785Excess mortality in severe mental disorders: a systematic review and meta-regression

Abstract

Abstract Background Decades worth of epidemiological studies, synthesised by systematic reviews and meta-analyses, have consistently shown that people with severe mental disorders (SMD) have a higher risk of mortality compared to the general population, which has not improved over time. One of the major limitations of previous reviews is the use of meta-analytic models to synthesise mortality estimates without taking into account potential sources of heterogeneity. Methods A systematic review of studies examining mortality in people with schizophrenia and bipolar disorder compared to the general population was conducted. Estimates of all-cause and cause-specific mortality were calculated using meta-regression models to quantify and adjust for the effects of covariates, including both study-level and population-level factors. Results A total of 76 studies were included in the analyses. The adjusted relative risk for all-cause mortality in schizophrenia was 2.80 (95% CI 2.30 to 3.41) and 2.33 (95%CI 2.01 to 2.71) for bipolar disorder. Mortality was elevated in each cause of death examined, across both unnatural and natural causes. Some heterogeneity was explained by age and sex. Conclusions The mortality gap for people with SMD compared to the general population remains unchanged. Most of the heterogeneity between studies could not be accounted for by the covariates included in our analyses. Key messages More work needs to be done towards understanding the causal factors underlying excess mortality in people with SMD in order to achieve more equitable health outcomes.