Dembling B P, Chen D T, Vachon L
Southeastern Rural Mental Health Research Center, University of Virginia, Charlottesville 22908, USA.
Psychiatr Serv. 1999 Aug;50(8):1036-42. doi: 10.1176/ps.50.8.1036.
This cross-sectional mortality linkage study describes the prevalence of specific fatal disease and injury conditions in an adult population with serious mental illness. The large sample of decedents and the use of multiple-cause-of-death data yield new clinical details relevant to those caring for persons with serious mental illness.
Age-adjusted frequency distributions and years of potential life lost were calculated by gender and causes of death for persons in the population of 43,274 adults served by the Massachusetts Department of Mental Health who died between 1989 and 1994. Means and frequencies of these variables were compared with those for persons in the general population of the state who did not receive departmental services and who died during the same period.
A total of 1,890 adult decedents served by the department of mental health were identified by electronic linkage of patient and state vital records. They had a significantly higher frequency of deaths from accidental and intentional injuries, particularly poisoning by psychotropic medications. Deaths from cancer, diabetes, and circulatory disorders were significantly less frequently reported. On average, decedents who had been served by the department of mental health lost 8.8 more years of potential life than decedents in the general population-a mean of 14.1 years for men and 5.7 for women. The differential was consistent across most causes of death.
Findings in this study are consistent with previous findings identifying excess mortality in a population with serious mental illness. The high rate of injury deaths, especially those due to psychotropic and other medications, should concern providers.
这项横断面死亡率关联研究描述了患有严重精神疾病的成年人群中特定致命疾病和损伤状况的患病率。大量的死亡者样本以及多死因数据的使用产生了与照顾严重精神疾病患者相关的新临床细节。
计算了1989年至1994年间由马萨诸塞州精神健康部服务的43274名成年人死亡人群按性别和死因调整年龄后的频率分布及潜在寿命损失年数。将这些变量的均值和频率与该州同期未接受部门服务的普通人群死亡者的均值和频率进行了比较。
通过患者与州生命记录的电子关联，共识别出1890名由精神健康部服务的成年死亡者。他们因意外和故意伤害导致的死亡频率显著更高，尤其是精神药物中毒。癌症、糖尿病和循环系统疾病导致的死亡报告频率显著更低。平均而言，接受精神健康部服务的死亡者比普通人群的死亡者多损失8.8年的潜在寿命——男性平均为14.1年，女性为5.7年。这种差异在大多数死因中都是一致的。
本研究的结果与先前关于严重精神疾病人群死亡率过高的研究结果一致。伤害死亡的高发生率，尤其是因精神药物和其他药物导致的死亡，应引起医疗服务提供者的关注。
