Valenti M, Necozione S, Busellu G, Borrelli G, Lepore A R, Madonna R, Altobelli E, Mattei A, Torchio P, Corrao G, Di Orio F
Epidemiological Research Centre, Faculty of Medicine, L'Aquila, Italy.
Int J Epidemiol. 1997 Dec;26(6):1227-35. doi: 10.1093/ije/26.6.1227.
This work followed a group of patients living in a psychiatric hospital in Central Italy in 1978 at the time of enforcement of the Italian reform law (No. 180) for closing down mental hospitals. The study had the following aims: a) to compare in terms of mortality patients discharged into the community with patients who did not experience deinstitutionalization; b) to determine the survival of the cohort of patients and to analyse prognostic risk factors for death; c) to analyse differences in mortality rates between psychiatric patients and the general population.
The study was designed as an historical follow-up investigation. Univariate (product limit) and multivariate (proportional hazards model) methods were used to estimate prognostic variables and related death risks. Mortality was assessed using standardized mortality ratios (SMR) on the entire cohort as well as after stratification according to age, sex, cause of death and discharge status, assuming the Abruzzo Region's population as standard.
Length of hospitalization and discharge from hospital are prognostic variables for death risk, with relative risks respectively of 4.22 (95% confidence interval [CI]: 2.41-7.40) for a length of hospitalization of 10-25 years, and 8.13 (95% CI: 4.73-13.88) for non-discharge. The global SMR of the cohort was 2.68 (95% CI: 2.42-3.07). Non-discharged patients showed higher SMR than discharged. Excess mortality was found both in males and females for circulatory, respiratory and undefined diseases. A significantly lower mortality for cancer was observed in male patients. A strong excess mortality was observed in younger patients (20-29 years: SMRmales = 43.57; SMRfemales = 97.52).
Longer periods of hospitalization and non-discharge from hospital are the main risk factors for death in psychiatric patients, who globally experience higher death rates than the general population for a wide spectrum of causes of death, whatever their diagnosis or gender. These findings strongly suggest positive actions in order to overcome the effects of institutionalization.
这项研究跟踪了1978年意大利中部一家精神病院的一组患者，当时正值意大利关闭精神病院的改革法（第180号）实施之时。该研究有以下目标：a）比较出院进入社区的患者与未经历非机构化的患者的死亡率；b）确定该组患者的生存率并分析死亡的预后风险因素；c）分析精神科患者与普通人群死亡率的差异。
该研究设计为一项历史性随访调查。采用单变量（乘积限）和多变量（比例风险模型）方法来估计预后变量和相关死亡风险。使用标准化死亡率（SMR）对整个队列以及根据年龄、性别、死因和出院状态分层后的情况进行死亡率评估，以阿布鲁佐地区的人口作为标准。
住院时间和未出院是死亡风险的预后变量，住院10 - 25年的相对风险分别为4.22（95%置信区间[CI]：2.41 - 7.40），未出院的相对风险为8.13（95% CI：4.73 - 13.88）。该队列的总体SMR为2.68（95% CI：2.42 - 3.07）。未出院患者的SMR高于出院患者。在循环系统疾病、呼吸系统疾病和不明原因疾病方面，男性和女性均发现超额死亡率。男性患者中观察到癌症死亡率显著较低。在年轻患者（20 - 29岁）中观察到强烈的超额死亡率（男性SMR = 43.57；女性SMR = 97.52）。
住院时间较长和未出院是精神科患者死亡的主要风险因素，无论其诊断或性别如何，精神科患者总体上因广泛的死因经历的死亡率高于普通人群。这些发现强烈建议采取积极行动以克服机构化的影响。
