Death and life-threatening situations in children and adolescents with psychiatric disorders: Literature review and examples in a university psychiatric hospitalization department

Background: Death is a rare event in child psychiatry and still not widely studied. Methods: Here, we report a review of literature concerning mortality in child psychiatry and a retrospective study (begun in 2007) of the implementation of “mortality and morbidity reviews” carried out in a university hospital within several inpatient units. Results: The review pulled together 73 studies, all of them confirming the excess mortality of children and adolescents in child psychiatry, whether in the general/non-specific populations (ex: hospitalized patients) or in specific populations (e.g.: autistic patients). The causes of excess mortality are undoubtedly suicide but also many natural causes (e.g.: complications due to addiction or anorexia nervosa). Our study includes 11 patients (mean average age = 15.5 years; 9 girls and 2 boys) and saw 5 deaths and 14 life-threatening situations. Again, suicides and serious suicide attempts were very common (n = 8 including 2 deaths), but the study also describes somatic causes, complications of pathological behaviour (n = 5: undernutrition in the context of anorexia, water poisoning) or underlying somatic disease (n = 5, including 2 deaths related to Sanfilippo disease and infiltrative brain lymphoma). Conclusion: As with adult psychiatry, children and adolescents with mental disorders appear to have a lower life expectancy compared to the general population. Nevertheless, death in child psychiatry remains a rare phenomenon, especially when it happens in hospital care. Our study shows that cases of death or life-threatening situations in hospitalized child psychiatry are due to somatic diseases (that are more or less entangled with psychiatric disorders) or due to suicides.