Mortality among discharged psychiatric patients in Florence, Italy.

OBJECTIVE: Psychiatric disorders involve an increased risk of mortality. In Italy psychiatric services are community based, and hospitalization is mostly reserved for patients with acute illness. This study examined mortality risk in a cohort of psychiatric inpatients for 16 years after hospital discharge to assess the association of excess mortality from natural or unnatural causes with clinical and sociodemographic variables and time from first admission. METHODS: At the end of 2002 mortality and cause of death were determined for all patients (N=845) who were admitted during 1987 to the eight psychiatric units active in Florence. The mortality risk of psychiatric patients was compared with that of the general population of the region of Tuscany by calculating standardized mortality ratios (SMRs). Poisson multivariate analyses of the observed-to-expected ratio for natural and unnatural deaths were conducted. RESULTS: The SMR for the sample of psychiatric patients was threefold higher than that for the general population (SMR=3.0; 95 percent confidence interval [CI]=2.7-3.4). Individuals younger than 45 years were at higher risk (SMR=11.0; 95 percent CI 8.0-14.9). The SMR for deaths from natural causes was 2.6 (95 percent CI=2.3-2.9), and for deaths from unnatural causes it was 13.0 (95 percent CI=10.1-13.6). For deaths from unnatural causes, the mortality excess was primarily limited to the first years after the first admission. For deaths from natural causes, excess mortality was more stable during the follow-up period. CONCLUSIONS: Prevention of deaths from unnatural causes among psychiatric patients may require promotion of earlier follow-up after discharge. Improving prevention and treatment of somatic diseases of psychiatric patients is important to reduce excess mortality from natural causes.

[Common mental disorders in primary care: prevalence and determinants of a general health questionnaire as a screening tool]. / Indagine sul disagio psichico in medicina generale: prevalenza e determinanti della positività al test GHQ-12.

OBJECTIVES: This study intends to evaluate the prevalence of common mental disorders in a population residing in Florence cared for by general practitioners and to assess the determinants of classification and recognition of common mental disorders of the General Health Questionnaire with 12 items as screening tool. (GHQ-12). PARTICIPANTS: The study includes a total of 676 patients received in the periods from June to September 1999 and from January to February 2000 in out-patient treatment by 13 general practitioners during a 2 week sampling in the consulting room of each doctor. METHODS: Every patient filled in a tool set composed of socio-demographic form, GHQ-12, Social Readjustment Rating Scale (SRRS). To evaluate the diagnostic reliability of GHQ-12, a subgroup of 158 patients underwent The Mini International Neuropsychiatric Interview (MINI). RESULTS: Among the 676 patients contacted the estimated prevalence (Probable Prevalence) of common mental disorders was of 43.6%. The factors connected to the GHQ-12 high-scorers are gender, number of consultations and life events evaluated through the SRRS. The school level results as protective factor. CONCLUSIONS: This study pointed out the importance of psycho-social factors in determining common mental disorders in the general practice, moreover the prevalence of such disorders is high.