Reducing all-cause mortality among patients with psychiatric disorders: a population-based study

Kisely, Steve, Preston, Neil, Xiao, Jianguo, Lawrence, David, Louise, Sandra and Crowe, Elizabeth (2013) Reducing all-cause mortality among patients with psychiatric disorders: a population-based study. CMAJ: Canadian Medical Association Journal, 185 1: E50-E56. doi:10.1503/cmaj.121077

Author Kisely, Steve
Preston, Neil
Xiao, Jianguo
Lawrence, David
Louise, Sandra
Crowe, Elizabeth
Title Reducing all-cause mortality among patients with psychiatric disorders: a population-based study
Journal name CMAJ: Canadian Medical Association Journal   Check publisher's open access policy
ISSN 0820-3946
Publication date 2013-01-08
Year available 2012
Sub-type Article (original research)
DOI 10.1503/cmaj.121077
Volume 185
Issue 1
Start page E50
End page E56
Total pages 7
Place of publication Ottawa, ON, Canada
Publisher Canadian Medical Association
Collection year 2013
Language eng
Formatted abstract
Background: Among patients with psychiatric disorders, there are 10 times as many preventable deaths from physical disorders as there are from suicide. We investigated whether compulsory community treatment, such as community treatment orders, could reduce all-cause mortality among patients with psychiatric disorders.
Methods: We conducted a population-based survival analysis of an inception cohort using record linking. The study period extended from November 1997 to December 2008. The cohort included patients from all community-based and inpatient psychiatric services in Western Australia (state population 1.8 million). We used a 2-stage design of matching and Cox regression to adjust for demographic characteristics, previous use of health services, diagnosis and length of psychiatric history. We collected data on successive cohorts for each year for which community treatment orders were used to measure changes in numbers of patients, their characteristics and outcomes. Our primary outcome was 2-year all-cause mortality. Our secondary outcomes were 1-and 3-year all-cause mortality.
Results: The study population included 2958 patients with community treatment orders (cases) and 2958 matched controls (i.e., patients with psychiatric disorders who had not received a community treatment order). The average age for cases and controls was 36.7 years, and 63.7% (3771) of participants were men. Schizophrenia and other nonaffective psychoses were the most common diagnoses (73.4%) among participants. A total of 492 patients (8.3%) died during the study. Cox regression showed that, compared with controls, patients with community treatment orders had significantly lower all-cause mortality at 1, 2 and 3 years, with an adjusted hazard ratio of 0.62 (95% confidence interval 0.45–0.86) at 2 years. The greatest effect was on death from physical illnesses such as cancer, cardiovascular disease or diseases of the central nervous system. This association disappeared when we adjusted for increased outpatient and community contacts with psychiatric services.
Interpretation: Community treatment orders might reduce mortality among patients with psychiatric disorders. This may be partly explained by increased contact with health services in the community. However, the effects of uncontrolled confounders cannot be excluded.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes First published: 12 November 2012.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Public Health Publications
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Created: Wed, 16 Jan 2013, 14:23:32 EST by Geraldine Fitzgerald on behalf of School of Public Health