Fabian Termorshuizen1, Addi P L van Bergen2, Ronald B J Smit3, Hugo M Smeets4, Erik J C van Ameijden2. 1. University Medical Center Utrecht, Utrecht, The Netherlands f.termorshuizen@umcutrecht.nl. 2. Department of Health Promotion and Epidemiology, Municipal Health Service Utrecht, Utrecht, The Netherlands. 3. Department of Social Health Care, Municipal Health Service Utrecht, Utrecht, The Netherlands. 4. University Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
BACKGROUND: Different studies have shown similar or even lower mortality among homeless persons with compared to homeless persons without a severe mental disorder. AIMS: To clarify the association between presence of a psychiatric diagnosis and mortality among the socially marginalized. METHODS: The Public Mental health care (PMHc) is a legal task of the municipal authority aiming at prevention and intervention in case of (imminent) homelessness among persons with a serious shortage of self-sufficiency. The data of PMHc clients (N=6,724) and personally matched controls (N=66,247) were linked to the registries of Statistics Netherlands and analysed in a Cox model. RESULTS: The increased mortality among PMHc clients, compared to the general population (HR=2.99, 95%-CI: 2.63-3.41), was associated with a broad range of death causes. Clients with a record linkage to the Psychiatric Case Registry Middle Netherlands ('PMHc+') had an increased risk of suicide (HR=2.63, 0.99-7.02, P=0.052), but a lower risk of natural death causes (HR=0.71, 0.54-0.92, P=0.011), compared to clients without this record linkage ('PMHc-'). Compared to controls, however, 'PMHc-' clients experienced substantially increased risks of suicide (HR=3.63, 1.42-9.26, P=0.007) and death associated with mental and behavioural disorders (ICD-10 Ch.V) (HR=7.85, 3.54-17.43, P<0.001). CONCLUSION: Psychiatric services may deliver an important contribution to the prevention of premature natural death among the socially marginalized. KEYPHRASES: The earlier observed lower mortality among vulnerably housed and homeless persons with a psychiatric diagnosis compared to vulnerably housed and homeless persons without a psychiatric diagnosis appears to be due to a significantly lower risk of natural causes of death. Compared to controls from the general population, vulnerably housed and homeless persons without registered diagnosis at a local psychiatric service have a significantly increased mortality associated both with natural death causes and with suicide and death due to mental and behavioural disorders. Services for mental health care may deliver an important contribution to the prevention of premature death due to somatic disorders among the socially marginalized.
BACKGROUND: Different studies have shown similar or even lower mortality among homeless persons with compared to homeless persons without a severe mental disorder. AIMS: To clarify the association between presence of a psychiatric diagnosis and mortality among the socially marginalized. METHODS: The Public Mental health care (PMHc) is a legal task of the municipal authority aiming at prevention and intervention in case of (imminent) homelessness among persons with a serious shortage of self-sufficiency. The data of PMHc clients (N=6,724) and personally matched controls (N=66,247) were linked to the registries of Statistics Netherlands and analysed in a Cox model. RESULTS: The increased mortality among PMHc clients, compared to the general population (HR=2.99, 95%-CI: 2.63-3.41), was associated with a broad range of death causes. Clients with a record linkage to the Psychiatric Case Registry Middle Netherlands ('PMHc+') had an increased risk of suicide (HR=2.63, 0.99-7.02, P=0.052), but a lower risk of natural death causes (HR=0.71, 0.54-0.92, P=0.011), compared to clients without this record linkage ('PMHc-'). Compared to controls, however, 'PMHc-' clients experienced substantially increased risks of suicide (HR=3.63, 1.42-9.26, P=0.007) and death associated with mental and behavioural disorders (ICD-10 Ch.V) (HR=7.85, 3.54-17.43, P<0.001). CONCLUSION:Psychiatric services may deliver an important contribution to the prevention of premature natural death among the socially marginalized. KEYPHRASES: The earlier observed lower mortality among vulnerably housed and homeless persons with a psychiatric diagnosis compared to vulnerably housed and homeless persons without a psychiatric diagnosis appears to be due to a significantly lower risk of natural causes of death. Compared to controls from the general population, vulnerably housed and homeless persons without registered diagnosis at a local psychiatric service have a significantly increased mortality associated both with natural death causes and with suicide and death due to mental and behavioural disorders. Services for mental health care may deliver an important contribution to the prevention of premature death due to somatic disorders among the socially marginalized.
Authors: Fran Calvo; Oriol Turró-Garriga; Carles Fàbregas; Rebeca Alfranca; Anna Calvet; Mercè Salvans; Cristina Giralt; Sandra Castillejos; Mercè Rived-Ocaña; Paula Calvo; Paz Castillo; Josep Garre-Olmo; Xavier Carbonell Journal: Int J Environ Res Public Health Date: 2021-02-11 Impact factor: 3.390