Osby U, Brandt L, Correia N, Ekbom A, Sparén P
Department of Clinical Neuroscience, Karolinska Institutet, Karolinska sjukhuset S4, S-171 76 Stockholm, Sweden.
Arch Gen Psychiatry. 2001 Sep;58(9):844-50. doi: 10.1001/archpsyc.58.9.844.
Selected groups of patients with bipolar and unipolar disorder have an increased mortality rate from suicide and natural causes of death. However, there has been no population-based study of mortality of patients followed up from the onset of the illness.
All patients with a hospital diagnosis of bipolar (n = 15 386) or unipolar (n = 39 182) disorder in Sweden from 1973 to 1995 were identified from the inpatient register and linked with the national cause-of-death register to determine the date and cause of death. Overall and cause-specific standardized mortality ratios (SMRs) and numbers of excess deaths were calculated by 5-year age classes and 5-year calendar periods.
The SMRs for suicide were 15.0 for males and 22.4 for females with bipolar disorder, and 20.9 and 27.0, respectively, for unipolar disorder. For all natural causes of death, SMRs were 1.9 for males and 2.1 for females with bipolar disorder, and 1.5 and 1.6, respectively, for unipolar disorder. For bipolar disorder, most excess deaths were from natural causes, whereas for unipolar disorder, most excess deaths were from unnatural causes. The SMR for suicide was especially high for younger patients during the first years after the first diagnosis. Increasing SMR for suicide during the period of study was found for female patients with unipolar disorder.
This population-based study of patients treated in the hospital documented increased SMRs for suicide in patients with bipolar and unipolar disorder. The SMR for all natural causes of death was also increased, causing about half the excess deaths.
部分双相情感障碍和单相情感障碍患者的自杀死亡率以及自然原因死亡率有所上升。然而，尚未有基于人群的对疾病发作后进行随访的患者死亡率研究。
从住院登记册中识别出1973年至1995年在瑞典医院诊断为双相情感障碍（n = 15386）或单相情感障碍（n = 39182）的所有患者，并将其与国家死亡原因登记册相链接，以确定死亡日期和原因。按5岁年龄组和5年日历期计算总体和特定原因的标准化死亡率（SMR）以及超额死亡人数。
双相情感障碍男性患者的自杀SMR为15.0，女性为22.4；单相情感障碍男性患者的自杀SMR为20.9，女性为27.0。对于所有自然死亡原因，双相情感障碍男性患者的SMR为1.9，女性为2.1；单相情感障碍男性患者的SMR为1.5，女性为1.6。对于双相情感障碍，大多数超额死亡是由自然原因导致的，而对于单相情感障碍，大多数超额死亡是由非自然原因导致的。首次诊断后的头几年，年轻患者的自杀SMR尤其高。在研究期间，发现单相情感障碍女性患者的自杀SMR有所上升。
这项基于人群的对住院治疗患者的研究表明，双相情感障碍和单相情感障碍患者的自杀SMR有所上升。所有自然死亡原因的SMR也有所上升，导致约一半的超额死亡。
