Mortality among forensic psychiatric patients in Finland ILKKA OJANSUU, HANNA PUTKONEN, JARI TIIHONEN Ojansuu I, Putkonen H, Tiihonen J. Mortality among forensic psychiatric patients in Finland. Nord J Psychiatry 2015;69:25–27. Background: Both mental illness and criminality are associated with higher risk of early death, yet the mortality among forensic psychiatric patients who are affected by both mental illness and criminal behaviour has scarcely been studied. Aims: To analyse the mortality among all patients who were committed to a compulsory forensic psychiatric hospital treatment in Finland between 1980 and 2009. Mortality was analysed according to the age when the patient was committed to forensic treatment. Results: A total of 1253 patients were included, of which 153 were females and 1100 were males. The mean follow-up time in this study was 15.1 years, and 351 (28%) had died during the follow-up period. The standardized mortality rate (SMR) for the whole study group was 2.97 (95% CI 2.67–3.29). Among females the SMR was 3.62 (95% CI 2.57–5.09), and among males 2.91 (95% CI 2.61–3.25). The SMRs were higher when patients were committed to forensic treatment before the age of 40 years. Conclusion: This study showed an increased mortality among forensic psychiatric patients compared with the general population and the mortality was inversely proportional to the age when the treatment had begun. In contrast to the earlier studies, the mortality in this study was lower indicating that prolonged treatment may have an overall protective effect on forensic psychiatric patients. • Compulsory treatment, Forensic psychiatry, Mortality. Ilkka Ojansuu, M.D., Niuvankuja 65, 70240 Kuopio, Finland, E-mail: ilkka.ojansuu@niuva.fi; Accepted 24 March 2014. M ortality among psychiatric patients is known to be higher than the general population (1), and patients who are admitted to hospital for a mental disorder in Denmark, Finland and Sweden have a two- to threefold higher mortality than the general population (2). Finnish patients with schizophrenia between the ages of 20 and 40 had 17.0–22.5 years less life expectancy when com- pared with the general population (3). Discharged adult prisoners have a 5–10 times higher mortality when com- pared with an age-matched population in Finland, and in 2002, the mean age of death was 45 years for those with a prior criminal act (4). Only a few scientific articles have been published on the mortality of the forensic patients who are affected by both mental illness and criminal behaviour, both of which appear to be associated with a higher risk of early death. In Sweden, 400 subjects aged 15–29 years were found to be mentally abnormal in a forensic psychiatric examination conducted between 1951 and 1954, and subsequently followed for approximately 20 years (5). Forty-three of those subjects had died during the study period, which was three times the expected mortality in the average population. One hundred subjects in that study had been designated “insane” and 11 of them had died during the study period, which was four times the expected mortality when compared with the average population. In another Swedish study, 46 subjects who had been in forensic treatment because of serious mental disorder were followed after their discharge during a study period of 1992–1999 (6). The median follow-up time was 53 months (range 0–93 months) and five subjects died during the follow-up, which gave a standardized mortality rate (SMR) of 13.4 (95% CI 4.35–31.3). Subjects from that study were also involved in another study of 88 forensic patients that were discharged in Sweden dur- ing 1992–2007 (7). These subjects were followed until the end of 2008, and 20 died during the follow-up time, which gave a SMR of 10.4 (95% CI 6.4–16.1). The SMR for males was 9.2 (95% CI 5.3–14.8; 17 deaths), and for females 40.5 (95% CI 8.3–118.3; three deaths). Aims Earlier research into forensic patients’ mortality primarily suffers from antiquity as well as small sample sizes and subsequently large confidence intervals. Therefore, it © 2014 Informa Healthcare DOI: 10.3109/08039488.2014.908949 Nord J Psychiatry Downloaded from informahealthcare.com by Kuopio University on 12/17/14 For personal use only.