The excess mortality of schizophrenia

Abstract

I searched the medical literature for reports of schizophrenia mortality, checking each citation until I found no new references. I then aggregated the data from all studies which met predetermined inclusion criteria and measured mortality by the Standardised Mortality Ratio (SMR) with 95% confidence intervals. I then traced at 13 years a cohort of 370 patients with schizophrenia, identified from service contacts in 1981-2. I took cause of death from death certificates and clinical details from medical records, calculated SMRs from UK national morality tables by the added years method and examined the circumstances of each death. Meta-analysis of the literature showed an overall SMR of 151 (CI 148-154) which was higher among males and the young and fell with length of illness. Nearly half the excess deaths were unnatural, most from suicide. The excess natural mortality was spread across most disease categories. This pattern suggests that suicide is intrinsic to schizophrenia but the excess natural mortality is largely due to altered exposure to environmental risk factors.

The local cohort had 58 natural (SMR 232, CI 176-296) and 19 unnatural deaths (SMR 1273, CI 767-1988), an overall SMR of 299 (CI 236-372). The pattern of deaths was similar to previous studies. The excess mortality was not explained by social disadvantage. Some of the mechanisms of excess mortality include unhealthy lifestyle, poor treatment of chronic disease and treatment compliance and failed recognition of acute medical disease.

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