The mortality of patients with severe mental disorders and the impact of community management: a community-based prospective study in Sichuan, China

Abstract Background The mortality of people with mental illness is consistently higher than that of the general population according to current literature in developed countries. However, evidence in China is scarce. Patients with severe mental disorders (SMD) have been managed in the community since 2009 in China, but there has been no study of mortality, or the impact of community management on mortality, in this patient population. This study aims to provide preliminary empirical evidence. Methods This study identified 134 182 patients with SMD who were aged 15 years and over and managed in the community between January 2009 and January 2014. The patients were from 21 municipalities in Sichuan province, China. The follow-up duration (provided as part of the community management), risk behaviour (scored from low to high [1–6]), and stability of disease (scored from stable to unstable [1–3]) were treated as proxy measures of the extent and success of management in the community (improved disease stability and lower risk behaviour were targets of the community management team). The standardized mortality ratio (SMR) was compared with that of the general population, and the association between the above three factors and risk of death was estimated using multilevel Cox proportional hazards models. Findings The percentage of patients with SMD followed up for 0, 0–1, 1–2, and greater than 2 years was 10·2%, 24·0%, 35·1%, and 30·7%, with death rates of 3·1%, 3·6%, 2·2%, and 0·8%, respectively. Over the study period, the median scores for disease stability and risk behaviour decreased from 1·76 to 1·0, and from 1·45 to 1·0, respectively. The standardized mortality rate of patients with SMD was 1.3 and 1.4 times higher than that of general population in 2012 and 2013, respectively. The SMR for patients aged 15 to 64 was 2, and for those aged 65 and over it was 0·85. With adjustment, the result showed that longer follow-up time was associated with lower risk of death (hazard ratio 0·533 for 1–2 years, 0·149 for >2 years [vs 0–1 year], p 2 years) was associated with higher disease stability (hazard ratio of 0·766, p 0·687). Interpretation Evidence from Sichuan province demonstrates higher mortality in patients with SMD than in the general population, and suggests that aspects of current community management affect mortality in patients with SMD.