Martin R L, Cloninger C R, Guze S B, Clayton P J
Arch Gen Psychiatry. 1985 Jan;42(1):58-66. doi: 10.1001/archpsyc.1985.01790240060006.
In a six- to 12-year follow-up study of 500 psychiatric outpatients, death from natural causes occurred 11/2 times the expected rate, although the excess was not significant. Death from unnatural causes occurred 31/2 times the expected rate, a significant elevation. Suicide and homicide rates were particularly excessive. Unnatural mortality was excessive among younger, but not older, patients, and among all sex-race groups except black women, none of whom died unnaturally. Initial psychiatric diagnoses highly predictive of unnatural death included alcoholism, antisocial personality, drug addiction, and homosexuality. Secondary affective disorder was predictive of excess unnatural mortality, but in all cases of such death one of the four disorders associated with excess mortality antedated the affective disturbance. No patient with an index diagnosis of primary affective disorder died of an unnatural cause. Despite a frequent history of suicide attempts, hysteria was not associated with excess unnatural mortality.
在一项对500名精神科门诊患者进行的为期6至12年的随访研究中，自然原因导致的死亡发生率是预期发生率的1.5倍，尽管这种超额并不显著。非自然原因导致的死亡发生率是预期发生率的3.5倍，这是一个显著的升高。自杀和杀人率尤其过高。非自然死亡率在年轻患者中过高，但在老年患者中并非如此，在除黑人女性之外的所有性别-种族群体中也是如此，黑人女性中没有一人死于非自然原因。高度预测非自然死亡的初始精神科诊断包括酒精中毒、反社会人格、药物成瘾和同性恋。继发性情感障碍可预测非自然死亡率过高，但在所有此类死亡病例中，与死亡率过高相关的四种障碍之一早于情感障碍出现。初始诊断为原发性情感障碍的患者均未死于非自然原因。尽管常有自杀未遂史，但癔症与非自然死亡率过高无关。
