This study is the first in a series investigating different aspects of living conditions and care utilization in a total population with long-term functional psychoses (LFP). The study cohort (n = 302) was defined as people that: were aged 18-64 years, were affected by a nonorganic psychosis continuously during at least 6 months, showed psychotic features or residual symptoms during 1984, and had their home address in the study area during 1984. The study area consists of one rural and one suburban municipality, and one urban parish (57,035 inhabitants aged 18-64 years). The LFP concept used shows a high interrater reliability (kappa = 0.93). The one-year prevalence in the rural, suburban and urban areas was 3.4, 5.6 and 6.6 per 1000 respectively, thus producing a gradient from the rural to the urban areas. The prevalence of schizophrenia (DSM-III) was 2.6, 3.8 and 5.0 per 1000 respectively. The other diagnoses covered by the LFP concept (paranoia, major affective disorder with psychotic features, and psychotic disorder not elsewhere classified) showed the same gradient, with the exception of paranoia, which showed a lower rate in the urban area. The prevalence of schizophrenia was higher among males, while for paranoia the prevalence was higher among females.
The aim of the study was to estimate life expectancies in different diagnostic groups for individuals treated as inpatients at Swedish psychiatric clinics. All individuals, older than 18 y and alive on the first of January 1983, who had been registered in the National Hospital Discharge Registry by a psychiatric clinic in 1978-82, were monitored for mortality during 1983 by using the National Cause of Death Registry. The study group consisted of 91 385 men and 77 217 women. The patients were divided into nine diagnostic groups according to the principal diagnosis registered at the latest discharge. Actuarial mathematics was used to construct life expectancy tables, which present the number of years expected to live, by gender and diagnostic group.Expectancies of life were significantly shortened for both genders and in all nine diagnostic groups (with one exception). Mental disorders in general are life shortening. This fact should be recognised in community health when setting health priorities. It should also be addressed in curricula as well as in treatment and preventive programmes.
BACKGROUND: An important aim in all psychiatric care should be a reduction of overall mortality. Information on mortality patterns in different types of psychiatric populations is vital for a successful design of treatment strategies and preventive programmes. The present study aims to describe mortality among persons with a history as psychiatric inpatients with functional psychosis. METHODS: All psychiatric inpatients, 17,878 men and 23,256 women, registered in the Swedish National Hospital Discharge Registry between 1978 and 1982 with a functional psychosis (ICD-8 = 295-299) as principal diagnosis were followed for mortality during the time period 1983-85. Life tables were constructed and death rates for various types of causes of death were calculated. RESULTS: Compared to the general population, the excess mortality in the study group caused a reduction in life expectancy of 22.1-27.9% (95% CI) among the men and 15.0-21.7% among the women. In the age group 2049 years, 62% of the excess mortality was caused by suicide. In the age group 50-89 years, only 8% of the excess was suicide, while 52% was caused by cardiovascular disorders. CONCLUSIONS: Reduction in mortality rates requires different strategies in different age groups. Even if the suicide rate were reduced to zero, it would only have a marginal influence on the highly elevated mortality among patients in upper middle age and among the elderly. Among the younger patients (
This study of long-term functionally psychotic people in Stockholm County describes the psychiatric and somatic care provided as well as social welfare support and medication in a total cohort. This group included all non-organic cases of psychosis aged 18-64 years. The group was found still to be very dependent on institutional care, with an average of 75 d of psychiatric inpatient care. Males spent twice as long as females as inpatients, and people from the urban area spent a longer time than those from the other areas. Antipsychotic medication increased from the rural to the urban area. The diagnosis of schizophrenia and early age at onset were each per se associated with higher likelihood of inpatient treatment and depot medication. Contrary to expectations, medication with antipsychotic drugs was shown to increase with illness duration.
A number of social conditions regarding interpersonal relations, housing and employment were studied in a total population of individuals with long-term functional psychosis (n = 341) drawn from the population aged 18-64 years inhabiting three different areas of Stockholm County, altogether about 57,000 inhabitants. Individuals were included irrespective of whether they had a psychiatric treatment contact or not. They were mostly unmarried (57%) and living alone (64%). Most were unemployed (69%) and over half received a disability pension. However, 76% had their own flat and a reasonable financial standard, not deteriorating with illness duration. The diagnosis of schizophrenia led to poorer social conditions, as did early age at onset, male sex and co-morbidity of substance abuse. A larger number of individuals lived in an institution in the urban area while a greater number lived with relatives in the rural area.