title: Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders.
abstract: BACKGROUND
  People with mental disorders evince excess mortality due to natural and unnatural deaths. The relative life expectancy of people with mental disorders is a proxy measure of effectiveness of social policy and health service provision.
  
  
  OBJECTIVE
  To evaluate trends in health outcomes of people with serious mental disorders.
  
  
  METHODS
  We examined nationwide 5-year consecutive cohorts of people admitted to hospital for mental disorders in Denmark, Finland and Sweden in 1987-2006. In each country the risk population was identified from hospital discharge registers and mortality data were retrieved from cause-of-death registers. The main outcome measure was life expectancy at age 15 years.
  
  
  RESULTS
  People admitted to hospital for a mental disorder had a two- to threefold higher mortality than the general population in all three countries studied. This gap in life expectancy was more pronounced for men than for women. The gap decreased between 1987 and 2006 in these countries, especially for women. The notable exception was Swedish men with mental disorders. In spite of the positive general trend, men with mental disorders still live 20 years less, and women 15 years less, than the general population.
  
  
  CONCLUSIONS
  During the era of deinstitutionalisation the life expectancy gap for people with mental disorders has somewhat diminished in the three Nordic countries. Our results support further development of the Nordic welfare state model, i.e. tax-funded community-based public services and social protection. Health promotion actions, improved access to healthcare and prevention of suicides and violence are needed to further reduce the life expectancy gap.
authors: Nordic School of Public Health, Nordic Research Academy in Mental Health, Gothenburg, Sweden, and National Institute for Health and Welfare (THL), Vaasa, Finland. kristian.wahlbeck@thl.fi
authors: Kristian
authors: K
authors: Wahlbeck
authors: Jeanette
authors: J
authors: Westman
authors: Merete
authors: M
authors: Nordentoft
authors: Mika
authors: M
authors: Gissler
authors: Thomas Munk
authors: TM
authors: Laursen