Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Sep 13:343:d5422.
doi: 10.1136/bmj.d5422.

Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006

Uy Hoang  1 , Robert Stewart, Michael J Goldacre
Affiliations

Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006

Uy Hoang et al. BMJ. .

Abstract

Objective: To investigate whether the mortality gap has reduced in recent years between people with schizophrenia or bipolar disorder and the general population.

Design: Record linkage study.

Setting: English hospital episode statistics and death registration data for patients discharged 1999-2006.

Participants: People discharged from inpatient care with a diagnosis of schizophrenia or bipolar disorder, followed for a year after discharge.

Main outcome measures: Age standardised mortality ratios at each time, comparing the mortality in people with schizophrenia or bipolar disorder with mortality in the general population. Poisson test of trend was used to investigate trend in ratios over time.

Results: By 2006 standardised mortality ratios in the psychiatric cohorts were about double the population average. The mortality gap widened over time. For people discharged with schizophrenia, the ratio was 1.6 (95% confidence interval 1.5 to 1.8) in 1999 and 2.2 (2.0 to 2.4) in 2006 (P < 0.001 for trend). For bipolar disorder, the ratios were 1.3 (1.1 to 1.6) in 1999 and 1.9 (1.6 to 2.2) in 2006 (P = 0.06 for trend). Ratios were higher for unnatural than for natural causes. About three quarters of all deaths, however, were certified as natural, and increases in ratios for natural causes, especially circulatory disease and respiratory diseases, were the main components of the increase in all cause mortality.

Conclusions: The total burden of premature deaths from natural causes in people with schizophrenia or bipolar disorder is substantial. There is a need for better understanding of the reasons for the persistent and increasing gap in mortality between discharged psychiatric patients and the general population, and for continued action to target risk factors for both natural and unnatural causes of death in people with serious mental illness.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Fig 1 Trend in standardised 365 day all cause mortality ratio for all people discharged from hospital with principal diagnosis of bipolar disorder or schizophrenia
None
Fig 2 All cause mortality rate within 365 days after discharge per 1000 people discharged with principal diagnosis of bipolar disorder by age
None
Fig 3 All cause mortality rate within 365 days after discharge per 1000 people discharged with principal diagnosis of schizophrenia by age
See this image and copyright information in PMC

Comment in

References

    1. Allebeck P. Schizophrenia: a life-shortening disease. Schizophr Bull 1989;15:81-9. - PubMed
    1. Goldacre M, V Seagroatt, K Hawton. Suicide after discharge from psychiatric inpatient care. Lancet 1993;342:283-6. - PubMed
    1. Hall DJ, O’Brien F, Stark C, Pelosi A, Smith H. Thirteen-year follow-up of deliberate self-harm, using linked data. Br J Psychiatry 1998;172:239-42. - PubMed
    1. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 1997;170:205-28. - PubMed
    1. Hiroeh U, Appleby L, Mortensen PB, Dunn G. Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. Lancet 2001;358:2110-2. - PubMed

Publication types