SAN DIEGO – Heart disease and suicide were the leading causes of death in a large study of patients with mental illness in Ohio.
Moreover, these patients died at a mean age of 48 years, which represented 32 years of potential life lost, Dr. Brian J. Miller reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.
“That is a strikingly high figure,” said Dr. Miller, a psychiatry resident at the Medical College of Georgia, Augusta. The findings underscore the importance of integrating the delivery of health care services to patients with serious mental illness and targeting interventions that improve their quality of life, such as monitoring blood glucose levels, taking waist circumference measurements, and looking for metabolic syndrome.
The study results “confirm findings of previous reports that patients with serious mental illness are at increased risk of death,” said Dr. Miller, who conducted the research while a medical student at Ohio State University in Columbus. “The cited literature suggests a 1.6- to 2.8-fold increased risk of premature death. We found a 3.2-fold increased risk of premature death.”
He and his associates analyzed Ohio Department of Mental Health records for 20,018 patients discharged from an Ohio public psychiatric hospital between 1998 and 2002, and matched them against Ohio Department of Health records for the same time period. They identified 608 deaths and calculated leading causes of death, medical comorbidities, age-adjusted mortality, years of potential life lost, and standardized mortality ratios.
Most patients (72%) died within 2 years of discharge from the psychiatric hospital. The leading causes of death were heart disease (21%), suicide (18%), and accidents (14%). The most prevalent medical comorbidities were obesity (24%), hypertension (22%), and diabetes mellitus (12%).
The overall standardized mortality ratio was 3.2, which corresponded to 417 excess deaths.
“What's interesting is that we found that the leading medical comorbidities–specifically, obesity, hypertension, diabetes, and COPD–are consistent with the risk factors for the observed leading [medical] causes of death: heart disease, COPD, and diabetes,” Dr. Miller said.
In the text of their poster, the investigators acknowledged that the findings may not apply to other populations with serious mental illness. “While our statistical models adjusted for age and gender differences, there are many other demographic, health, and socioeconomic factors that are difficult to adequately and accurately control,” they wrote.
The investigators said that their data came entirely from state mental health inpatient records. The study population was largely male, unmarried, and uneducated–a group for which alcohol and substance abuse were well documented.
Patients died at a mean age of 48 years, which represented 32 years of potential life lost. DR. MILLER