Research

Excess mortality in persons with severe mental disorder in Sweden: a cohort study of 12 103 individuals with and without contact with psychiatric services

Dag Tidemalm¹, Margda Waern², Claes-Göran Stefansson³, Stig Elofsson⁴ and Bo Runeson¹

¹  Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychiatry St. Göran Hospital, Vårdvägen 3, SE-112 81 Stockholm, Sweden

²  Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy at Göteborg University, Blå Stråket 15, SE-413 45 Göteborg, Sweden

³  National Board of Health and Welfare, SE-106 30 Stockholm, Sweden

⁴  Department of Social Work, Stockholm University, SE-106 91 Stockholm, Sweden

Clinical Practice and Epidemiology in Mental Health 2008, 4:23doi:10.1186/1745-0179-4-23

Published:	14 October 2008

Abstract

Background

Investigating mortality in those with mental disorder is one way of measuring effects of mental health care reorganisation. This study's aim was to investigate whether the excess mortality in those with severe mental disorder remains high in Sweden after the initiation of the Community Mental Health Care Reform. We analysed excess mortality by gender, type of mental health service and psychiatric diagnosis in a large community-based cohort with long-term mental disorder.

Methods

A survey was conducted in Stockholm County, Sweden in 1997 to identify adults with long-term disabling mental disorder (mental retardation and dementia excluded). The 12 103 cases were linked to the Hospital Discharge Register and the Cause of Death Register. Standardised mortality ratios (SMRs) for 1998–2000 were calculated for all causes of death, in the entire cohort and in subgroups based on treatment setting and diagnosis.

Results

Mortality was increased in both genders, for natural and external causes and in all diagnostic subgroups. Excess mortality was greater among those with a history of psychiatric inpatient care, especially in those with substance use disorder. For the entire cohort, the number of excess deaths due to natural causes was threefold that due to external causes. SMRs in those in contact with psychiatric services where strikingly similar to those in contact with social services.

Conclusion

Mortality remains high in those with long-term mental disorder in Sweden, regardless of treatment setting. Treatment programs for persons with long-term mental disorder should target physical as well as mental health.