Mortality in long-stay patients from psychiatric hospitals in Italy : results from the Qualyop Project

Background: Mortality in psychiatric patients both from natural and non-natural causes was reported to be markedly higher than in the general population. The effect of the psychiatric hospital (PH) closure process on mortality has nonetheless seldom been investigated. We studied mortality in a cohort of PH patients, taking into account the closure process in Italy. Methods: A total of 2915 patients from 12 PH were described in the period 1994-1996 and followed up until June 2000, and discharges and deaths were registered. Standardized mortality ratios (SMR) for natural and non-natural causes were computed on the basis of regional death rates. Results: Observed deaths were 714 vs. 291.2 expected. The all-causes SMR was 2.47 in males and 2.43 in females. The SMR was 26.92 in males and 13.75 in females for psychiatric causes, 6.84 and 7.89 for undefined causes, 9.57 and 7.27 for pneumonia, 6.38 and 7.78 for chronic obstructive respiratory disease, and 1.27 and 1.58 for ischemic heart disease. No excess was observed for all cancers in males, but the SMR was 1.50 for lung cancer in males, 2.30 for breast cancer and 1.48 for all neoplasms in females. SMR for suicide was 3.85 in males and 2.73 in females. Most SMR were higher at younger age, although the rate of absolute excess deaths was greater above age 60. The SMR for all causes was 2.66 before discharge from PH, and 2.09 after discharge. Conclusions: Mortality remained high after leaving the PH, but no increase was associated to the PH closure.