Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
Acta Psychiatr Scand. 2023 Oct;148(4):338-346. doi: 10.1111/acps.13608. Epub 2023 Sep 11.
Mental disorders are burdensome and are associated with increased mortality. Mortality has been researched for various mental disorders, especially in countries with national registries, including the Nordic countries. Yet, knowledge gaps exist around national differences, while also relatively less studies compare mortality of those seeking help for mental disorders in specialized mental healthcare (SMH) by diagnosis. Additional insight into such mortality distributions for SMH users would be beneficial for both policy and research purposes. We aim to describe and compare the mortality in a population of SMH users with the mortality of the general population. Additionally, we aim to investigate mortality differences between sexes and major diagnosis categories: anxiety, depression, schizophrenia spectrum and other psychotic disorders, and bipolar disorder.
Mortality and basic demographics were available for a population of N = 10,914 SMH users in the north of The Netherlands from 2010 until 2017. To estimate mortality over the adult lifespan, parametric Gompertz distributions were fitted on observed mortality using interval regression. Life years lost were computed by calculating the difference between integrals of the survival functions for the general population and the study sample, thus correcting for age. Survival for the general population was obtained from Statistics Netherlands (CBS).
SMH users were estimated to lose 9.5 life years (95% CI: 9.4-9.6). Every major diagnosis category was associated with a significant loss of life years, ranging from 7.2 (95% CI: 6.4-7.9) years for anxiety patients to 11.7 (95% CI: 11.0-12.5) years for bipolar disorder patients. Significant differences in mortality were observed between male SMH users and female SMH users, with men losing relatively more life years: 11.0 (95% CI: 10.9-11.2) versus 8.3 (95% CI: 8.2-8.4) respectively. This difference was also observed between sexes within every diagnosis, although the difference was insignificant for bipolar disorder.
There were significant differences in mortality between SMH users and the general population. Substantial differences were observed between sexes and between diagnoses. Additional attention is required, and possibly specific interventions are needed to reduce the amount of life years lost by SMH users.
精神障碍负担沉重，与死亡率增加有关。已经研究了各种精神障碍的死亡率，尤其是在有国家登记处的国家，包括北欧国家。然而，国家之间的差异仍然存在知识差距，同时，与那些在专门的精神保健机构（SMH）中寻求精神障碍帮助的人的死亡率相比，研究相对较少。更多地了解 SMH 用户的这种死亡率分布对政策和研究都将是有益的。我们旨在描述和比较 SMH 用户人群的死亡率与普通人群的死亡率。此外，我们旨在调查性别和主要诊断类别之间的死亡率差异：焦虑症、抑郁症、精神分裂症谱系和其他精神病性障碍以及双相情感障碍。
2010 年至 2017 年，我们获得了荷兰北部 10914 名 SMH 用户的死亡率和基本人口统计学数据。为了估计成年期的死亡率，我们使用间隔回归对观察到的死亡率进行参数戈珀兹分布拟合。通过计算总体人群和研究样本的生存函数积分之间的差异来计算失去的生命年数，从而校正年龄。总体人群的生存数据来自荷兰统计局（CBS）。
SMH 用户估计会失去 9.5 个生命年（95%CI：9.4-9.6）。每个主要诊断类别都与显著的生命年损失相关，从焦虑症患者的 7.2 年（95%CI：6.4-7.9）到双相情感障碍患者的 11.7 年（95%CI：11.0-12.5）。在 SMH 用户中，男性和女性之间的死亡率存在显著差异，男性失去的生命年数相对较多：11.0（95%CI：10.9-11.2）与 8.3（95%CI：8.2-8.4）。在每个诊断类别中，男性和女性之间也观察到了这种差异，尽管对于双相情感障碍，这种差异并不显著。
SMH 用户与普通人群之间的死亡率存在显著差异。在性别和诊断之间观察到了显著差异。需要引起更多关注，可能需要采取特定干预措施来减少 SMH 用户失去的生命年数。
