title: Five-year mortality of Finnish schizophrenia patients in the era of deinstitutionalization.
abstract: BACKGROUND
  Excess mortality among people with schizophrenia due to natural and unnatural causes, especially due to suicides, is a well-known fact. It has been suggested that deinstitutionalization increases suicide mortality but there are also contradictory results. We studied the changes in mortality and causes of death among schizophrenia sufferers during and after the years of deinstitutionalization process in Finland.
  
  
  METHODS
  The sample, identified from the Finnish hospital discharge register (FHDR), consisted of patients aged 15-65 and hospitalized for the first time due to schizophrenia. We focused on the 5-year follow-up from inclusion years 1980-1998 (N=23,959). Changes in 5-year follow-up mortality during the study period were explored for both genders and for different causes of death separately using multivariate logistic regression analyses.
  
  
  RESULTS
  During the study period 1,926 deaths occurred. Suicide was the major cause of death in both genders. A significant reduction in overall 5-year mortality was observed among persons hospitalized in 1995-1998 when compared to people hospitalized 1980-1984. In males a significant reduction was seen in all mortality (P=0.025) due to suicides (P=0.007) but not in the case of natural deaths. In females no significant changes in mortality were found.
  
  
  CONCLUSIONS
  Our study confirms a reduction in suicide mortality of male schizophrenia sufferers after the deinstitutionalization process. However the overall mortality is still very high and the attention needs to be focused on the general well-being of schizophrenia patients.
authors.affiliation: Tampere School of Public Health, University of Tampere, and Department of Psychiatry, Tampere University Hospital, 33014, Tampere, Finland. helena.rantanen@uta.fi
authors.forename: Helena
authors.initials: H
authors.lastname: Rantanen
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Koivisto
authors.forename: Raimo K R
authors.initials: RK
authors.lastname: Salokangas
authors.forename: Mika
authors.initials: M
authors.lastname: Helminen
authors.forename: Hannu
authors.initials: H
authors.lastname: Oja
authors.forename: Sami
authors.initials: S
authors.lastname: Pirkola
authors.forename: Kristian
authors.initials: K
authors.lastname: Wahlbeck
authors.forename: Matti
authors.initials: M
authors.lastname: Joukamaa
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D003625:Data Collection / Q000379:methods / Q000706:statistics & numerical data; D003688:Deinstitutionalization / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000401:mortality*; D017678:Sex Distribution; D013405:Suicide / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate; D055815:Young Adult