Association of psychiatric illness and all-cause mortality in the National Department of Veterans Affairs Health Care System.
OBJECTIVE
To assess the independent association of seven psychiatric illnesses with all-cause mortality in a representative national sample of veterans, after adjustment for demographic factors, psychiatric and medical comorbidity, obesity, tobacco use, and exercise frequency.


METHODS
Analyses were conducted using data from the 1999 Large Health Survey of Veteran Enrollees (n = 559,985). Cox proportional hazards models were used to examine the relationship of seven psychiatric diagnoses with mortality. Date of all-cause mortality was determined from the Department of Veterans Affairs' Beneficiary Identification and Records Locator System. All-cause mortality rates were calculated as the total number of deaths in each group divided by the person-years of follow-up time in each group.


RESULTS
During the 9-year study period, 27% of the subjects (n = 131,396) died. Each of the psychiatric diagnoses was associated with significantly increased HR for all-cause mortality after adjusting for age, race, and gender. Hazard ratios ranged from 1.02 (95% confidence interval, 1.01, 1.04) for posttraumatic stress disorder to 1.97 (95% confidence interval, 1.89, 2.04) for alcohol use disorders. After adjustment for psychiatric and medical comorbidity, obesity, current smoking and exercise frequency, alcohol and drug abuse and dependence, and schizophrenia were statistically significantly associated with an increased risk of mortality.


CONCLUSIONS
In this study of a large representative national sample of veterans, schizophrenia and alcohol and drug use disorders were independently associated with an increased risk of all-cause mortality over a 9-year period.
Chwastiak
Lydia A
LA
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA. lydia.chwastiak@yale.edu
Rosenheck
Robert A
RA
Desai
Rani
R
Kazis
Lewis E
LE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000401:mortality*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012559:Schizophrenia / Q000401:mortality; D012907:Smoking / Q000401:mortality; D013313:Stress Disorders, Post-Traumatic / Q000401:mortality; D019966:Substance-Related Disorders / Q000401:mortality; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*