 2005; 1: 14.
35 Link, BG, Phelan, JC. Stigma and its public health implications. Lancet 2006; 367: 528–9.
36 European Commission. Mental Well-being. Special Eurobarometer 248/wave 64.4. EC Directorate General Communication, 2006 (http://ec.europa.eu/health/ph_information/documents/ebs_248_en.pdf).
37 Pichler, F, Wallace, C. Patterns of formal and informal social capital in Europe. Eur Sociol Rev 2007; 23: 423–35.
38 Halpern, D. Social Capital. Polity Press, 2005.
39 Lahelma, E, Kivelä, K, Roos, E, Tuominen, T, Dahl, E, Diderichsen, F, et al. Analysing changes of health inequalities in the Nordic welfare states. Soc Sci Med 2002; 55: 609–25.
40 Zaridze, D, Brennan, P, Boreham, J, Boroda, A, Karpov, R, Lazarev, A, et al. Alcohol and cause-specific mortality in Russia: a retrospective case–control study of 48,557 adult deaths. Lancet 2009; 373: 2201–14.
41 Finland National Institute for Health and Welfare. Nordic Alcohol Statistics 2008. Finland National Institute for Health and Welfare, 2009 (http://www.stakes.fi/tilastot/tilastotiedotteet/2009/Tr20_09.pdf).
42 Pirkola, S, Sund, R, Sailas, E, Wahlbeck, K. Community mental-health services and suicide rate in Finland: a nationwide small-area analysis. Lancet 2009; 373: 147–53.
43 Swedish Ministry of Health and Social Affairs. Ambition och ansvar. Nationell strategi för utveckling av samhällets insatser till personer med psykiska sjukdomar och funktionshinder. Slutbetänkande av Nationell psykiatrisamordning. SOU 2006:100 [Ambition and Responsibility. National Strategy for People with Mental Disorders and Disabilities]. Socialdepartementet, 2006 (http://www.sweden.gov.se/content/1/c6/07/31/78/f8d9f649.pdf).
44 Nordentoft, M, Gudnason, K, Laigaard, A, Koch, I, Bille-Brahe, U, Hjorth Madsen, B, et al. Forslag til Handlingsplan til Forebyggelse af Selvmordsfors⊘g og Selvmord i Danmark [Action Plan for Prevention of Suicide and Suicide Attempts in Denmark]. Denmark National Board of Health, 1998.
45 Alonso, J, Angermeyer, MC, Bernert, S, Bruffaerts, R, Brugha, TS, Bryson, H, et al. Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004; 420: 4754.
46 Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 819.
47 Norwegian Patient Register. Aktivitetsdata i Psykisk Helsevern for Voksne 2008. Rapport IS-1749 [Activity Data from Adult Mental Health Services 2008]. Helsedirektoratet, 2010.
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Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders

  • Kristian Wahlbeck (a1), Jeanette Westman (a2), Merete Nordentoft (a3), Mika Gissler (a4) and Thomas Munk Laursen (a5)...
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eLetters

Benefits of bettter treatments lost to loss of beds

aparna maganty, Spr year 3
04 January 2012

The study authors conclude that In spite of the transition of mental health services, the life expectancy gap has remained largely unchanged over 20 years, and major health inequalities persist between people with mental disorders and the rest of the population.It is also noted that there were" a stable number of in-patients over the study period indicated that the composition of the in-patient populations had not undergone a major shift".Patients requiring inpatient care remaining constant through out this period this could suggest that massive strides made in physical health monitoring of mental health patients and improved treatments with newer psychopharmacological methods especially atypical antipsychotics has had little relative effect on life expectancy or the effect has been negatedby the disadvantages of closure of psychiatric hospital beds.The later is more likely; we have possibly traded the benefits of better mental health treatments to disadvantages of closure of hospital beds

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Conflict of interest: None declared

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