International Journal of Epidemiology, Vol 26, 1227-1235, Copyright © 1997 by International Epidemiological Association
M Valenti, S Necozione, G Busellu, G Borrelli, AR Lepore, R Madonna, E Altobelli, A Mattei, P Torchio, G Corrao and F Di Orio
BACKGROUND: This work followed a group of patients living in a psychiatric
hospital in Central Italy in 1978 at the time of enforcement of the Italian
reform law (No. 180) for closing down mental hospitals. The study had the
following aims: a) to compare in terms of mortality patients discharged
into the community with patients who did not experience
deinstitutionalization; b) to determine the survival of the cohort of
patients and to analyse prognostic risk factors for death; c) to analyse
differences in mortality rates between psychiatric patients and the general
population. METHODS: The study was designed as an historical follow-up
investigation. Univariate (product limit) and multivariate (proportional
hazards model) methods were used to estimate prognostic variables and
related death risks. Mortality was assessed using standardized mortality
ratios (SMR) on the entire cohort as well as after stratification according
to age, sex, cause of death and discharge status, assuming the Abruzzo
Region's population as standard. RESULTS: Length of hospitalization and
discharge from hospital are prognostic variables for death risk, with
relative risks respectively of 4.22 (95% confidence interval [CI]:
2.41-7.40) for a length of hospitalization of 10-25 years, and 8.13 (95%
CI: 4.73-13.88) for non- discharge. The global SMR of the cohort was 2.68
(95% CI: 2.42-3.07). Non-discharged patients showed higher SMR than
discharged. Excess mortality was found both in males and females for
circulatory, respiratory and undefined diseases. A significantly lower
mortality for cancer was observed in male patients. A strong excess
mortality was observed in younger patients (20-29 years: SMRmales = 43.57;
SMRfemales = 97.52). CONCLUSIONS: Longer periods of hospitalization and
non- discharge from hospital are the main risk factors for death in
psychiatric patients, who globally experience higher death rates than the
general population for a wide spectrum of causes of death, whatever their
diagnosis or gender. These findings strongly suggest positive actions in
order to overcome the effects of institutionalization.
ARTICLES
Mortality in psychiatric hospital patients: a cohort analysis of prognostic factors
Epidemiological Research Centre, Faculty of Medicine, L'Aquila, Italy.
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