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Twenty-five year mortality of a community cohort with schizophrenia

  • Steve Brown (a1), Miranda Kim (a2), Clemence Mitchell (a3) and Hazel Inskip (a4)
Abstract
Background

People with schizophrenia have significantly raised mortality but we do not know how these mortality patterns in the UK have changed since the 1990s.

Aims

To measure the 25-year mortality of people with schizophrenia with particular focus on changes over time.

Method

Prospective record linkage study of the mortality of a community cohort of 370 people with schizophrenia.

Results

The cohort had an all-cause standardised mortality ratio of 289 (95% CI 247–337). Most deaths were from the common causes seen in the general population. Unnatural deaths were concentrated in the first 5 years of follow-up. There was an indication that cardiovascular mortality may have increased relative to the general population (P = 0.053) over the course of the study.

Conclusions

People with schizophrenia have a mortality risk that is two to three times that of the general population. Most of the extra deaths are from natural causes. The apparent increase in cardiovascular mortality relative to the general population should be of concern to anyone with an interest in mental health.

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Copyright
Corresponding author
Steve Brown, Cannon House, 6 Cannon Street, Shirley, Southampton S015 5PQ, UK. Email: steve.brown@hantspt-sw.nhs.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Twenty-five year mortality of a community cohort with schizophrenia

  • Steve Brown (a1), Miranda Kim (a2), Clemence Mitchell (a3) and Hazel Inskip (a4)
Submit a response

eLetters

mortality in schizophrenia

gwenole loas, psychiatrist
14 April 2010

Sir

Brown et al 1 reported the mortality of a community cohort of 370 people with schizophrenia using a twenty-five year follow-up study. Using standardised mortality ratio (SMR) the authors found that schizophrenia subjects have a mortality risk that is two to three times that of the general population. Moreover the changes of mortality over time were examined and the authors found firstly that unnatural deaths were concentrated in the first 5 years of follow-up and secondly that cardiovascular mortality may have increased relative to the general population over the course of the study.

The aim of the letter is to compare the SMR and the changes of the mortality rates notably for unnatural and cardiovascular causes of deaths with the results of a French cohort of schizophrenic subjects.

Using a well-defined sample of 150 schizophrenic patients meeting theResearch Diagnosis Criteria of chronic schizophrenia we have reported the mortality of the cohort at two points of the follow-up 2, 3. The patients were included between 1991 and 1995 and the two end points were May 1999 and May 2005.In the first analysis 2 (8-year follow-up) the SMR for overall mortality was 2.5 and there were among the 13 deaths respectively 5 unnatural deathsand 3 deaths by cardiovascular causes.In the second analysis 3 (14-year follow-up) the SMR for overall mortalitywas 4.8 and there were among the 25 deaths respectively 10 unnatural deaths and 7 deaths by cardiovascular causes.Using an additional analysis of our data the aim of the study was to compare the mortality rates between the two periods of time (1991-1998 and1999-2004) of the unnatural deaths and deaths by cardiovascular causes.To take into account that the number of years (8 and 6) is different between the two periods of time we calculated the absolute mortality ratesby the following formula: deaths/number of years/ exposed subjects. For the first period of time the absolute mortality rates for unnatural causesand cardiovascular causes of death were respectively 4.2  (5/8/150) and 2.5 %° (3/8/150). For the second period of time the absolutemortality rates for unnatural causes and cardiovascular causes of death were respectively 6.1 %° (5/6/137) and 4.9 %° (4/6/137).

Higher SMR for overall mortality was observed in the French cohort for the 14-year follow-up than in the English cohort although the durationof the follow-up was shorter for the French comparatively to the English cohort. One of the main reasons was related to the inclusion of severe schizophrenic patients in the French sample who were recruited from psychiatric hospitals. Although the changes of mortality over time were calculated differently in the English and French cohorts using respectively relative (SMR) and absolute ratios (absolute mortality rates)the cardio-vascular mortality of schizophrenia seems increase over time inthe two cohorts.Several risk factors could explain the increase of cardiovascular death over time. The long-term exposure to antipsychotic drugs increases mortality in schizophrenia 4 and atypical antipsychotic drugs have side effects (obesity, insulin resistance…) that constitute risk factors for coronary heart disease.One of the explanations of the increase of cardiovascular death over time could be related to the introduction of the second generation of antipsychotic drugs but evidence for differential effects on cardiovascular mortality in favour of second generation compared to first generation antipsychotics was inconsistent. As suggested by Weinmann et al4 more rigorously designed, prospective studies are urgently needed.

Declaration of interest: none

Pr Gwenolé Loas, M.D, University Psychiatric Department, Hopital Pinel, 80044, Amiens cedex 01, France, tel 33 3 22 53 46 44, fax 33 3 22 95 41 15, email: g.loas@ch-pinel.fr

References

1 Brown S, Kim M, Mitchell C, Inskip H. twenty-five year mortality ofa community cohort with schizophrenia.Br J Psychiatry 2010; 196:116-121.

2 Bralet M., Yon V, Loas G, Noisette C. Mortality in schizophrenia: a8-year follow-up study in 150 chronic schizophrenia. Encéphale 1999; 26:32-41.

3 Loas G, Azi A, Noisette C, Yon V. Mortality among chronic schizophrenic patients: a prospective study of 150 schizophrenic patients.Encéphale 2008; 34: 54-60.

4 Weinmann S, Read J, Aderhold V. Influence of antipsychotics on mortality in schizophrenia: systematic review. Schizophr Res 2009; 113:1-11.
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Conflict of interest: None Declared

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