Five-year mortality of Finnish schizophrenia patients in the era of deinstitutionalization.
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.
Rantanen
Helena
H
Tampere School of Public Health, University of Tampere, and Department of Psychiatry, Tampere University Hospital, 33014, Tampere, Finland. helena.rantanen@uta.fi
Koivisto
Anna-Maija
AM
Salokangas
Raimo K R
RK
Helminen
Mika
M
Oja
Hannu
H
Pirkola
Sami
S
Wahlbeck
Kristian
K
Joukamaa
Matti
M
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