Mortality After the First Diagnosis of Schizophrenia-Spectrum Disorders: A Population-based Retrospective Cohort Study

Abstract

There is emerging evidence of high mortality rates after the first diagnosis of psychotic disorder. The objective of this study was to estimate the standardized mortality ratio (SMR) in a population-based cohort of individuals with a first diagnosis of schizophrenia-spectrum psychotic disorder (SSD). The cohort included a population-based sample of individuals with a first diagnosis of SSD based on the first diagnosis occurring during hospitalization or in an outpatient setting between 2007 and 2010 in Ontario, Canada. All patients were followed for 5 years after the first diagnosis. The primary outcome was SMR, including all-cause, suicide-related, accidental, and other causes. Between 2007 and 2010, there were 2382 patients in the hospitalization cohort and 11 003 patients in the outpatient cohort. Over the 5-year observation period, 97 (4.1%) of the hospitalization cohort and 292 (2.7%) of the outpatient cohort died, resulting in an SMR of 13.6 and 9.1, respectively. In both cohorts, suicide was the most common cause of death. Approximately 1 in 25 patients with a first diagnosis of SSD during hospitalization, and 1 in 40 patients with a first diagnosis of SSD in an outpatient setting, died within 5 years of first diagnosis in Ontario, Canada. This mortality rate is between 9 and 13 times higher than would be expected in the age-matched general population. Based on these data, timely access to services should be a public health priority to reduce mortality following a first diagnosis of an SSD.

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

“…An initial search retrieved 8,345 abstracts; removal of duplicates resulted in 6,390 abstracts for review. Of these, a total of 135 studies 5‐10,38‐166 were included, after excluding 463 articles upon full text assessment (see Figure 1, Table 1 and supplementary information). We ultimately included 4,536,447 individuals with schizophrenia who were compared with 1,115,600,059 control subjects from the general population.…”

Low physical activity is associated with two hypokinetic motor abnormalities in psychosis

“…Cardio metabolic health is a major issue in schizophrenia spectrum disorders. Schizophrenia spectrum disorders are associated with lower life expectancy of 15–20 years, which may be partially accounted for the impact of these disorders on health behaviors ( Hjorthoj et al, 2017 ; Kurdyak et al, 2021 ; Nielsen et al, 2021 ). Meta-analyses indicate that subjects with schizophrenia have lower physical activity (PA), particularly of moderate to vigorous activity than healthy controls (moderate activity – 10 min per day, vigorous activity – 3 min per day) ( Stubbs et al, 2016 ; Vancampfort et al, 2017 ).…”

Aripiprazole and Risperidone Present Comparable Long-Term Metabolic Profiles: Data From a Pragmatic Randomized Controlled Trial in Drug-Naïve First-Episode Psychosis

“…In this regard, SGAs have been widely linked to weight gain, which, along with other lifestyle risk factors, contributes to an increased risk of dyslipidemia, glucose intolerance, diabetes mellitus, metabolic syndrome (MetS), and, ultimately, cardiovascular disease ( Henderson et al, 2015 ; Nielsen et al, 2021 ). These physical conditions are underlying causes of up to 70% of the excess mortality seen in schizophrenia, resulting in a life expectancy reduction of up to 20 years ( Owen et al, 2016 ; Kurdyak et al, 2021 ). Recent evidence, however, indicates that there are differences in the side effects profile of antipsychotics in terms of weight gain ( Leucht et al, 2013 ; Huhn et al, 2019 ).…”