Meloni Debora, Miccinesi Guido, Bencini Andrea, Conte Michele, Crocetti Emanuele, Zappa Marco, Ferrara Maurizio
Neurological and Psychiatric Sciences Department, University of Florence, Viale Morgagni 85, Florence 50140, Italy.
Psychiatr Serv. 2006 Oct;57(10):1474-81. doi: 10.1176/ps.2006.57.10.1474.
Psychiatric disorders involve an increased risk of mortality. In Italy psychiatric services are community based, and hospitalization is mostly reserved for patients with acute illness. This study examined mortality risk in a cohort of psychiatric inpatients for 16 years after hospital discharge to assess the association of excess mortality from natural or unnatural causes with clinical and sociodemographic variables and time from first admission.
At the end of 2002 mortality and cause of death were determined for all patients (N=845) who were admitted during 1987 to the eight psychiatric units active in Florence. The mortality risk of psychiatric patients was compared with that of the general population of the region of Tuscany by calculating standardized mortality ratios (SMRs). Poisson multivariate analyses of the observed-to-expected ratio for natural and unnatural deaths were conducted.
The SMR for the sample of psychiatric patients was threefold higher than that for the general population (SMR=3.0; 95 percent confidence interval [CI]=2.7-3.4). Individuals younger than 45 years were at higher risk (SMR=11.0; 95 percent CI 8.0-14.9). The SMR for deaths from natural causes was 2.6 (95 percent CI=2.3-2.9), and for deaths from unnatural causes it was 13.0 (95 percent CI=10.1-13.6). For deaths from unnatural causes, the mortality excess was primarily limited to the first years after the first admission. For deaths from natural causes, excess mortality was more stable during the follow-up period.
Prevention of deaths from unnatural causes among psychiatric patients may require promotion of earlier follow-up after discharge. Improving prevention and treatment of somatic diseases of psychiatric patients is important to reduce excess mortality from natural causes.
精神疾病患者的死亡风险增加。在意大利，精神科服务以社区为基础，住院治疗主要针对急性病患者。本研究调查了一组精神科住院患者出院后16年的死亡风险，以评估自然或非自然原因导致的超额死亡率与临床及社会人口学变量以及首次入院时间之间的关联。
2002年底，确定了1987年入住佛罗伦萨8个活跃精神科病房的所有患者（N = 845）的死亡率和死亡原因。通过计算标准化死亡率（SMR），将精神科患者的死亡风险与托斯卡纳地区的普通人群进行比较。对自然死亡和非自然死亡的观察与预期比率进行了泊松多变量分析。
精神科患者样本的SMR比普通人群高三倍（SMR = 3.0；95%置信区间[CI] = 2.7 - 3.4）。45岁以下的个体风险更高（SMR = 11.0；95% CI 8.0 - 14.9）。自然原因导致的死亡SMR为2.6（95% CI = 2.3 - 2.9），非自然原因导致的死亡SMR为13.0（95% CI = 10.1 - 13.6）。对于非自然原因导致的死亡，超额死亡率主要限于首次入院后的头几年。对于自然原因导致的死亡，超额死亡率在随访期间更为稳定。
预防精神科患者非自然原因导致的死亡可能需要促进出院后更早的随访。改善精神科患者躯体疾病的预防和治疗对于降低自然原因导致的超额死亡率很重要。
