Changes in mortality after first psychiatric admission: a 20-year prospective longitudinal clinical study.

OBJECTIVE

To examine changes in the mortality of patients admitted to a Norwegian psychiatric hospital from 1985 to 2003: this period saw profound changes in structure and organization of the mental healthcare system.

METHOD

A 20-year prospective longitudinal, record linkage study of all patients admitted to a psychiatric hospital with sector responsibility from 1985 to 2003.

RESULTS

Excess mortality was found for the patient group. Overall standardized mortality ratio (SMR) (95% confidence interval, CI) was 2.85 (2.53-3.07)/2.15 (1.94-2.41) for male/female patients. One third of the patients who died in the study period died within 2 years after first admission, and 45% of the deaths happened within 2 years after last discharge. The median age at death decreased in the study period for patients who were younger than 65 years at their first admission. The median difference of lost years of life for the patients younger than 65 years at first admittance was 26.95/23.96 years for male/female patients. SMR increased for the youngest cohorts during the study period over time. From 1985 to 2003, SMR increased dramatically for both genders.

CONCLUSION

Patients admitted to a Norwegian psychiatric hospital for their first stay during 1985-2003 suffered increased excess mortality, whereas mortality in the general population decreased. The mortality was highest in the first 2 years after admission. Despite profound changes in the mental healthcare system, the mortality gap increased in the study period and was highest in the youngest birth cohorts.