Time trends in schizophrenia mortality in Stockholm County, Sweden: cohort study
Increased death rates among patients with schizophrenia are most probably due to fundamental changes in psychiatric care and a reduction in hospital beds, says a study in this week's BMJ.
Researchers in Sweden investigated the date and cause of death among residents of Stockholm County who had been diagnosed with schizophrenia between 1976 and 1995. Overall, they found that death rates had increased 1.7-fold in men and 1.3-fold in women. Deaths from natural and cardiovascular causes increased 4.7-fold in men and 2.7-fold in women; suicide increased 1.6-fold in men and 1.9-fold in women and deaths from unspecified violence increased 3.8-fold in men and 3.4-fold in women.
During the study period, there were important changes in psychiatric care offered to patients with schizophrenia, say the authors. For instance, outpatient treatment replaced long term patient care and, between 1976 and 1994, hospital beds available for patients with schizophrenia fell by 64%. This, suggest the authors, is the most probable explanation for the rising mortality and emphasises the importance of monitoring trends in patient groups as indicators of outcome and quality of psychiatric and medical care.
Contact:
Urban Ösby, Consultant, Department of Clinical Neuroscience, Karolinska Institute, S-171 76 Email: Urban.Osby@nvso.sll.se