Selam Aberra, Ataly Alem, Abebaw Fekadu


Introduction: Mortality among people with mental illness is higher than the general population. Given the changes in the health service delivery in the past decade in Ethiopia, evaluating the pattern of mortality during this period may provide policy relevant information.  The aim of this study was to assess the mortality pattern in a tertiary psychiatric hospital in Ethiopia.

Method: A case-control design was employed. Using the Health Management Information System  records and clinical records kept at the tertiary hospital; data on inpatient mortality was collected respectively for a period of nine years (2006-2014). Changes in the service configuration were also tracked over the nine years period to explore the potential impact of changes in management upon mortality. Data was analyzed through simple descriptive methods and logistic regression.

Result: A total of 16,081 patients were admitted during the nine year period. The overall mortality rate of inpatients was 2.5/1000 admitted patients. The sex specific all-cause mortality rates were high in females (4.6/1000) than in males (1.8/1000). The mortality rate varied over the nine years between 0.5/1000 to 5.0/1000, with indications of fluctuations commensurate with changes in service organizational changes although these changes were not statistically significant. Although suicide  accounted for the death of 12.5% (n=5), most died of natural causes and also primarily of infectious diseases .

Conclusion:Mortality occurs mainly from preventable causes including suicide. Service reconfigurations may play important role in mitigating mortality. However, further systematic studies are required to determine the impact of service configurations on mortality and general morbidity.

Keywords: Mortality, Pattern of Mortality, Mental Illness, Serious Mental Illness, Inpatient Service, Ethiopia


Full Text:



Khamker N, Moola NM, Roos JL, et al. Profile of mortality of patients admitted to Weskoppies Psychiatric hospital in South Africa over a 5-year period (2001-2005). Afr J Psychiatry 2010; 13:211-217

Harris EC, Barraclough B. Excess mortality of mental disorders. Br J Psychiatry 1998; 173:11-53

Kisely S, Smith M, Lawrence D, et al. Mortality in individuals who have had psychiatric treatment; population based study in Nova Scotia. BMJ 2005; 187:552-58

Fekadu A, Medhin G, Kebede D, et al. Excess Mortality in Severe Mental Disorders: A 10-year population based cohort study in rural Ethiopia. Br J Psychiatry 2015; 206:289-96

Abiodun O.A. Mortality in a psychiatric population: a Nigerian psychiatric hospital experience. Acta Psychiatr. Scand. 1988; 77:654-57

Markkula N, HarkanenT, Perala J, et al. Mortality in people with depressive, anxiety and alcohol use disorders in Finland. BJP 2012; 200:143-9

Sims A. Mortality statistics In Psychiatry. Br J Psychiatry 2001; 179:477-78

MIND. Mental health crisis care: A report on physical restraint in hospital settings in England. June 2013. Available at: www.physical_restraint_final_web_version.pdf. Accessed on 26 May 2018.

Abdelmawla N, Mitchell AJ. Sudden cardiac death and antipsychotics. Adv Psychiatr Treat 2005; 12(1):35-44

Appleby L , Thomas S , Ferrier N, et al. Sudden unexplained death in psychiatric in-patients. BJP 2000; 176:405-06

Reilly JG, Ayis SA, Ferrier JN, et al. Thioridazine and sudden unexplained death in psychiatric in-patients. Brit J Psychiatry 2002; 180:515-22

Fekadu A, Desta M, Alem A, Prince M. A descriptive analysis of admissions to Amanuel psychiatric hospital in Ethiopia. Ethiop J Health Dev 2007;21:173-78

Combs H, Romm S. Psychiatric inpatient suicide: A literature review. Prim Psychiatry 2007; 14(12):67-74

Teferra S, Shibre T, Fekadu A, et al. Five-year mortality in a cohort of people with schizophrenia in Ethiopia. BMC Psychiatry 2011; 11:165

Wahlbeck K, Westman J, Nordantoft M et al. Outcomes of Nordic mental health Systems: Life expectancy of patients with mental disoders. Brit J Psychiatry 2011; 99:453-58

Healy D, Noury J, Harris M, et al. Mortality in schizophrenia and related psychoses: Data from two cohorts, 1875-1924 and 1994-2010. BMJ 2012; 2:e001810

Brown S, Kim M, Mitchell C, et al. Twenty-five year mortality of a community cohort with schizophrenia. Brit J Psychiatry 2010; 196:116-21

Powell J, Geddes J, Hawton. A Suicide in Psychiatric hospital in-Patients. Brit J Psychiatry 2000; 176:266-272

Velentino M, Necozione S, Busellu G, et al. Mortality in psychiatric patients: A Cohort analysis of prognostic factors. Int J Epidemiol 1997; 26:1227-235

Frost M. The Medical Care of Psychiatric Inpatients. The Internet Journal of Healthcare Administration 2006; 4: 2

Boroffka A, Olatawura M. Community psychiatry in Nigeria: The current status. Int J Soc Psychiatry 1977; 23:275-81

Black DW, Warrack G, Winokur G. Excess mortality among psychiatric patients the Iowa record linkage study. JAMA 1985; 4:253:58-61

Hewer W, Rossler W, Fatkenhauer B, et al. Mortality among patients in psychiatric hospitals in Germany. Acta Psychiatr Scand 1995; 91:174-179

Kurihara T, Kato M, Takibayashi T, et al. Excess mortality of schizophrenia in developing country of Bali. Schizophrenia Research 2006;83:103-105

Saha S, Chant D, McGranth J, et al. A systematic review of mortality in schizophrenia. Arch Gen Psychiatry 2007;64:1123-31


  • There are currently no refbacks.

Comments on this article

View all comments

Kirkos Sub-City, Woreda 05
Roosevelt street, Infront of Africa Union main gate
Tel: +251 115 533742 Fax: +251 115 151005
P.O.Box 2179 Email:
Copyright © Ethiopian Medical Association 2018 All rights Reserved

Powered by OJS & Designed and Hosted by MAKE Enterprise