In 1928, Benjamin Malzberg, a young epidemiologist in New York State's Division of Mental Hygiene, began a groundbreaking study examining causes of mortality in New York State's mental hospitals. During the ensuing 3 years, Malzberg reviewed every death that occurred throughout the state's psychiatric hospital system; his findings were both surprising and troubling. Patients in these hospitals died an average of 15 years younger than the general population of New York State.1 Malzberg speculated that these excess deaths were likely due to a complex combination of factors:
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