Reducing all-cause mortality among patients with psychiatric disorders: a population-based study
- 12 November 2012
- journal article
- Published by CMA Impact Inc. in CMAJ : Canadian Medical Association Journal
- Vol. 185 (1), E50-E56
- https://doi.org/10.1503/cmaj.121077
Abstract
Background: Among patients with psychiatric disorders, there are 10 times as many preventable deaths from physical disorders as there are from suicide. We investigated whether compulsory community treatment, such as community treatment orders, could reduce all-cause mortality among patients with psychiatric disorders. Methods: We conducted a population-based survival analysis of an inception cohort using record linking. The study period extended from November 1997 to December 2008. The cohort included patients from all community-based and inpatient psychiatric services in Western Australia (state population 1.8 million). We used a 2-stage design of matching and Cox regression to adjust for demographic characteristics, previous use of health services, diagnosis and length of psychiatric history. We collected data on successive cohorts for each year for which community treatment orders were used to measure changes in numbers of patients, their characteristics and outcomes. Our primary outcome was 2-year all-cause mortality. Our secondary outcomes were 1-and 3-year all-cause mortality. Results: The study population included 2958 patients with community treatment orders (cases) and 2958 matched controls (i.e., patients with psychiatric disorders who had not received a community treatment order). The average age for cases and controls was 36.7 years, and 63.7% (3771) of participants were men. Schizophrenia and other nonaffective psychoses were the most common diagnoses (73.4%) among participants. A total of 492 patients (8.3%) died during the study. Cox regression showed that, compared with controls, patients with community treatment orders had significantly lower all-cause mortality at 1, 2 and 3 years, with an adjusted hazard ratio of 0.62 (95% confidence interval 0.45–0.86) at 2 years. The greatest effect was on death from physical illnesses such as cancer, cardiovascular disease or diseases of the central nervous system. This association disappeared when we adjusted for increased outpatient and community contacts with psychiatric services. Interpretation: Community treatment orders might reduce mortality among patients with psychiatric disorders. This may be partly explained by increased contact with health services in the community. However, the effects of uncontrolled confounders cannot be excluded.Keywords
This publication has 23 references indexed in Scilit:
- Australian and Canadian Mental Health Acts ComparedAustralian & New Zealand Journal of Psychiatry, 2010
- Review: Inequalities in healthcare provision for people with severe mental illnessJournal of Psychopharmacology, 2010
- Treatment of ischaemic heart disease and stroke in individuals with psychosis under universal healthcareThe British Journal of Psychiatry, 2009
- A Systematic Review of Mortality in SchizophreniaArchives of General Psychiatry, 2007
- Propensity Scores in Cardiovascular ResearchCirculation, 2007
- Can epidemiological studies assist in the evaluation of community treatment orders? — The experience of Western Australia and Nova ScotiaInternational Journal of Law and Psychiatry, 2006
- Mortality in individuals who have had psychiatric treatmentThe British Journal of Psychiatry, 2005
- Community Treatment Orders: Relationship to Clinical Care, Medication Compliance, Behavioural Disturbance and ReadmissionAustralian & New Zealand Journal of Psychiatry, 2000
- beta Blockade after myocardial infarction: systematic review and meta regression analysisBMJ, 1999
- Factors influencing compulsory admission of psychiatric patientsPsychological Medicine, 1991