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Rev. Bras. Psiquiatr. vol.34 no.2 São Paulo June 2012
LETTER TO THE EDITORS
Morbidity and mortality due to mental disorders in Brazil
Rafael Bernardon Ribeiro, MDI; Débora Luciana Melzer-RibeiroII; Quirino Cordeiro MD, PhDIII
IAttending Physician at ECT Service at Centro de Atenção Integral em Saúde Mental, Santa Casa Medical School, São Paulo, Brazil
IIMSc student, Attending Physician at the Institute of Psychiatry, Hospital das Clínicas, Medical School of Universidade de São Paulo (USP), Brazil
IIIChairman of the Department of Psychiatry, Santa Casa Medical School, São Paulo, Brazil
During a recent research, while checking the official epidemiological database, hosted by the Brazilian Health Ministry (DATASUS: www.datasus.gov.br), some interesting information emerged. In determining morbidity and mortality directly related to Mental Disorders (based on World Health Organization - International Classification of Diseases [ICD 10]; "Chapter V - mental and behavioral disorders"), the following data was retrieved (Table 1).
From a national perspective, in 2006, 2007, 2008 and 2009 (latest available data) Brazil had respectively 10,256, 10,948, 11,560 and 11,861 deaths reported with mental disorders as the main cause. This represents, respectively, 5.49, 5.78, 6.09 and 6.19 deaths per 100,000 inhabitants. These numbers exclude part of the suicides, coded under another ICD-10 chapter (Table 1). The number of psychiatric hospital admissions in Brazil for those years were, respectively, 317,441, 290,079, 304,522 and 275,286, with an average length of stay between 45 and 50 days. The hospital mortality related to mental disorders was, respectively, 3.95, 4.22, 3.79 and 3.89 deaths per 1,000 admissions. Worldwide, about 1% of deaths can be attributed to psychiatric causes (approximately 873,000 deaths by suicide alone).1
As a reference, from 2003-2005, mortalities in Taiwan and United States were respectively 3.6 and 21.9/100,000 (mental disorders as underlying-cause-of death); using multiple-cause-of-death, which included a psychiatric diagnosis, the respective numbers were 10.3 and 115.4/100,000.2 In 2007, other countries had the following mortalities due to mental disorders (per 100,000): Chile: 17.3, Finland: 23.9, France: 14, Greece: 0.7, Italy: 6.5, Japan: 1.8, Mexico: 5.1, Netherlands: 22.2, New Zealand: 12.3, Norway: 17.1, Portugal: 1.2, Spain: 2.6, United Kingdom: 16.2 (from: Organisation for Economic Co-operation and Development - www.oecd.org). The rates vary significantly from one country to another, reflecting internal particularities in healthcare, culture, coding and reporting artifacts and sub-notification. Caution is advised when interpreting these numbers. Intrinsically, psychiatric patients have a higher risk of death by any cause (RR 1.56 for men and 1.38 for women) when compared to the general population.3 In Brazilian official records, we find about 11,000 deaths each year attributed to psychiatric causes; 10% of those, in hospital wards. The authors speculate about how many could be prevented with proper and immediate treatment.
This topic of importance and concern has not been explored by research. The national and international databases (Lilacs, Scielo and Pubmed) retrieved only one paper, by Câmara,4 discussing mental disorders in Brazil as cause of death, excluding the relationship of mental disorders and mortality for other causes.4,5 In this paper, the author reports an increase of 62.3% psychiatric mortality from 1996 to 2005, while the number of inpatient treatments decreased. Interestingly, the mortality risk for public sector patients was 4.6 times higher than in the private sector.1 Despite the difficulty in directly associating national policies for mental health, the unavailability of sufficient hospital beds, outpatient clinics and ECT in the public sector with these data, future research in this area might clarify the matter. Evidently, most of these deaths were avoidable, especially those inside hospitals.4 We expect to bring this important matter to the attention of both researchers and public agents advocating for concrete actions - science and evidence-based - in order to decrease these numbers within the shortest possible timeframe.
1. Stewart DE, Ashraf IJ, Munce SE. Women's mental health: a silent cause of mortality and morbidity. Int J Gynaecol Obstet. 2006;94(3):343-9. [ Links ]
2. Lu T-H, Lin J-J. Using multiple-cause-of-death data as a complement of underlying-cause-of-death data in examining mortality differences in psychiatric disorders between countries. Soc Psychiatry Psychiatr Epidemiol. 2010;45(8):837-42. [ Links ]
3. Sims AC. Mortality statistics in psychiatry. Br J Psychiatry. [Comment Editorial]. 2001;179:477-8. [ Links ]
4. Câmara FP. Mortalidade por transtornos mentais e comportamentais e a reforma psiquiátrica no Brasil contemporâneo - II: elementos para um debate. Rev Latinoam Psicopatol Fundam. 2008;11:470-4. [ Links ]
5 Menezes PR, Mann AH. Mortality among patients with non-affective functional psychoses in a metropolitan area of South-Eastern Brazil. Rev Saúde Pública. 1996;30:304-9.