Psychiatric disorders certified on death certificates in an English population.
BACKGROUND
Psychiatric disorders are sometimes certified on death certificates, but seldom selected as the underlying cause of death. The majority of deaths with a certified psychiatric cause are usually omitted from official mortality statistics, which are typically based on the underlying cause alone.


OBJECTIVE
To report on death rates for psychiatric disorders, as certified on death certificates, including all mentioned causes as well as the underlying cause of death.


METHODS
Analysis of database including all certified causes of death in 1979-1999, in three time periods defined by coding rule changes.


RESULTS
Statistics on the underlying cause of death grossly under-estimated certified psychiatric disorders. For example, in the first period of our study they missed 88% of deaths in which schizophrenia was a certified cause, 98% of affective psychosis, and 96% of depression. Over time, considering all certified causes, age-standardised death rates for schizophrenia declined, those for affective psychosis showed no change, and those for depression and dementia increased.


CONCLUSIONS
The decline in mortality rates for schizophrenia, and the increase for depression and dementia, may reflect real changes over time in disease prevalence at death, although other explanations are possible and are discussed.
Unit of Health-Care Epidemiology, Dept. of Public Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK. michael.goldacre@dphpc.ox.ac.uk
Michael J
MJ
Goldacre
Marie E
ME
Duncan
Myfanwy
M
Griffith
Paula
P
Cook-Mozaffari
D017677:Age Distribution; D000368:Aged; D000544:Alzheimer Disease / Q000401:mortality*; D002391:Catchment Area, Health; D002423:Cause of Death; D003644:Death Certificates; D003863:Depression / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D011618:Psychotic Disorders / Q000401:mortality*; D012559:Schizophrenia / Q000401:mortality*; D017678:Sex Distribution; D013405:Suicide / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology