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Mortality risk higher in individuals with severe mental illness

Mortality risk was higher among individuals with severe mental illness, particularly those of white British ethnicity.

“The association between severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders) and excess mortality has been well established worldwide,” Jayati Das-Munshi, PhD, of King’s College London, and colleagues wrote. “Few studies have assessed the nature of this inequality by ethnicity. In most studies, ethnicity is treated as a confounder or the sample size has been too small to allow stratified analysis. This concern is noteworthy because many mortality risk factors implicated in severe mental illness, such as cardiovascular disease and diabetes, are also known to be more prevalent in some ethnic minority groups relative to white British, European, and non-Hispanic white American populations.”

To assess excess mortality and associations with ethnicity among individuals with severe mental illness, researchers conducted a longitudinal cohort study of 18,021 individuals diagnosed with severe mental illness. Mortality data was linked from the U.K. Office for National Statistics. Median follow-up was 6.36 years.

Age- and sex-standardized mortality ratios (SMRs) were higher among participants with severe mental illness for suicide (7.65; 95% CI, 6.43-9.04), non-suicide unnatural causes (4.01; 95% CI, 3.34-4.78), respiratory disease (3.38; 95% CI, 3.04-3.74), cardiovascular disease (2.65; 95% CI, 2.45-2.86), and cancer (1.45; 95% CI, 1.32-1.6).

Among participants with severe mental illness, SMRs significantly varied among ethnic groups; however, south Asian participants had reduced SMR for cancer mortality (0.49; 95% CI, 0.21-0.96).

Among participants with severe mental illness, risk for all-cause mortality, natural cause mortality and unnatural-cause mortality were lower among most ethnic groups, compared with the white British group.

“Irrespective of ethnicity, people with severe mental illness have excess mortality, underlining an urgent need to address tractable causes within this group of people,” the researchers wrote. “Reduced mortality risk in black African, black Caribbean, and south Asian groups with severe mental illness, relative to a white British reference group with severe mental illness, might be due to several factors, including but not limited to differential socioenvironmental factors, differences in underlying physical health, and differences in the prescribing of psychotropic medications. These factors could be relevant to improving mortality outcomes in all people with severe mental illness.” – by Amanda Oldt

Disclosure: Das-Munshi reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.