Mortality risk and psychiatric disorders

Results of a general physician survey
  • Jane M. Murphy
  • Richard R. Monson
  • Donald C. Olivier
  • Arthur M. Sobol
  • Lisa A. Pratt
  • Alexander H. Leighton


As part of the Stirling County Study (Canada), general physicians were interviewed to identify the psychiatric disorders experienced by a sample of adults selected in 1952. Based on information about vital status gathered 16 years later, we found that those with a psychiatric disorder at the beginning of the study experienced 1.6 times the expected number of deaths. The effect in regard to premature mortality and accidental deaths was particularly strong. Four of six categories of psychiatric diagnoses were significantly associated with mortality. In terms of standardized mortality ratios, depression had the highest and anxiety the lowest risk in this general population. The findings are discussed as providing historical background from the 1950s and 1960s for studying trends.


Public Health General Population Lower Risk Psychiatric Disorder Mortality Risk 
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  1. American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders, 3rd edn. American Psychiatric Association, Washington, DCGoogle Scholar
  2. Babigian HM, Odoroff CL (1969) The mortality experience of a population with psychiatric illness. Am J Psychiatry 126: 470–480PubMedGoogle Scholar
  3. Bebbington P, Hurry J, Tennant C, Sturt E, Wing JK (1981) Epidemiology of mental disorders in Camberwell. Psychol Med 11: 561–579PubMedGoogle Scholar
  4. Beiser M (1971) A study of personality assets in a rural community. Arch Gen Psychiatry 24: 244–254PubMedGoogle Scholar
  5. Benfari RC, Leighton AH, Beiser M, Coen K (1972) CASE: computer assigned symptom evaluation: an instrument for psychiatric epidemiological application. J Nerv Merit Dis 154: 115–124Google Scholar
  6. Black DW, Warrack G, Winokur G (1985) The Iowa record-linkage study, III. Excess mortality among patients with ‘functional’ disorders. Arch Gen Psychiatry 42: 82–88PubMedGoogle Scholar
  7. Carter G, Jancar J (1983) Mortality in the mentally handicapped: a 50 year survey at the Stoke Park group of hospitals (1930–1980). J Merit Defic Res 27: 143–156Google Scholar
  8. Erhardt CL, Berlin JE (1974) Mortality and morbidity in the United States. Harvard University Press, Cambridge, MAGoogle Scholar
  9. Goldberg DP, Huxley P (1980) Mental illness in the community: the pathway to psychiatric care. Tavistock Press, LondonGoogle Scholar
  10. Hollinger PC (1987) Violent deaths in the United States: an epidemiologic study of suicide, homocide, and accidents. Guilford Press, New YorkGoogle Scholar
  11. Innes G, Millar WM (1970) Mortality arriong psychiatric patients. Scott Med J 15: 143–148PubMedGoogle Scholar
  12. Kessel WIN (1960) Psychiatric morbidity in a London general practice. Br J Prev Soc Med 14: 16–20PubMedGoogle Scholar
  13. Laird N, Olivier DC (1981) Covariance analysis of censored survival data using log-linear analysis techniques. J Am Stat Assoc 76: 231–240Google Scholar
  14. Leighton AH (1959) My name is Legion: the Stirling County study of psychiatric disorder and social environment, vol 1. Basic Books, New YorkGoogle Scholar
  15. Leighton DC, Harding JS, Macklin DB, Macmillan AM, Leighton AH (1963a) The character of danger: the Stirling County Study, vol 3. Basic Books, New YorkGoogle Scholar
  16. Leighton DC, Harding JS, Macklin DB, Hughes CC, Leighton AH (1963b) Psychiatric findings of the Stirling County Study. Am J Psychiatry 119: 1021–1026PubMedGoogle Scholar
  17. Martin RL, Cloninger CR, Guze SB, Clayton PJ (1985) Mortality in a follow-up of 500 psychiatric outpatients. I. Total mortality. Arch Gen Psychiatry 42: 47–54PubMedGoogle Scholar
  18. Merikangas KR, Leckman JF, Prusoff BA, Pauls DL, Weissman MM (1985) Familial transmission of depression and alcoholism. Arch Gen Psychiatry 42: 367–372PubMedGoogle Scholar
  19. Monson RR (1974) Analysis of relative survival and proportional mortality. Comput Biomed Res 7: 325–332PubMedGoogle Scholar
  20. Murphy JM (1980) Continuities in community-based psychiatric epidemiology. Arch Gen Psychiatry 37: 1215–1223PubMedGoogle Scholar
  21. Murphy JM, Sobol AM, Neff RK, Olivier DC, Leighton AH (1984) Stability of prevalence: depression and anxiety disorders. Arch Gen Psychiatry 41: 990–997PubMedGoogle Scholar
  22. Murphy JM, Neff RK, Sobol AM, Rice JX, Olivier DC (1985) Computer diagnosis of depression and anxiety: the Stirling County Study. Psychol Med 15: 99–112PubMedGoogle Scholar
  23. Murphy JM, Olivier DC, Sobol AM, Monson RR, Leighton AH (1986) Diagnosis and outcome: depression and anxiety in a general population. Psychol Med 16: 117–126PubMedGoogle Scholar
  24. Murphy JM, Monson RR, Olivier DC, Sobol AM, Leighton AH (1987a) Affective disorders and mortality: a general population study. Arch Gen Psychiatry 44: 473–480PubMedGoogle Scholar
  25. Murphy JM, Berwick DM, Weinstein MC, Borus JF, Budman SH, Klerman GL (1987b) Performance of screening and diagnostic tests: receiver operating characteristic analysis. Arch Gen Psychiatry 44: 550–555PubMedGoogle Scholar
  26. Murphy JM, Olivier DC, Monson RR, Sobol AM, Leighton AH (1988a) Incidence of depression and anxiety: the Stirling County Study. Am J Public Health 78: 534–540PubMedGoogle Scholar
  27. Myers JK, Weissman MM, Tischler GL, Holzer CE, Leaf PJ, Orvaschel H, Anthony JC, Boyd JH, Burke JD, Kramer M, Stoltzman R (1984) Six month prevalence of psychiatric disorders in three communities. Arch Gen Psychiatry 41: 959–967PubMedGoogle Scholar
  28. Ødegård Ø (1952) The excess mortality of the insane. Acta Psychiatr Scand 27: 353–367Google Scholar
  29. Öjesjö L (1981) Long-term outcome in alcohol abuse and alcoholism among males in the Lundby general population, Sweden. Br J Addict 76: 391–400PubMedGoogle Scholar
  30. Regier DA, Goldberg ID, Taube CA (1978) The de facto US mental health service system: a public health perspective. Arch Gen Psychiatry 35: 685–693PubMedGoogle Scholar
  31. Robins LN, Helzer JE, Weissman MM, Orvaschel H, Gruenberg E, Burke JD, Regier DA (1984) Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry 41: 949–958PubMedGoogle Scholar
  32. Schuckit MA (1986) Genetic and clinical implications of alcoholism and affective disorder. Am J Psychiatry 143: 140–147PubMedGoogle Scholar
  33. Schwartz DM, Thompson MG (1981) Do anorectics get well? Current research and future needs. Am J Psychiatry 138: 319–323PubMedGoogle Scholar
  34. Shapiro S, Skinner EA, Kessler LG, Korff von M, German PS, Tischler GL, Leaf PJ, Benham L, Cottier L, Regier DA (1984) Utilization of health and mental health services: three epidemiologic catchment area sites. Arch Gen Psychiatry 41: 971–978PubMedGoogle Scholar
  35. Shepherd M (1987) Mental illness and primary care. Am J Public Health 77: 12–13PubMedGoogle Scholar
  36. Shepherd M, Cooper B, Brown AC, Kalton GW (1966) Psychiatric illness in general practice. Oxford University Press, LondonGoogle Scholar
  37. Tsuang MT, Simpson JC (1985) Mortality studies in psychiatry: should they stop or proceed? Arch Gen Psychiatry 42: 98–103PubMedGoogle Scholar
  38. Tsuang MT, Woolson RF (1977) Mortality in patients with schizophrenia, mania, depression and surgical conditions. Br J Psychiatry 130: 162–166PubMedGoogle Scholar
  39. United Nations Demographic Yearbook (1961, Table 17; 1982, Table 20) Deaths and death rates by cause. United Nations Department of International, Economic, and Social Affairs Statistical Office, New YorkGoogle Scholar
  40. Weissman MM (1987) Advances in psychiatric epidemiology: rates and risks for major depression. Am J Public Health 77: 445–451PubMedGoogle Scholar
  41. Williams P, Tarnopolsky A, Hand D, Shepherd M (1986) Minor psychiatric morbidity and general practice consultations: the West London Survey. Psychol Med 9 [Suppl 9]: 1–37Google Scholar
  42. Winokur G (1979) Alcoholism and depression in the same family. In: Goodwin DW, Erickson CK (eds) Alcoholism and affective disorders: clinical, genetic, and biochemical studies. SP Medical and Scientific Books, New York, pp 49–56Google Scholar
  43. Woodruff RA, Guze SB, Clayton PJ, Carr D (1973) Alcoholism and depression. Arch Gen Psychiatry 28: 97–100PubMedGoogle Scholar
  44. World Health Organization (1957) International classification of diseases. World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • Jane M. Murphy
    • 1
    • 2
  • Richard R. Monson
    • 3
  • Donald C. Olivier
    • 4
  • Arthur M. Sobol
    • 5
  • Lisa A. Pratt
    • 5
  • Alexander H. Leighton
    • 6
  1. 1.Psychiatric Epidemiology Unit Department of Psychiatry 703 Warren BuildingMassachusetts General HospitalBostonUSA
  2. 2.Department of PsychiatryHarvard Medical SchoolUSA
  3. 3.Department of EpidemiologyHarvard School of Public HealthUSA
  4. 4.Office for Information TechnologyHarvard UniversityUSA
  5. 5.Department of PsychiatryMassachusetts General HospitalUSA
  6. 6.Department of Psychiatry and Department of Community Health and EpidemiologyDalhousie University Medical SchoolCanada

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