Dying Too Soon: Excess Mortality in Severe Mental Illness.

Liselotte D De Mooij,Pim W.R.A Duurkoop,Lieuwe De Haan,Jack J.M Dekker,Aartjan T.F Beekman,Jan Theunissen,Henricus L Van,Martijn Kikkert

doi:10.3389/fpsyt.2019.00855

Abstract

Aims: We aimed to identify baseline predictors of mortality in patients with a severe mental illness (SMI) over a 6-year period and to describe mortality rates as standardised mortality ratios (SMRs). We hypothesised that cardiovascular diseases, older age, cigarette smoking, more severe psychiatric symptoms and more severe psychotropic side effects, and alcohol or drug use were independent risk factors for mortality. Method: Medical examinations were conducted at baseline in a cohort of 322 SMI patients. SMRs were estimated after 6 years and an evaluation was made of the impact of a wide range of variables on survival time. Results: Almost 11% of the SMI patients had died at the end of the study period. All-cause SMRs were 4.51 (95% CI 3.07–5.95) for all SMI patients (4.89, 95% CI 2.97–6.80 for men, and 3.94, 95% CI 1.78–6.10 for women). Natural causes accounted for 86% of excess mortality and unnatural causes for 14%. Cardiovascular disease was a major contributor to this excess mortality. Multivariate Cox regression analyses showed that premature death was associated with a longer history of tobacco use (HR: 1.03, 95% CI 1.02–1.03) and more severe symptoms of disorganisation (HR: 2.36, 95% CI 2.21–2.52). Conclusions: The high SMR and the incidence of cardiovascular disease-related death in SMI patients in our study justify concern. This study underscores the urgent need for interventions to reduce excess mortality in patients with SMI.

Highlights

Researchers have consistently shown that mortality rates in patients with a severe mental illness (SMI) are excessively high
With previous literature lacking theoretical support for interaction between the above-mentioned predictors, no specific prediction model was a priori expected. This prospective longitudinal study was conducted between 2005 and 2011 in a survey sample of SMI patients treated by the mental healthcare institutions Arkin, Geestelijke Gezondheidszorg [GGZ] InGeest, Regionale Instelling voor Bescherm Wonen [(RIBW [Regional Institute for Sheltered Housing)] and Huis voor Onbehuisden [HVO (Sheltered housing for Homeless people)] Querido in Amsterdam, The Netherlands) (37), which are responsible for the treatment of SMI patients residing in Amsterdam
The current study describes the baseline predictors of mortality in SMI patients over a 6-year period

Summary

Introduction

Researchers have consistently shown that mortality rates in patients with a severe mental illness (SMI) are excessively high. SMI patients die about 10–20 years earlier than the general population (1–5). Most systematic reviews showed that all-cause mortality in SMI patients is 2 to 3.5 times higher than in the general population (3–18). There is evidence that this mortality gap has been increasing over time (4, 19, 6). This seems to indicate that SMI patients benefit less than the general population from progressions in healthcare (6). Reduced life expectancy in SMI patients is explained by unnatural causes of death like suicide and accidents and by physical illnesses (8, 20–23). Studies have shown that cardiovascular diseases (CVD), respiratory and metabolic diseases

Methods

Results

Conclusion