Mentally ill patients are six times more likely to die by homicide than the general population, conclude authors of a study in this week’s issue of THE LANCET. The study also highlights how people with mental illness have higher death rates from suicide and accidental causes.
People with mental illness are at great risk of suicide, but little is known about their risk of death from other unnatural causes. No previous study has commented on their risk of being victims of homicide; public concern is pre-occupied with their role as perpetrators. Louis Appleby (National Director for Mental Health in England) and colleagues from the University of Manchester, UK, and Aarhus, Denmark, aimed to calculate standardised mortality ratios (SMRs) and directly standardised rate ratios for death by homicide, suicide, and accident in people admitted to hospital because of mental illness.
The investigators linked the data for around 72,200 individuals listed in the Danish Psychiatric Case Register between 1973 and 1993 (who died before Dec 31, 1993) with data in the Danish National Register of Causes of Death.
A quarter of deaths among mentally ill patients were from unnatural causes: 1% from homicide, 73% from suicide, and 26% from accidental death. Overall, mentally ill patients were six times more likely to die by homicide than people without mental illness. The mortality rates for suicide and accidental death were also higher for mentally ill patients compared with the general population. Within the population of mentally ill patients there was an increased risk of dying by homicide among men with schizophrenia and in individuals with affective psychosis; the highest risks of death by homicide and accident were among patients with alcoholism and patients who were drug users, whereas the highest risks of suicide were associated with drug users.
Louis Appleby comments: “People with mental disorders, including severe mental illness, are at increased risk of death by homicide. Strategies to reduce mortality in the mentally ill are correct to emphasise the high risk of suicide, but they should also focus on other unnatural causes of death.”
Contact: Professor Louis Appleby, School of Psychiatry and Behavioural Sciences, University of Manchester, Withington Hospital, MANCHESTER M20 8LR, UK; T) +44 (0)161 291 4362; F) +44 (0)161 445 9263; E) Louis.Appleby@man.ac.uk
Journal
The Lancet