Suicide and violent death among patients with schizophrenia

From the Stockholm County in-patient register we selected all patients with schizophrenia, discharged from all hospitals in the county during 1971, in voluntary and compulsory care. The cohort of 1,190 patients was followed for 10 years in the national cause-of-death register. 231 deaths were identified and 68 came under the ICD chapter XVII, "Injuries...". These 68 deaths were analysed through medical records and death certificates in order to find out detailed causes of death, evidence of misclassification, and information on suicides during psychiatric care. Of the 68 deaths 33 were classified as suicides, 14 undetermined, 20 accidents and one homicide. Suicides predominated among the younger patients and accidents among the elderly. By scrutinizing medical records we identified seven deaths we judged to be suicides but which had been classified as accidents or undetermined. 36% of all deaths and 44% of those classified as suicides occurred during psychiatric care. The record-linkage method proved valuable for identifying deaths among psychiatric patients and for obtaining data on hospital care, thus giving access to medical records, and should be useful in further research.