Deaths in patients with psychiatric disorders: a 10-year retrospective records review in Northern Tunisia

Abstract

Background: Patients with psychiatric disorders experience a higher all-cause mortality compared with the general population. The aim of our study was to investigate the causes of death in psychiatric patients.

Methods: We retrospectively reviewed medical and autopsy records of clinically diagnosed psychiatric patients who underwent autopsy, from January 2012 to December 2021. We collected data related to demographics, medical history and autopsy findings. Statistical analysis included descriptive statistics, crossings and trend analysis.

Results: A total of 826 deaths among psychiatric patients were collected, including 622 (75.3%) men and 204 (24.7%) women. The rate of deaths in psychiatric patients increased over the years (R² = 0.65). The mean age at death was 47.3 ± 13.9 years. Schizophrenia was the most frequent psychiatric diagnosis (41.4%). 331 (40.1%) had been receiving antipsychotic drugs. The primary manner of death was suicide (53.2%), with hanging (23%) and drowning (7.6%) as the most frequent methods. Natural causes accounted for 23.8% (primarily cardiovascular disease (56.9%) and respiratory disorder (14.7%)), followed by undetermined deaths (21.4%) and homicide (1.6%).

Conclusions: Suicide and cardiovascular diseases were the major causes of death in psychiatric patients. Suicide risk stratification, lifestyle and cardio-metabolic factor modifications and careful antipsychotic management are crucial for reducing mortality in psychiatric patients.

Keywords: Antipsychotic drugs; Autopsy; Death; Psychiatric disorders; Suicide.