Authors:
Kisely S, Preston N, Xiao J, Lawrence D, Louise S, Crowe E
Authors notes:
Canadian Medical Association Journal. 2013;185(1):E50-E56
Keywords:
Psychiatric disorders, physical disorders, community treatment, health services
Abstract:
Among patients with psychiatric disorders, there are 10 times as many preventable deaths from physical disorders as there are from suicide.
We investigated whether compulsory community treatment, such as community treatment orders, could reduce all-cause mortality among patients with psychiatric disorders.
The study population included 2958 patients with community treatment orders (cases) and 2958 matched controls (i.e., patients with psychiatric disorders who had not received a community treatment order).
The average age for cases and controls was 36.7 years, and 63.7% (3771) of participants were men.
Schizophrenia and other nonaffective psychoses were the most common diagnoses (73.4%) among participants.
A total of 492 patients (8.3%) died during the study.
Cox regression showed that, compared with controls, patients with community treatment orders had significantly lower all-cause mortality at 1, 2 and 3 years, with an adjusted hazard ratio of 0.62 (95% confidence interval 0.45-0.86) at 2 years.
The greatest effect was on death from physical illnesses such as cancer, cardiovascular disease or diseases of the central nervous system.
This association disappeared when we adjusted for increased outpatient and community contacts with psychiatric services.
Community treatment orders might reduce mortality among patients with psychiatric disorders.
This may be partly explained by increased contact with health services in the community.
However, the effects of uncontrolled confounders cannot be excluded.