Introduction The mortality among homeless people is linked to the presence of psychiatric disorders. Objectives We compared the risk of specific death causes among clients of the Public Mental Health care (PMHc) in Utrecht with that of the general population, and assessed whether treatment at a local psychiatric service is associated with this risk. Aims To clarify the association between the presence of a mental disorder and mortality among the socially marginalized. Methods Out of 8,741 clients in the PMHc register, the records of 6,724 could be linked to the registries of Statistics Netherlands (CBS). Controls (N=66,247) from the population register were personally matched to a PMHc client. A Cox regression analysis was used to estimate hazard ratios (HR) of death. Results An increased all-cause mortality among PMHc clients compared to controls was found (HR=2.99, 95%-CI: 2.63- 3.41), associated with a broad range of death causes.PMHc clients with record linkage to the Psychiatric Case Registry Middle Netherlands (’PMHc+’) had an increased risk of suicide (HR=2.63, 0.99-7.02), but a lower risk of death from natural causes (HR=0.71, 0.54-0.92), compared to PMHc clients without (‘PMHc-’). Compared to controls, however, ‘PMHc-’ clients experienced increased risks of suicide (HR=3.63, 1.42-9.26) and death due to mental & behavioural disorders (HR=7.85, 3.54- 17.43). Conclusion Among PMHc clients, a registered diagnosis at a local psychiatric service appears to be favourably associated with lower mortality due to natural death causes. The high risk of suicide among ‘PMHc-’ clients probably indicates a high prevalence of undiagnosed mental disorders among PMHc clients.
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