Citation

Termorshuizen F, van Bergen AP, Smit RB, Smeets HM, van Ameijden EJ. Int. J. Soc. Psychiatry 2013; 60(5): 426-435.

Affiliation

University Medical Center Utrecht, Utrecht, Netherlands.

Copyright

(Copyright © 2013, SAGE Publishing)

DOI

10.1177/0020764013491942

PMID

23812410

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.

Language: en