Abstract
SummaryBackgroundPeople with schizophrenia and related disorders are at an increased risk of adverse outcomes, including conviction of a violent offence, suicide, and premature mortality. However, the rates of, and risk factors for, these outcomes need clarification as a basis for population-based and targeted interventions. We aimed to determine rates and risk factors for these outcomes, and investigate to what extent they are shared across outcomes and are specific to schizophrenia and related disorders.MethodsWe undertook a total population cohort study in Sweden of 24 297 patients with schizophrenia and related disorders between January, 1972 and December, 2009. Patients were matched by age and sex to people from the general population (n=485 940) and also to unaffected sibling controls (n=26 357). First, we investigated rates of conviction of a violent offence, suicide, and premature mortality, with follow-up until conviction of a violent offence, emigration, death, or end of follow-up (Dec 31, 2009), whichever occurred first. Second, we analysed associations between these adverse outcomes and sociodemographic, individual, familial, and distal risk factors, for men and women separately, with Cox proportional hazards models. Finally, we assessed time trends in adverse outcomes between 1972 and 2009, for which we compared patients with unaffected siblings, and analysed associations with changes in the number of nights spent in inpatient beds in psychiatric facilities nationwide.FindingsWithin 5 years of their initial diagnosis, 13·9% of men and 4·7% of women with schizophrenia and related disorders had a major adverse outcome (10·7% of men and 2·7% of women were convicted of a violent offence, and 3·3% of men and 2·0% of women died prematurely of any cause). During the study, the adjusted odds ratio of any adverse outcomes for patients compared with general population controls was 7·5 (95% CI 7·2–7·9) in men and 11·1 (10·2–12·1) in women. Three risk factors that were present before diagnosis were predictive of any adverse outcome: drug use disorders, criminality, and self-harm, which were also risk factors for these outcomes in unaffected siblings and in the general population. Over the period 1973–2009, the odds of these outcomes increased in patients with schizophrenia and related disorders compared with unaffected siblings.InterpretationSchizophrenia and related disorders are associated with substantially increased rates of violent crime, suicide, and premature mortality. Risk factors for these three outcomes included both those specific to individuals with schizophrenia and related disorders, and those shared with the general population. Therefore, a combination of population-based and targeted strategies might be necessary to reduce the substantial rates of adverse outcomes in patients with schizophrenia and related disorders.FundingWellcome Trust and The Swedish Research Council.
Highlights
People with schizophrenia have increased risks for a range of adverse outcomes, including violent outcomes,[1] suicide,[2] and premature mortality,[3] compared with the general population
Odds of convictions for a violent offence, suicide, and premature mortality rates were higher in patients with schizophrenia and related disorders than in the general population, with some evidence of familial confounding shown by the results in the unaffected siblings group
In an analysis of the relation between inpatient nights per year and adverse outcomes, we showed that the number of inpatient nights was negatively associated with violence but had no significant associations with suicide or premature mortality—that is, fewer annual inpatient nights were associated with more violence perpetrated by those with schizophrenia and related disorders compared with unaffected siblings
Summary
People with schizophrenia have increased risks for a range of adverse outcomes, including violent outcomes,[1] suicide,[2] and premature mortality,[3] compared with the general population. Research has focused on these outcomes separately, and rates and risk factors for any adverse outcome are rarely reported.[5] little is known about the risk factors that lead to these outcomes, whether they are modifiable, and to what extent the factors are shared across the outcomes. Such information is necessary to trial therapies and preventive strategies to mitigate risks. We aimed to determine rates and risk factors for these outcomes, and investigate to what extent they are shared across outcomes and are specific to schizophrenia and related disorders
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