scholarly journals Cause-specific mortality in psychiatric patients after deinstitutionalisation

2001 ◽  
Vol 179 (5) ◽  
pp. 438-443 ◽  
Author(s):  
Vidje Hansen ◽  
Bjarne K. Jacobsen ◽  
Egil Arnesen
Keyword(s):  
Service System ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Cardiovascular Death ◽  
First Year ◽  
Case Register ◽  
Unnatural Death ◽  
Central Register ◽  
Specific Mortality ◽  
Standardised Mortality Ratios

BackgroundSince the late 1970s, the psychiatric service system in Norway has been changed gradually according to the principles of deinstitutionalisation.AimsTo document the mortality of psychiatric patients in a deinstitutionalised service system.MethodsThe case register of a psychiatric hospital covering the period 1980–1992 was linked to the Central Register of Deaths. Age-adjusted death rates and standardised mortality ratios (SMRs) were computed.ResultsPatients with organic psychiatric disorders had significantly higher mortality regardless of cause of death. SMRs ranged from 0.9 for death by cancer in women to 36.3 for suicide in men. For unnatural death, SMRs were highest in the first year after discharge. Compared to the periods 1950–1962 and 1963–1974, there has been an increase in SMRs for cardiovascular death and suicide in both genders.ConclusionsDeinstitutionalisation seems to have had as its cost a relative rise both in cardiovascular death and unnatural deaths for both genders, but most pronounced in men.

Episodes of Care for First-Ever Psychiatric Patients a Long-Term Case-Register Evaluation in a Mainly Urban Area

1995 ◽  
Vol 167 (2) ◽  
pp. 220-227 ◽  
Author(s):  
Michele Tansella ◽  
Rocco Micciolo ◽  
Annibale Biggeri ◽  
Giulia Bisoffi ◽  
Matteo Balestrieri
Keyword(s):  
Cox Regression ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Mental Illnesses ◽  
Rank Test ◽  
First Episode ◽  
Case Register ◽  
Episode Of Care ◽  
Episodes Of Care ◽  
Community Psychiatric Service

BackgroundPsychiatric case registers (PCRs) are particularly useful for studying patterns of care over time. Methods of ‘survival analysis’ have rarely been used for assessing such data.MethodA longitudinal study was conducted over 10 years (1 January 1982 to 31 December 1991) on 1423 first-ever psychiatric patients, using the PCR of South Verona, Italy. The product-limit method, the log-rank test, the Cox regression model and the Poisson regression analysis were used to analyse episodes of care and relapses.ResultsThe duration of the episodes of care increased consistently from the first to the fifth episode. The probability of opening a new episode of care after the first one increased consistently from the second to the sixth episode. The only variable significantly associated with the length of the first episode of care was diagnosis (highest probability of having longer episodes for schizophrenic patients), while the length of the breaks following the first episode of care was associated with diagnosis, sex and occupational status (highest probability of opening a second episode of care for schizophrenic subjects and those with alcohol and personality disorders, for males, and for unemployed patients). The probability of opening a new episode of care decreased with time since last contact and increased with number of previous contacts.ConclusionsThe community psychiatric service in South Verona is fulfilling its original aim, that is, to give priority to the continuity of care for patients with chronic and severe mental illnesses. Survival analyses proved to be useful methods for assessing episodes of care.

Mortality Among Patients with Psychiatric Illness a Ten-Year Case Register Study in an Area with a Community-based System of Care

1995 ◽  
Vol 166 (6) ◽  
pp. 783-788 ◽  
Author(s):  
Francesco Amaddeo ◽  
Giulia Bisoffi ◽  
Paola Bonizzato ◽  
Rocco Micciolo ◽  
Michele Tansella
Keyword(s):  
Poisson Regression ◽  
Psychiatric Patients ◽  
Age Groups ◽  
System Of Care ◽  
Register Study ◽  
First Year ◽  
Community Based ◽  
Pattern Of Care ◽  
Case Register ◽  
Specialist Services

BackgroundMost studies which showed an excess mortality in psychiatric patients have been conducted on hospitalised samples.MethodThis was a case register study. All South Verona patients with an ICD diagnosis who had psychiatric contacts with specialist services in 1982–1991 were included. Mortality was studied in relation to sex, age, diagnosis, pattern of care and interval from registration. Standardised Mortality Rates (SMRs) and Poisson regression analysis were calculated.ResultsThe overall SMR was 1.63 (95% CI = 1.5–1.8), which is the lowest value reported so far. Mortality was higher among men (SMR = 2.24; 95% CI = 1.9–2.6), among patients who were admitted to hospital (SMR = 2.23; 95% CI = 1.9–2.6), among younger age groups (SMR = 8.82; 95% CI = 4.9–14.6) and in the first year after registration (SMR = 2.32; 95% CI = 1.8–2.9). Higher mortality was found in patients with a diagnosis of alcohol and drug dependence (SMR = 3.87; 95% CI = 3.0–4.9). The SMR for suicide was 17.41. Using a Poisson regression model, diagnosis, pattern of care and interval from registration were all found to be significantly associated with mortality. When all these variables were entered together in the model, each maintained its predictive role.ConclusionsThe overall mortality of psychiatric patients treated in a community-based system of care was higher than expected, but lower than the mortality reported in other psychiatric settings. The highest mortality risk was found in the first year after registration.

Total mortality in people admitted to a psychiatric hospital

1997 ◽  
Vol 170 (2) ◽  
pp. 186-190 ◽  
Author(s):  
Vidje Hansen ◽  
Egil Arnesen ◽  
Bjarne K. Jacobsen
Keyword(s):  
General Population ◽  
Psychiatric Hospital ◽  
Psychiatric Patients ◽  
Age Groups ◽  
Total Mortality ◽  
Mortality Rates ◽  
High Risk Group ◽  
First Year ◽  
Central Register ◽  
Population Ratio

BackgroundThe aim was to document the mortality of psychiatric patients within a service system characterised by a low beds-to-population ratio.MethodAll patients admitted to one psychiatric hospital were followed from date of first admission after 31 July 1980 until 31 December 1992 with regard to death, by linkage to the Norwegian Central Register of Persons. Age-adjusted total mortality rates and standardised mortality ratios (SMRs) compared with the general population were computed.ResultsMortality rates were highest in men, and increased with age in both sexes. SMRs were highest in the younger age-groups, and the overall SMR was significantly higher for men than for women. Mortality was highest during the first year after admission for both sexes and was higher than in the general population in all diagnostic groups.ConclusionsThe mortality of psychiatric patients is still unsatisfactorily high, and men constitute a special high-risk group.

scholarly journals Death after Kidney Transplantation: An Analysis by Era and Time Post-Transplant

2020 ◽  
Vol 31 (12) ◽  
pp. 2887-2899 ◽  
Author(s):  
Tracey Ying ◽  
Bree Shi ◽  
Patrick J. Kelly ◽  
Helen Pilmore ◽  
Philip A. Clayton ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Failure ◽  
Graft Loss ◽  
Cardiovascular Death ◽  
First Year ◽  
Policy Makers ◽  
Time Points ◽  
Post Transplant ◽  
Risk Of Death ◽  
Specific Mortality

BackgroundMortality risk after kidney transplantation can vary significantly during the post-transplant course. A contemporary assessment of trends in all-cause and cause-specific mortality at different periods post-transplant is required to better inform patients, clinicians, researchers, and policy makers.MethodsWe included all first kidney-only transplant recipients from 1980 through 2018 from the Australia and New Zealand Dialysis and Transplant Registry. We compared adjusted death rates per 5-year intervals, using a piecewise exponential survival model, stratified by time post-transplant or time post–graft failure.ResultsOf 23,210 recipients, 4765 died with a functioning graft. Risk of death declined over successive eras, at all periods post-transplant. Reductions in early deaths were most marked; however, recipients ≥10 years post-transplant were 20% less likely to die in the current era compared with preceding eras (2015–2018 versus 2005–2009, adjusted hazard ratio, 0.80; 95% confidence interval, 0.69 to 0.90). In 2015–2018, cardiovascular disease was the most common cause of death, particularly in months 0–3 post-transplant (1.18 per 100 patient-years). Cancer deaths were rare early post-transplant, but frequent at later time points (0.93 per 100 patient-years ≥10 years post-transplant). Among 3657 patients with first graft loss, 2472 died and were not retransplanted. Death was common in the first year after graft failure, and the cause was most commonly cardiovascular (50%).ConclusionsReductions in death early and late post-transplant over the past 40 years represent a major achievement. Reductions in cause-specific mortality at all time points post-transplant are also apparent. However, relatively greater reductions in cardiovascular death have increased the prominence of late cancer deaths.

Mortality among Psychiatric Patients

1970 ◽  
Vol 15 (4) ◽  
pp. 143-148 ◽  
Author(s):  
G. Innes ◽  
W. M. Millar
Keyword(s):  
Causes Of Death ◽  
Psychiatric Patients ◽  
Psychiatric Services ◽  
Social Classes ◽  
First Year ◽  
Organic Psychosis ◽  
Physical Symptomatology ◽  
Regional Board ◽  
Excessive Number

A 5-year follow-up study was carried out of all referrals to the psychiatric services in a Regional Board area. The death registers of the Registrar General for Scotland were searched for all patients who were not known to be alive at the end of the study. Of the 2103 patients included in the original study, 343 were found to have died. This represents 15.9 per cent of males and 16.7 per cent of females referred. Most of the deaths (41%) occurred in the first year of follow-up, 20 per cent in the first 3 months. The overall death rate was approximately twice the expectation based on death rates in the general population of the area. The excess was greatest in those aged under 55 years. All areas of residence, occupations and social classes had increased mortality. Those patients diagnosed as organic psychosis had highest mortality (70%) but all diagnoses had an excessive number of deaths when standardised for age. Of the initial referrals, 1.4 per cent committed suicide during the follow-up period. Apart from neoplasms where deaths were close to expectation, all other broad categories of causes of death were equally involved in the increase. This survey of a total psychiatric referral group (in-patients, out-patients and domiciliary visits and private patients) supports previously reported studies, mainly of in-patients, in their finding of an association between high mortality rates and psychiatric illness. It is possible that this association may result from selective referral to the psychiatric services of those psychiatrically ill patients who exhibit physical symptomatology.

Socialization Scores in Psychiatric Patients and Their Implications for the Diagnosis of Personality Disorders

1986 ◽  
Vol 31 (2) ◽  
pp. 138-141 ◽  
Author(s):  
Kevin Standage
Keyword(s):  
Personality Disorder ◽  
Parental Care ◽  
Personality Disorders ◽  
General Hospital ◽  
Clinical Diagnosis ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Strong Association

The distribution scores on the Socialization (So) scale of the California Psychologial Inventory was examined in a series of 83 admissions to a general hospital psychiatric service. The series was divided into groups of low and high scorers (Low So and High So). Low So scorers were younger than high scorers and had a raised mean Neuroticism score. A strong association was found between So scores and the quality of parental care which patients reported receiving from their fathers. Other parental attributes are reported. Patients with a clinical diagnosis of personality disorder were found in the Low So, but not the High So group.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Caltagirone 1987–1990

1992 ◽  
Vol 1 (1) ◽  
pp. 45-60 ◽  
Author(s):  
Gaetano Interlandi ◽  
Maria Grazia Sotera
Keyword(s):  
Psychiatric Service ◽  
Similar Rate ◽  
Outpatient Clinics ◽  
Case Register ◽  
Diagnostic Categories ◽  
Community Psychiatric ◽  
Multiple Structures ◽  
Community Psychiatric Service ◽  
Made In

RiassuntoSono descritte, con la stessa metodologia impiegata in altre 4 aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-aerea, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Caltagirone. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (763/100000 residenti adulti) e un giorno (223/100000 residenti adulti) hanno valori inferiori ai RPC europei. I tassi di incidenza (281/100000 residenti adulti) indicano un afflusso di nuovi casi appartenenti a tutte le categorie diagnostiche. II RPC di Caltagirone monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale: residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, domiciliare, ecc. II rapporto tra prevalenza annua non ospedaliera e ospedaliera è nel 1990 di 4,4 a 1. II tasso di lungoassistiti è di 122/100000 residenti adulti, con una tendenza ad un accumulo per quelli che vivono nel territorio, mentre vi è un calo di quelli che sono in Comunità. II costo del Dipartimento, che è andato riducendosi dal 1987 al 1990, è in buona parte da addebitare alle giornate di assistenza in Comunità.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Caltagirone are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the year prevalence (763'100000 adult inhabitants) and day prevalence (248'100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (248'100000 adult inhabitants) shows that new patients belong to all diagnostic categories. The PCR records data of the activities made in multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, care in outpatient clinics, domiciliary care, etc. The ratio between non-hospitalized and hospitalized users is 4.3 to 1. The rate of long-term patients is 122'100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the sheltered apartments is decreasing. The costs of the Service (which have decrease from 1987 to 1990) have to be attributed mainly to the costs of the treatment in sheltered apartments.

Suicide and other causes of mortality after post-partum psychiatric admission

1998 ◽  
Vol 173 (3) ◽  
pp. 209-211 ◽  
Author(s):  
Louis Appleby ◽  
Preben B. Mortensen ◽  
E. Brian Faragher
Keyword(s):  
Psychiatric Disorder ◽  
Psychiatric Hospital ◽  
Post Partum ◽  
High Rate ◽  
First Year ◽  
Psychiatric Admission ◽  
Case Register ◽  
Postnatal Women ◽  
Causes Of Mortality ◽  
One Year

BackgroundThe risk of suicide in postnatal women is low and those suicides that occur appear to be associated with severe psychiatric illness. No previous study has specifically studied the risk of suicide following post-partum psychiatric disorder.MethodWe calculated standardised mortality ratios (SMRs) for suicide, unnatural deaths and deaths from natural causes for women admitted to psychiatric hospital in the first year after childbirth, using computerised cross-linkages between the Danish Psychiatric Case Register and the Danish registers of birth and causes of death for 1973–1993.ResultsDuring the study period 1567 women were admitted to psychiatric hospital of whom 107 (6.8%) died. The SMRs (compared with 100) were 1719 (95% CI 1284–2254) for suicide, 1329 (95% CI 1038–1676) for all unnatural causes and 238 (95% CI 167–329) for natural causes. Suicides and deaths from all unnatural causes were most likely to occur in the first year after childbirth, the SMR for suicide within one year being 7216 (95% CI 3945–12 108).ConclusionsAlthough postnatal women as a whole appear to have a low rate of suicide, severe post-partum psychiatric disorder is associated with a high rate of deaths from natural and unnatural causes, particularly suicide. The risk is especially high in the first postnatal year, when the suicide risk is increased 70-fold. Close clinical superivision at this time is indicated.

Towards a comprehensive Mayo psychiatric service: a preliminary survey of longstay patients

1991 ◽  
Vol 8 (1) ◽  
pp. 65-67 ◽  
Author(s):  
Deirdre A Garvey ◽  
Susan M Finnerty ◽  
Eamon J Smith
Keyword(s):  
Inpatient Care ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Psychiatric Services ◽  
Preliminary Survey ◽  
Future Planning ◽  
Active Rehabilitation ◽  
One Year ◽  
Discharge Potential ◽  
Age And Sex

AbstractA group of 183 longstay psychiatric patients were evaluated regarding their immediate and future discharge potential in order to assist in the future planning of the Mayo Psychiatric Services. Comparisons were made between new longstay patients, who were defined as those who had been in hospital for greater than one but less than five years, and old longstay patients who were in hospital for greater than five years. Age and sex comparisons were also made.While 28% of those included in the survey were thought fit for immediate discharge, a further 18% were thought to require further active rehabilitation before discharge into the community within one year. The accommodation requirements of those needing continuing inpatient care are discussed. Age and length of time in hospital were found to be associated with discharge potential. Sex difference was not found to be significant. Implications for the development of the service are dicussed on the basis of the findings.

An Evaluation of the Implementation and the Effectiveness of Case Management in the Rehabilitation of Psychiatric Outpatients in South Africa

1996 ◽  
Vol 26 (4) ◽  
pp. 226-230 ◽  
Author(s):  
L.R. Uys ◽  
R.N. Zulu
Keyword(s):  
South Africa ◽  
Case Management ◽  
Rural Areas ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Routine Care ◽  
Control Group ◽  
Legal Provisions ◽  
Long Term Treatment ◽  
Organizational Rules

Patients with a major mental illness usually need long-term treatment and rehabilitation. Since the adoption of the principle of de-institutionalization of psychiatric patients in South Africa in the 1970s, most treatment has been done in the community, through a system of psychiatric outpatient clinics. There is now a growing realization that more is needed than treatment with medication, but in a developing country resources, both human and financial, are limited. It is therefore important to establish which rehabilitation strategies can be implemented in the South African services, and how effective they are. In this study case management was implemented in the psychiatric service to black patients in rural areas. A sample of 41 patients formed the experimental group, who were seen by six nurses trained as case workers. The control group consisted of 15 patients in another clinic, who received additional attention to routine care. There were specific problems with the implementation of case management, especially inadequate training of nurses in these techniques, the restrictions on the functioning of the nurse by legal provisions and organizational rules, and the paucity of community resources. The case management was found to positively influence functional status, but did not achieve symptom reduction.

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