Of 5,412 patients admitted to the University of Iowa Psychiatric Hospital between Jan 1, 1972, and Dec 31, 1981, three hundred thirty-one died during the follow-up period, significantly more than expected. The risk for premature death was greatest among women and the young, especially those between the ages of 30 and 39 years. Risk was associated with all psychiatric diagnoses and was significantly higher among patients of either sex with an organic mental disorder or schizophrenia; women with acute schizophrenia, depressive neuroses, alcoholism, drug abuse, and psychophysiologic disorders and special symptoms; and men with neuroses. Suicide and accidental death were more frequent than expected and were responsible for two thirds of the excess deaths. During the total time of follow-up, women were at risk for natural deaths but men were not. Our most important finding was that 99% of the excess deaths occurred within two years of discharge. During this period there were undue numbers of both "natural" and "unnatural" deaths. The first two years after discharge are a time of great risk for psychiatric patients, particularly women. (JAMA1985;253:58-61)