Excess mortality among psychiatric patients. The Iowa Record-Linkage Study

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Abstract
Of 5412 patients admitted to the University of Iowa [USA] Psychiatric Hospital between Jan. 1, 1972, and Dec. 31, 1981, 331 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 30-39 yr. 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 2/3 of the excess deaths. During the total time of follow-up, women were at risk for natural deaths but men were not. The most important finding was that 99% of the excess deaths occurred within 2 yr of disharge. During this period there were undue numbers of both natural and unnatural deaths. The 1st 2 yr after discharge are a time of great risk for psychiatric patients, particularly women.

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