title: The mortality risk among persons with psychiatric hospitalizations.
abstract: BACKGROUND
  Persons affected by severe mental disorders have a higher mortality risk than the general population.
  
  
  OBJECTIVE
  To investigate the overall mortality and selected natural and external causes of death by age, gender and mental health-related variables among persons who were ever admitted to psychiatric inpatient services.
  
  
  METHODS
  This cohort study compared the mortality risk among Israeli Jews aged 18 and over who were ever hospitalized in psychiatric facilities until 2006, as recorded in the Psychiatric Case Register (PCR), with never- hospitalized subjects. The national database on causes of death was linked to the PCR.
  
  
  METHODS
  Mortality rates were computed by age, gender and psychiatric diagnosis, while proportions of deaths were computed by time from discharge. Rates were also analyzed by time-periods of date of death to check for possible association with mental health policy decisions. Age-adjusted and age-specific mortality rates and rate ratios (RR) were computed for persons in the PCR compared with those never hospitalized.
  
  
  RESULTS
  The age-adjusted mortality rate of hospitalized psychiatric persons was double that of the nonhospitalized, RR = 1.98 (95% CI 1.96-2.00). The rate was higher in both genders and for persons of all age groups, particularly for the young. The highest RRs were found for external causes of death, in particular suicide (RR = 16.34, 95% CI 15.49-17.24). Natural causes also showed higher risk, except for malignancies (RR = 1.13, 95% CI 1.10- 1.16). The risk for death was highest for persons admitted for substance abuse, while it was almost equal for those diagnosed with either schizophrenic or affective disorders. The rate ratios were not observed to change as a result of policy decisions, e.g., dehospitalization and the introduction of the atypical antipsychotics. A third of all deaths and 62% of suicides occurred before discharge or within a year from discharge.
  
  
  CONCLUSIONS
  This study highlights the importance for advancing programs of both preventative and curative medical care among persons who had psychiatric inpatient care.
authors.affiliation: Department of Health Information, Ministry of Health, Jerusalem, Israel.
authors.forename: Ziona
authors.initials: Z
authors.lastname: Haklai
authors.forename: Nehama
authors.initials: N
authors.lastname: Goldberger
authors.forename: Nechama
authors.initials: N
authors.lastname: Stein
authors.forename: Inna
authors.initials: I
authors.lastname: Pugachova
authors.forename: Itzhak
authors.initials: I
authors.lastname: Levav
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D008875:Middle Aged; D055815:Young Adult