Abstract：
This study aims to examine 20-year temporal trends in all-cause mortality among psychiatric patients and investigating impacts of risk factors on the time trends based on 218,703 Finnish adults with mental disorders who were discharged from 87 psychiatric hospitals between 1 Jan 1995 and 31 Dec 2014. The age-period-cohort analysis of Poisson model with random hospital effects estimated temporal trends in death rate and associated factors at individual, healthcare system, and society levels, following the WHO multilevel intervention framework model for six major psychiatric diagnosis. The adjusted annual mortality declined by 2.2 % annually (RR: 0.978 [95 % CI 0.976-0.980]) for all individuals, and by 2.8 % after adjusting for all risk factors, with varied decreasing rate between 2.0 % and 3.6 % by diagnosis. Individual level factors accounted for the declining rate by 54.5 % for all patients, with the highest impact on patients with personality disorders, followed by patients with affective disorders and patients with schizophrenia. Identified declining trends and associated factors which are preventable and modifiable for individuals with specific psychiatric diagnosis may lead to develop targeted service and intervention strategies in bringing down mortality further for the population.
摘要：
本研究旨在研究精神病患者20年全因死亡率的时间趋势，并基于1995年1月1日至2014年12月31日期间从87家精神病医院出院的218,703名芬兰精神障碍成年人，调查危险因素对时间趋势的影响。具有随机医院效应的Poisson模型的年龄周期队列分析估计了个体死亡率和相关因素的时间趋势，医疗保健系统,和社会层面，遵循WHO六个主要精神病诊断的多层次干预框架模型。调整后的年死亡率每年下降2.2%(RR:0.978[95%CI0.976-0.980])，调整所有风险因素后，增幅为2.8%，根据诊断，下降率在2.0%至3.6%之间。个体水平因素占所有患者下降率的54.5%，对人格障碍患者的影响最大，其次是情感障碍患者和精神分裂症患者。已确定的下降趋势和相关因素对于具有特定精神病诊断的个人是可预防和可改变的，可能会导致制定有针对性的服务和干预策略，以进一步降低人群的死亡率。
