Excess mortality in severe mental illness: 10-year
                        population-based cohort study in rural Ethiopia

Fekadu, Abebaw; Medhin, Girmay; Kebede, Derege; Alem, Atalay; Cleare, Anthony J.; Prince, Martin; Hanlon, Charlotte; Shibre, Teshome

doi:10.1192/bjp.bp.114.149112

Cited by 141 publications

(141 citation statements)

References 41 publications

(46 reference statements)

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“…Many more deaths occur in people with schizophrenia in excess of what would be expected on the basis of general population mortality rates. These deaths are certified and coded to other diseases and injuries as the underlying cause, such as self-harm, unintentional injuries, infectious diseases, substance use, cardiovascular disease, and cancers, for which excess mortality in people with schizophrenia has been reported 109, 110, 111. Most deaths from self-harm can be attributed to underlying mental and substance disorders such as depression, anxiety disorders, schizophrenia, bipolar disorder, and alcohol and drug use disorders, as has been quantified based on GBD 2010 estimates 112 .…”

Section: Discussionmentioning

confidence: 99%

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Wang¹,

Naghavi²,

Allen³

et al. 2016

The Lancet

5,072

3,004

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SummaryBackgroundImproving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.MethodsWe estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography–year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).FindingsGlobally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4–61·9) in 1980 to 71·8 years (71·5–72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7–17·4), to 62·6 years (56·5–70·2). Total deaths increased by 4·1% (2·6–5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8–18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-com...

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Section: Discussionmentioning

confidence: 99%

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Wang¹,

Naghavi²,

Allen³

et al. 2016

The Lancet

5,072

3,004

View full text Add to dashboard Cite

show abstract

“…This may be explained by evidence that individuals with schizophrenia also have greater vulnerability to infections when they are exposed. Excess mortality from infectious disease, for example, has been found in patients with schizophrenia compared with the general population (Brown et al, 2000;Fedaku et al, 2015;Harris and Barraclough, 1998). The results from a multi-national meta-analysis revealed that, after adjusting for age and gender, the risk of death from infectious disease was 9.4 times higher in schizophrenia patients than in the general population (Harris and Barraclough, 1998).…”

Section: 2mentioning

confidence: 99%

Abnormal immune system development and function in schizophrenia helps reconcile diverse findings and suggests new treatment and prevention strategies

Anders¹,

Kinney

2015

Brain Research

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“…Whilst lifetime prevalence is relatively low (4/1000 population globally [7] and 4.7/1000 in Ethiopia [8]), the often severe and chronic nature of schizophrenia means it can have a catastrophic impact on individuals and their families, expressed in high levels of mortality (over three times that of the general population in Ethiopia [9]), disability [10] and economic burden [11]. Insufficient service provision is one of the reasons why 90% of people with schizophrenia in rural Ethiopia do not access formal care [12], a treatment gap reflected in other LMIC [13].…”

Section: Introductionmentioning

confidence: 99%

“I cry every day and night, I have my son tied in chains”: physical restraint of people with schizophrenia in community settings in Ethiopia

et al. 2017

Self Cite

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BackgroundA primary rationale for scaling up mental health services in low and middle-income countries is to address human rights violations, including physical restraint in community settings. The voices of those with intimate experiences of restraint, in particular people with mental illness and their families, are rarely heard. The aim of this study was to understand the experiences of, and reasons for, restraint of people with schizophrenia in community settings in rural Ethiopia in order to develop constructive and scalable interventions.MethodsA qualitative study was conducted, involving 15 in-depth interviews and 5 focus group discussions (n = 35) with a purposive sample of people with schizophrenia, their caregivers, community leaders and primary and community health workers in rural Ethiopia. Thematic analysis was used.ResultsMost of the participants with schizophrenia and their caregivers had personal experience of the practice of restraint. The main explanations given for restraint were to protect the individual or the community, and to facilitate transportation to health facilities. These reasons were underpinned by a lack of care options, and the consequent heavy family burden and a sense of powerlessness amongst caregivers. Whilst there was pervasive stigma towards people with schizophrenia, lack of awareness about mental illness was not a primary reason for restraint. All types of participants cited increasing access to treatment as the most effective way to reduce the incidence of restraint.ConclusionRestraint in community settings in rural Ethiopia entails the violation of various human rights, but the underlying human rights issue is one of lack of access to treatment. The scale up of accessible and affordable mental health care may go some way to address the issue of restraint.Trial registration Clinicaltrials.gov NCT02160249 Registered 3rd June 2014.

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Excess mortality in severe mental illness: 10-year population-based cohort study in rural Ethiopia

Abstract: Mortality is an important adverse outcome of SMI irrespective of setting. Addressing common natural and unnatural causes of mortality are urgent priorities. Premature death and mortality related to self-harm should be considered in the estimation of the global burden of disease for SMI.

Cited by 141 publications

References 41 publications

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Abnormal immune system development and function in schizophrenia helps reconcile diverse findings and suggests new treatment and prevention strategies

“I cry every day and night, I have my son tied in chains”: physical restraint of people with schizophrenia in community settings in Ethiopia

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