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Cited by 56Mental Health Treatment and AccessPsychiatric care and mental health servicesSuicide and Self-Harm Studies

Early death in those previously hospitalised for mental healthcare in Scotland: a nationwide cohort study, 1986-2010

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Ajetunmobi, Omotomilola, Taylor, Mark, Stockton, Diane, Wood, Rachael·2013·BMJ Open
DOI 10.1136/bmjopen-2013-002768PMC PMC3731727
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Abstract

OBJECTIVES: To compare the mortality in those previously hospitalised for mental disorder in Scotland to that experienced by the general population. DESIGN: Population-based historical cohort study using routinely available psychiatric hospital discharge and death records. SETTING: All Scotland. PARTICIPANTS: Individuals with a first hospital admission for mental disorder between 1986 and 2009 who had died by 31 December 2010 (34 243 individuals). OUTCOMES: The main outcome measure was death from any cause, 1986-2010. Excess mortality was presented as standardised mortality ratios (SMRs) and years of life lost (YLL). Excess mortality was assessed overall and by age, sex, main psychiatric diagnosis, whether the psychiatric diagnosis was 'complicated' (ie, additional mental or physical ill-health diagnoses present), cause of death and time period of first admission. RESULTS: 111 504 people were included in the study, and 34 243 had died by 31 December 2010. The average reduction in life expectancy for the whole cohort was 17 years, with eating disorders (39-year reduction) and 'complicated' personality disorders (27.5-year reduction) being worst affected. 'Natural' causes of death such as cardiovascular disease showed modestly elevated relative risk (SMR1.7), but accounted for 67% of all deaths and 54% of the total burden of YLL. Non-natural deaths such as suicide showed higher relative risk (SMR5.2) and tended to occur at a younger age, but were less common overall (11% of all deaths and 22% of all YLL). Having a 'complicated' diagnosis tended to elevate the risk of early death. No worsening of the overall excess mortality experienced by individuals with previous psychiatric admission over time was observed. CONCLUSIONS: Early death for those hospitalised with mental disorder is common, and represents a significant inequality even in well-developed healthcare systems. Prevention of suicide and cardiovascular disease deserves particular attention in the mentally disordered.

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  • Typical behavioral manifestations of emotion dysregulation, such as self-harm, suicidal ideation, eating disorder behaviors, or substance abuse, are associated with increased morbidity and mortality.

    “Additionally, typical behavioral manifestations of emotion dysregulation, such as self-harm, suicidal ideation, eating disorder behaviors, or substance (ab)use, are associated with increased morbidity and mortality (4–7).”

    From Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study (2022) · cites this paper as [4]

    The Key messages and Discussion > Implications report excess mortality among people previously hospitalised for mental disorders, particularly those with eating disorders; Discussion > Comorbidity and early death includes substance misuse among factors recorded in more complex diagnoses associated with premature death. The paper does not establish that self-harm, suicidal ideation, or these behaviors as manifestations of emotion dysregulation are associated with increased morbidity and mortality; it measures deaths, including deaths by suicide, rather than suicidal ideation. (LLM, conf=0.88)

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Authors
Ajetunmobi, O., Taylor, M., Stockton, D., & Wood, R.
Affiliations
  • National Health Service Scotland (GB)
  • NHS Lothian (GB)
Corresponding author
Taylor, Mark
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2013-07
Volume
3
Issue
7
Pages
e002768
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2013-002768
PMC
PMC3731727
OpenAlex
W2116375232
Cited by
56
References
23
Citations by year
2026: 1 · 2025: 5 · 2024: 2 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 3 · 2019: 6 · 2018: 2 · 2017: 3 · 2016: 6 · 2015: 6 · 2014: 4 · 2013: 1
FWCI
8.51
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
NHS Health Scotland
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Keywords
excess mortality, mental illness, psychiatric hospitalization, suicide, cardiovascular disease, eating disorders, personality disorders, years of life lost, life expectancy, cause-specific mortality, health disparities, Scotland

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