Black D W, Warrack G, Winokur G
JAMA. 1985 Jan 4;253(1):58-61.
Of 5,412 patients admitted to the University of Iowa Psychiatric Hospital between Jan 1, 1972, and Dec 31, 1981, three hundred thirty-one died during the follow-up period, significantly more than expected. The risk for premature death was greatest among women and the young, especially those between the ages of 30 and 39 years. Risk was associated with all psychiatric diagnoses and was significantly higher among patients of either sex with an organic mental disorder or schizophrenia; women with acute schizophrenia, depressive neuroses, alcoholism, drug abuse, and psycho-physiologic disorders and special symptoms; and men with neuroses. Suicide and accidental death were more frequent than expected and were responsible for two thirds of the excess deaths. During the total time of follow-up, women were at risk for natural deaths but men were not. Our most important finding was that 99% of the excess deaths occurred within two years of discharge. During this period there were undue numbers of both "natural" and "unnatural" deaths. The first two years after discharge are a time of great risk for psychiatric patients, particularly women.
在1972年1月1日至1981年12月31日期间入住衣阿华大学精神病医院的5412名患者中，有331人在随访期间死亡，显著多于预期。过早死亡风险在女性和年轻人中最高，尤其是年龄在30至39岁之间的人群。风险与所有精神疾病诊断相关，在患有器质性精神障碍或精神分裂症的男性或女性患者中显著更高；患有急性精神分裂症、抑郁性神经症、酗酒、药物滥用以及心理生理障碍和特殊症状的女性；以及患有神经症的男性。自杀和意外死亡比预期更频繁，占额外死亡人数的三分之二。在整个随访期间，女性有自然死亡风险而男性没有。我们最重要的发现是，99%的额外死亡发生在出院后两年内。在此期间，“自然”和“非自然”死亡人数都过多。出院后的头两年是精神病患者，尤其是女性的高风险时期。
