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Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 2/2009

01-02-2009 | ORIGINAL PAPER

Five-year mortality of Finnish schizophrenia patients in the era of deinstitutionalization

Authors: Helena Rantanen, MSc, Anna-Maija Koivisto, MSc, Prof. Raimo K. R. Salokangas, MD, DrMedSci, Mika Helminen, MSc, Hannu Oja, PhD, Sami Pirkola, MD, DrMedSci, Prof. Kristian Wahlbeck, MD, DrMedSci, Prof. Matti Joukamaa, MD, DrMedSci

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 2/2009

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Abstract

Background

Excess mortality among people with schizophrenia due to natural and unnatural causes, especially due to suicides, is a well-known fact. It has been suggested that deinstitutionalization increases suicide mortality but there are also contradictory results. We studied the changes in mortality and causes of death among schizophrenia sufferers during and after the years of deinstitutionalization process in Finland.

Method

The sample, identified from the Finnish hospital discharge register (FHDR), consisted of patients aged 15–65 and hospitalized for the first time due to schizophrenia. We focused on the 5-year follow-up from inclusion years 1980–1998 (N = 23,959). Changes in 5-year follow-up mortality during the study period were explored for both genders and for different causes of death separately using multivariate logistic regression analyses.

Results

During the study period 1,926 deaths occurred. Suicide was the major cause of death in both genders. A significant reduction in overall 5-year mortality was observed among persons hospitalized in 1995–1998 when compared to people hospitalized 1980–1984. In males a significant reduction was seen in all mortality (P = 0.025) due to suicides (P = 0.007) but not in the case of natural deaths. In females no significant changes in mortality were found.

Conclusions

Our study confirms a reduction in suicide mortality of male schizophrenia sufferers after the deinstitutionalization process. However the overall mortality is still very high and the attention needs to be focused on the general well-being of schizophrenia patients.
Literature
1.
Auquier P, Lancon C, Rouillon F, Lader M, Holmes C (2006) Mortality in Schizophrenia. Pharmacoepidemiol Drug Saf 15:873–879PubMedCrossRef
2.
American Psychiatric Association (1987) DSM-III-R: diagnostic and statistical manual of mental disorders. 3rd edn. APA, Washington, DC
3.
Arranz B, Rosel P, Ramírez N, Dueñas R, Fernández P, Sanchez JM, Navarro MA, San L (2004) Insulin resistance and increased leptin concentrations in noncompliant schizophrenia patients but not in antipsychotic-naïve first-episode schizophrenia patients. J Clin Psychiatry 65:1335–1342PubMedCrossRef
4.
Babidge NC, Buhrich N, Butler T (2001) Mortality among homeless people with schizophrenia in Sydney, Australia. A 10-year follow-up. Acta Psychiatr Scand 103:105–110PubMedCrossRef
5.
6.
Brown S, Birtwistle J, Roe L, Thompson C (1999) The unhealthy lifestyle of people with schizophrenia. Psychol Med 29:697–701PubMedCrossRef
7.
Brown S, Inskip H, Barraclough B (2000) Causes of the excess mortality of schizophrenia. Br J Psychiatry 177:212–217PubMedCrossRef
8.
Cohen ME, Dembling B, Schorling JB (2002) The association between schizophrenia and cancer: a population-based mortality study. Schizophr Res 57:139–146PubMedCrossRef
9.
Connolly M, Kelly C (2005) Lifestyle and physical health in schizophrenia. Advan Psychiatr Treat 11:125–132CrossRef
10.
D’Avanzo B, La Vecchia C, Negri E (2003) Mortality in long-stay patients from psychiatric hospital in Italy: results from the Qualyop project. Soc Psychiatry Psychiatr Epidemiol 38:385–389PubMed
11.
De Hert M, van Winkel R, van Eyck D, Hanssens L, Wampers M, Scheen A, Peuskens J (2006) Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study. Clin Pract Epidemiol Ment Health 2:14CrossRefPubMed
12.
Dickerson FB, McNary SW, Brown CH, Kreyenbuhl J, Goldberg RW, Dixon LB (2003) Somatic healthcare utilization among adults with serious mental illness who are receiving community psychiatric services. Med Care 4:560–570CrossRef
13.
Dixon L, Postrado L, Delahanty J, Fischer P, Lehman A (1999) The association of medical comorbidity in schizophrenia with poor physical and mental health. J Nerv Ment Dis 187:496–502PubMedCrossRef
14.
Druss BG, Bradford DW, Rosenheck RA, Radford MJ, Krumholz HM (2000) Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA 283:506–511PubMedCrossRef
15.
Finnish Statistics on Medicines (2007) National Agency for Medicines and Social Insurance Institution. Helsinki
16.
Fors BM, Isacson D, Bingefors K, Widerlöv B (2007) Mortality among persons with schizophrenia in Sweden: An epidemiological study. Nord J Psychiatry 61:253–259CrossRef
17.
Grinshpoon A, Barchana M, Ponizovsky A, Lipshitz I, Nahon D, Tal O, Weizman A, Levav I (2005) Cancer in schizophrenia: is the risk higher or lower? Schizophr Res 73:333–341PubMedCrossRef
18.
19.
Halbreich U, Shen J, Panaro V (1996) Are chronic psychiatric patients at increased risk for developing breast cancer? Am J Psychiatry 153:559–560PubMed
20.
Heilä H, Haukka J, Suvisaari J, Lönnqvist J (2005) Mortality among patients with schizophrenia and reduced psychiatric hospital care. Psychol Med 35:725–732PubMedCrossRef
21.
Jeste DV, Gladsjo JA, Lindamer LA, Lacro JP (1996) Medical comorbidity in schizophrenia. Schizophr Bull 22:413–430PubMed
22.
Joukamaa M, Heliövaara M, Knekt P, Aromaa A, Raitasalo R, Lehtinen V (2001) Mental disorders and cause-specific mortality. Br J Psychiatry 179:498–502PubMedCrossRef
23.
Joukamaa M, Heliövaara M, Knekt P, Aromaa A, Raitasalo R, Lehtinen V (2006) Schizophrenia, neuroleptic medication and mortality. Br J Psychiatry 188:122–127PubMedCrossRef
24.
Kaltiala-Heino RK, Laippala P, Joukamaa M (2001) Has the attempt to reduce psychiatric inpatient treatment been successful in Finland? Eur Psychiatry 16:215–221PubMedCrossRef
25.
Keskimäki I, Aro S (1991) Accuracy of data on diagnoses, procedures and accidents in the Finnish Hospital Discharge Register. Int J Health Sci 2:15–21
26.
Korkeila J, Salminen JK, Hiekkanen H, Salokangas RKR (2007) Use of antidepressants and suicide rate in Finland: an ecological study. J Clin Psychiatry 68:505–511PubMedCrossRef
27.
Koro CE, Fedder DO, ĹItalien GJ, Weiss SS, Magder LS, Kreyenbuhl J, Revicki DA, Buchanan RW (2002) Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population-based nested case-control study. BMJ 325:243–247PubMedCrossRef
28.
Lawrence D, Jablensky AV, Holman CDJ, Pinder TJ (2000) Mortality in Western Australian psychiatric patients. Soc Psychiatry Psychiatr Epidemiol 35:341–347PubMedCrossRef
29.
Lawrence D, Holman C, Jablensky A, Hobbs MST (2003) Death rate from ischemic heart disease in western Australian psychiatric patients 1980–1998. Br J Psychiatry 182:31–36PubMedCrossRef
30.
Lichtermann D, Ekelund J, Pukkala E, Tanskanen A, Lönnqvist J (2001) Incidence of cancer among persons with schizophrenia and their relatives. Arch Gen Psychiatry 58:573–578PubMedCrossRef
31.
Middelboe T, Mackeprang T, Hansson L, Werdelin G, Karlsson H, Bjarnason O, Bengtsson-Tops A, DyBBro J, Nilsson LL, Sandlund M, Sörgaard KW (2001) The Nordic study on schizophrenic patients living in the community. Subjective needs and perceived help. Eur Psychiatry 16:207–215PubMedCrossRef
32.
Moilanen K, Veijola J, Läksy K, Mäkikyrö T, Miettunen J, Kantojärvi L, Kokkonen P, Karvonen J, Herva A, Joukamaa M, Järvelin M-R, Moring J, Jones P, Isohanni M (2003) Reasons for the diagnostic discordance between clinicians and researches in schizophrenia in the Northern Finland 1966 Birth Cohort. Soc Psychiatry Psychiatr Epidemiol 38:305–310PubMed
33.
Mortensen PB, Juel K (1993) Mortality and causes of death in first admitted schizophrenic patients. Br J Psychiatry 163:183–189PubMedCrossRef
34.
Mortensen PB (1994) The occurrence of cancer in first admitted schizophrenic patients. Schizophr Res 12:185–194PubMedCrossRef
35.
Muir-Cochrane E (2006) Medical comorbidity risk factors and barriers to care for people with schizophrenia. J Psychiatr Ment Health Nurs 13:447–452PubMedCrossRef
36.
Munk-Jørgensen P, Mors O, Mortensen PB, Ewald H (2000) The schizophrenic patient in the somatic hospital. Acta Psychiat Scand 102:96–99CrossRef
37.
38.
Nordentoft M, Laursen TM, Agerbo E, Qin P, Hoyer EH, Mortensen PB (2004) Change in suicide rates for patients with schizophrenia in Denmark, 1981–97: nested case-control study. BMJ 329:261PubMedCrossRef
39.
Osborn DPJ, Nazareth I, King MB (2007) Physical activity, dietary habits and Coronary Heart Disease risk factor knowledge amongst people with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 42:787–793PubMedCrossRef
40.
Öhberg A, Lönnqvist J (1997) Suicide trends in Finland 1980–1995. Psychiatr Fenn 28:11–23
41.
Ösby U, Correia N, Brandt L, Ekbom A, Sparen P (2000a) Mortality and causes of death in schizophrenia in Stockholm County, Sweden. Schizophr Res 45:21–28PubMedCrossRef
42.
Ösby U, Correia N, Brandt L, Ekbom A, Sparen P (2000b) Time trends in schizophrenia mortality in Stockholm County. BMJ 321:19–26CrossRef
43.
Palmer BA, Pankratz VS, Bostwick M (2005) The lifetime risk of suicide in schizophrenia. A re-examination. Arch Gen Psychiatry 62:247–253PubMedCrossRef
44.
Pirkola S, Sohlman B (2007) Reductions in postdischarge suicide after deinstitutionalization and decentralization: A Nationwide Register Study in Finland. Psychiatr Serv 58:221–226PubMedCrossRef
45.
Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, Montross LP, Mortensen PB, Munk-Jørgensen P, Nielsen J, Nordentoft M, Saarinen PI, Zisook S, Wilson ST, Tatarelli R (2007) Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry 6:10PubMedCrossRef
46.
Radomsky ED, Haas GL, Mann JJ, Sweeney JA (1999) Suicidal behaviour in patients with schizophrenia and other psychotic orders. Am J Psychiatry 156:1590–1595PubMed
47.
Reist C, Mintz J, Albers L, Jamal MM, Szabo S, Ozdemir V (2007) Second-generation antipsychotic exposure and metabolic-related disorders in patients with schizophrenia: An observational pharmacoepidemiologial study from 1988 to 2002. J Clin Psychopharmacol 27:46–51PubMedCrossRef
48.
Robinson DG, Worner MG, Napolitano B, Patel RC, Sevy SM, Gunduz-Bruce H, Soto-Perello JM, Mendelowitz A, Khadivi A, Miller R, MacCormack J, Lorell BS, Lesser ML, Schooler NR (2006) Randomized comparison of olanzapine versus risperidone for the treatment of first-episode schizophrenia: 4-month outcomes. Am J Psychiatry 163:2096–2102PubMedCrossRef
49.
Roick C, Fritz-Wieacker A, Matschinger H, Heider D, Schindler J, Riedel-Heller S, Angermeyer MC (2007) Health habits of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 42:268–276PubMedCrossRef
50.
Rossau CD, Mortensen PB (1997) Risk factors for suicide in patients with schizophrenia: nested case-control study. Br J Psychiatry 171:355–359PubMedCrossRef
51.
Ryan MC, Flanagan S, Kinsella U, Keeling F, Thakore JH (2004) The effects of atypical antipsychotics on visceral fat distribution in first episode, drug-naïve patients with schizophrenia. Life Sci 74:1999–2008PubMedCrossRef
52.
Räsänen S, Hakko H, Viilo K, Meyer-Rochow VB, Moring J (2003) Excess mortality among long-stay psychiatric patients in Northern Finland. Soc Psychiatry Psychiatr Epidemiol 38:297–304PubMed
53.
Saha S, Chant D, McGrath J (2007) Is the differential mortality gap worsening over time? A systematic review of mortality in schizophrenia. Arch Gen Psychiatry 64:1123–1131PubMedCrossRef
54.
Salo M, Kallinen M (2007) Yhteisasumisesta yhteiskuntaan? Mielenterveyskuntoutujien asumispalveluiden tila ja tulevaisuus. Mielenterveydenkeskusliitto, Pori
55.
Salokangas RKR, Stengård E (1990) Gender and short-term outcome in schizophrenia. Schizophr Res 3:333–345PubMedCrossRef
56.
Salokangas RKR, Stengård E, Räkköläinen V, Alanen YO, Kaljonen A (1991) Uusien skitsofreniapotilaiden hoito ja ennuste (USP-projekti) V:Viiden vuoden ennuste (English Summary: Treatment and prognosis of new schizophrenia patients).Reports of Psychiatria Fennica No 95, Helsinki
57.
Salokangas RKR, Honkonen T, Stengård E, Koivisto A-M (2001) Skitsofreniapotilaiden neuroleptilääkehoito ja sen muutokset sairaansijojen vähetessä. SLL 25–26:2755–2762
58.
Salokangas RKR, Honkonen T, Stengård E, Koivisto A-M (2002) Mortality in chronic schizophrenia during decreasing number of psychiatric beds in Finland. Schizophr Res 54:265–275PubMedCrossRef
59.
Salokangas RKR (2004) Psychiatric specialist care in Finland-achievements and challenges. J Ment Health 13:47–54CrossRef
60.
Salokangas RKR (2007) Medical problems in schizophrenia patients living in the community (alternative facilities). Curr Opin Psychiatry 20:402–405PubMedCrossRef
61.
Suvisaari J, Perälä J, Saarni SI, Härkänen T, Pirkola S, Joukamaa M, Koskinen S, Lönnqvist J, Reunanen A (2007) Type 2 diabetes among persons with schizophrenia and other psychotic disorders in a general population survey. Eur Arch Psychiatry Clin Neurosci (Online) Nov 7
62.
Tiihonen J, Wahlbeck K, Lönnqvist J, Klaukka T, Ioannidis PA, Volavka J, Haukka J (2006) Effectiveness of antipsychotic treatments in nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ 333:224–227PubMedCrossRef
63.
Wahlbeck K, Manderbacka K, Vuorenkoski L, Kuusio H, Luoma M, Widström E (2007) Equality in access to healthcare – focus on migrants, old people and people with mental disorders. HealthQUEST country report for Finland. STAKES reports, Helsinki
64.
World Health Organization (1967) The ICD-8 classification of mental and behavioural disorders. World Health Organization, Geneva
65.
World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders. World Health Organization, Geneva
66.
Young JK, Foster DA (2000) Cardiovascular procedures in patients with mental disorders. JAMA 284(letter), 3198
Metadata
Title
Five-year mortality of Finnish schizophrenia patients in the era of deinstitutionalization
Authors
Helena Rantanen, MSc
Anna-Maija Koivisto, MSc
Prof. Raimo K. R. Salokangas, MD, DrMedSci
Mika Helminen, MSc
Hannu Oja, PhD
Sami Pirkola, MD, DrMedSci
Prof. Kristian Wahlbeck, MD, DrMedSci
Prof. Matti Joukamaa, MD, DrMedSci
Publication date
01-02-2009
Publisher
D. Steinkopff-Verlag
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 2/2009
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-008-0414-1

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