Mortality in Western Australian psychiatric patients

Background: The aim was to examine mortality in psychiatric patients in Wes tern Australia (WA), over a time period of considerable change in the deliv ery of mental health services. Methods: A population-based record linkage a nalysis was undertaken to quantify mortality among people with mental illne ss in WA. Mortality rates were calculated in users of mental health service s and compared with rates in the whole population of WA. Trends in mortalit y were also examined using relative survival analysis, and proportional haz ards regression. Results: The overall mortality rate ratio was 2.57 in male s (95% CI: 2.51-2.64), and 2.18 in females (2.12-2.24). The highest cause-s pecific mortality rate ratio was for deaths due to suicide [RR: 7.37 in mal es (95% CI: 6.74-8.05) and 8.38 in females (959/0 CI: 7.11-9.89)], with mor tality rate ratios being significantly greater than 1 for all other major c auses of death. A relative survival analysis found that the excess mortalit y risk was concentrated in the first few years after first contact with men tal health services. Proportional hazards regression analysis found a sligh t elevation of mortality rates over time. Conclusions: Mortality among psyc hiatric patients remains high and appears to be increasing. Highest excess mortality rate is associated with suicide, but mortality rates are signific antly elevated for all major causes of death.