Poor longitudinal continuity of care is associated with an increased mortality rate among patients with mental disorders: results from the French National Health Insurance Reimbursement Database

Eur Psychiatry. 2014 Aug;29(6):358-64. doi: 10.1016/j.eurpsy.2013.12.001. Epub 2014 Jan 16.


Background: Research on the impact of the continuity of care (COC) on health outcomes in patients with mental illness is limited. This observational study examined whether the longitudinal COC is associated with a decreased likelihood of death among patients with mental disorders in the French general population.

Method: Data were derived from the French National Health Insurance (NHI) reimbursement database. Patients with any mental disorder who visited a psychiatrist at least twice within 6 months were included. The primary endpoint was death by all causes. We measured longitudinal COC with a psychiatrist twice a year between 2007 and 2010, using the COC index developed by Bice and Boxerman. The COC index was analysed as a time-dependent variable in a survival analysis after adjustments for age, gender and stratifying on comorbidities and social status.

Results: Among 14,515 patients visiting a psychiatrist at least twice in 6 months and tracked over 3 years, likelihood of death was significantly lower in patients with higher continuity of care (hazard ratio for an increase in 0.1 of continuity, adjusted for age, sex, and stratified on comorbidities and social status: 0.83 [0.83-0.83]), particularly in those with bipolar disorder, major depressive disorder and schizophrenia.

Conclusion: Improving longitudinal continuity of care in mental health care may contribute to substantially decrease mortality.

Keywords: Continuity of care; Mental disorders; Mortality.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Continuity of Patient Care*
  • Databases, Factual
  • Female
  • France
  • Humans
  • Infant
  • Longitudinal Studies
  • Male
  • Mental Disorders / mortality*
  • Mental Disorders / therapy
  • Middle Aged
  • Risk Factors
  • Young Adult