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The British Journal of Psychiatry (2005) 187: 552-558
© 2005 The Royal College of Psychiatrists

Mortality in individuals who have had psychiatric treatment

Population-based study in Nova Scotia

Stephen Kisely, MD, MSc

Department of Psychiatry, Dalhousie University and Health Outcome Unit, Capital District Health Authority, Halifax

Mark Smith, BSc

Population Health Research Unit, Dalhousie University, Halifax, Canada

David Lawrence, PhD

Centre for Developmental Health, Curtin University of Technology, Telethon Institute for Child Health Research, Perth, Australia

Sarah Maaten, MSc

Population Health Research Unit, Dalhousie University, Halifax, Canada

Correspondence: Dr Stephen Kisely, Dalhousie University, Abbie J. Lane Memorial Building, 5909 Veteran’s Memorial Lane, Suite 9211, Halifax, Nova Scotia B3H 2E2, Canada. Tel. +1 902 473 7356; fax +1 902 473 4887; e-mail: Stephen.Kisely{at}cdha.nshealth.ca

Declaration of interest None. Funding detailed in Acknowledgement.

Background Most studies of mortality in psychiatric patients have investigated in-patients rather than those attending out-patient clinics or primary care, where most receive treatment.

Aims To evaluate the mortality risk in mental illness for patients in contact with psychiatric services or primary care (n=221 048) across Nova Scotia (population 936 025).

Method A population-based record-linkage analysis was made of the period 1995-2000, using an inception cohortto calculate mortality rate ratios.

Results The mortality rate was 1.74, with increased ratios for all major causes of death. Male mortality was almost double that of females after controlling for demographic factors, treatment setting and place of residence. Patients of lower income, in specialist psychiatric settings, and with dementia or psychoses were also at greater risk. However, in absolute numbers, 72% of deaths occurred in patients who had only seen their general practitioner.

Conclusions Mortality risk is increased in all psychiatric patients, not just those who have received in-patient treatment.


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