The RCPsych Article of the Month for October is ‘Contribution of severe mental disorders to fatally harmful effects of physical disorders: national cohort study‘ and the blog is written by authors Tomáš Formánek et al. and the article is published in The British Journal of Psychiatry.

Deaths from physical illnesses account for most of the scandalous toll of premature deaths in people with severe mental disorders that include psychotic disorders, bipolar disorder or severe depression. But it is not clear whether they die too soon because physical illnesses are more common in this group, or whether those illnesses are more likely to be fatal when they develop them.

We used Czech national register data to explore this outstanding question. We investigated whether people with severe mental disorders died more often, and whether they died sooner when they developed 9 broadly defined and 19 specific common physical illnesses compared with counterparts who had the same physical illnesses but did not have a severe mental disorder preceding it.

We demonstrated that people with severe mental disorders were more likely to die following the onset of nearly all (7 out of 9) of the broadly defined and most (14 out of 19) of the specific physical illnesses. Not only that, but they also died sooner: people with severe mental disorders lost additional life-years following the onset of 8 out of 9 broadly defined and 13 out of 19 specific physical illnesses, respectively. Most findings –particularly those related to cardiovascular diseases and cancers– could not be explained by people with severe mental disorders having more than one physical illness at the same time. This suggests that individual physical illnesses are more fatal when people with severe mental disorders get them.

Strengthening care for mental health conditions across levels of the health care system has long been a central agenda of mental health reforms and movements.  The slogan of “no health without mental health” helped align multiple stakeholders, decision makers and advocates for better mental health care in primary and secondary health care services. Despite this, people with severe mental disorders keep dying earlier than people without them. And, as our results show, they are also more likely to die when they get common physical illnesses. It is time to pay more attention and advocate not only about better mental health care, but also physical health care for those with mental health conditions, expanding the mental health slogan to “no mental health without physical health”.

The article by Tomáš Formánek et al. is incisive, important, and intriguing. It examines specifically the question of whether severe mental illness contributes to the fatally deleterious effects of somatic diseases. It draws on data from a National Register to interrogate this question. It is important because the issue of general health in patients with mental illness has long been neglected, and only recently has it come to the fore. The paper is incisive as it examines a very particular interaction – and reveals findings that suggest people with severe mental illness have an elevated risk of all cause death following the onset of many somatic diseases. It is also an intriguing paper however, as it alludes to the possibility that physical disorders are more likely to be fatal in those with mental illness. Clearly all of these findings have clinical significance and it is therefore a must read article, not only for researchers, but clinicians as well.

Professor Gin Malhi
Editor-in-Chief, The British Journal of Psychiatry