Causes of Death During Psychiatric Hospitalization: An 11-Year Matched Case–Case Study in Northeast Brazil

Abstract

Objective

To compare the distribution of specific causes of death occurring during psychiatric and non-psychiatric hospitalizations in the state of Ceará, Brazil, over an 11-year period.

Method

A retrospective matched case-case study was conducted using data from the Brazilian Mortality Information System from 2012 to 2022. A total of 115 deaths occurring in psychiatric hospitals were identified. For each psychiatric hospital death, 5 comparison deaths from non-psychiatric hospitals were randomly selected and matched by year of death, sex, and exact age.

Results

Cardiovascular diseases were the most frequent cause of death in psychiatric hospitals (39.1%) and were more frequent than in non-psychiatric hospitals (18.3%) (OR = 2.87, 95% CI = 1.87-4.42). Deaths attributed to mental and behavioral disorders (OR = 7.72, 95% CI = 2.87-20.75), ill-defined natural causes (OR = 3.12, 95% CI = 1.39-7.01), and events of undetermined intent (OR = 28.60, 95% CI = 8.13-100.59) were also comparatively more frequent in psychiatric settings, whereas neoplasms were markedly less frequent (OR = 0.03, 95% CI = 0.00-0.26).

Conclusions

Cardiovascular diseases were the most common specific cause of death during psychiatric hospitalization. The comparatively higher frequency of diagnostically broad categories suggests challenges in clinical monitoring, diagnostic capacity, cause-of-death certification, as well as potential stigma-related influences on the classification of deaths of undetermined intent, including possible suicides, in psychiatric inpatient settings. These findings underscore the need for closer integration between psychiatric and general medical care.