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Cause-specific mortality in psychiatric patients after deinstitutionalisation

BJARNE K. JACOBSEN, PhD and EGIL ARNESEN, MD

Institute of Community Medicine, University of Tromsø, Norway

Correspondence: Vidje Hansen, Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway. Tel: 00 47 77 64 48 11; fax: 00 47 77 64 48 31; e-mail: vidje.hansen{at}ism.uit.no

Declaration of interest The Department of Psychiatry, University of Tromsø, partially funded this study.

Background Since the late 1970s, the psychiatric service system in Norway has been changed gradually according to the principles of deinstitutionalisation.

Aims To document the mortality of psychiatric patients in a deinstitutionalised service system.

Methods The case register of a psychiatric hospital covering the period 1980-1992 was linked to the Central Register of Deaths. Age-adjusted death rates and standardised mortality ratios (SMRs) were computed.

Results Patients with organic psychiatric disorders had significantly higher mortality regardless of cause of death. SMRs ranged from 0.9 for death by cancer in women to 36.3 for suicide in men. For unnatural death, SMRs were highest in the first year after discharge. Compared to the periods 1950-1962 and 1963-1974, there has been an increase in SMRs for cardiovascular death and suicide in both genders.

Conclusions Deinstitutionalisation seems to have had as its cost a relative rise both in cardiovascular death and unnatural deaths for both genders, but most pronounced in men.

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