title: Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care.
abstract: BACKGROUND
  Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services.
  
  
  METHODS
  All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population.
  
  
  RESULTS
  The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95% confidence interval (CI) 1.6-1.8], and higher still following the first admission (SMR 2.61, 95% CI 2.4-2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5-328.6) and personality disorders (20.87, 95% CI 5.2-83.4).
  
  
  CONCLUSIONS
  This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.
authors.affiliation: Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy. laura.grigoletti@univr.it
authors.forename: L
authors.initials: L
authors.lastname: Grigoletti
authors.forename: G
authors.initials: G
authors.lastname: Perini
authors.forename: A
authors.initials: A
authors.lastname: Rossi
authors.forename: A
authors.initials: A
authors.lastname: Biggeri
authors.forename: C
authors.initials: C
authors.lastname: Barbui
authors.forename: M
authors.initials: M
authors.lastname: Tansella
authors.forename: F
authors.initials: F
authors.lastname: Amaddeo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002423:Cause of Death; D003141:Communicable Diseases / Q000401:mortality; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000401:mortality*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000401:mortality; D012042:Registries; D012307:Risk Factors; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000401:mortality; D055815:Young Adult