Time trends in schizophrenia mortality in Sweden
To the Editor - The study by Osby., et al on the Time trends of
Schizophrenia mortality in Stockholm County: a cohort study, BMJ, 321, 483
-4, was very interesting. The
results show significant increases in mortality from all causes. Changes
in the philosophy of psychiatric care with out-patient care replacing in-
patient care were suggested as being at least partly contributory to this
A careful perusal of the data presented reveals a few further aspects to
1. The increase in mortality is mostly accounted for cardiovascular,
natural and other violence related causes of deaths.
2. Women had lesser increase in cardiovascular mortality than men, perhaps
hormonal or societal factors have a preferential protective influence upon
the female gender.
3. It is known that comorbid substance use is common among patients with
schizophrenia (especially males). This could also have a potential impact
upon the associated mortality among these patients and could contribute to
differential increase in mortality among males as compared to females.
4. The suicide related mortality has increased more for women than for
This finding is little difficult to explain and may need to be studied in
The study correlates the increase in mortality with community care of
schizophrenia patients as compared to institutional care and thus
questions the efficacy of the former in caring for the mentally ill.
Overall, the study has important heuristic implications for monitoring
efficacy of mental health services for patients with schizophrenia.
Registrar in Psychiatry
Queens Park Hospital,
BLACKBURN BB2 3HH
1. Osby U, Corriera N, Brandt L, Ekbom A and Sparen P. Time trends od
Schizophrenia in Stockholm county, Sweden: cohort study. BMJ, 321, 19-26
Competing interests: No competing interests