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Publications

Journal Article Ppublish 2 citations

PubMed: 42480565 DOI: 10.1016/S2468-2667(26)00116-7

Cause-specific mortality due to physical illness in severe mental disorders in Europe: a population-based multi-country cohort study.

Lancet Public Health 11(8):e506-e517

Authors: Tapio T Gustafsson, Vanessa Pauly, Aleksi Hamina, Mariusz Zięba, Andrzej Kiejna, Veronica Orleans, Esben Andersen Revsbech, Jan Brink Valentin, Ulker Isayeva, Mirko Manchia, Jari Tiihonen, Ellenor Mittendorfer-Rutz, René Ernst Nielsen, Laurent Boyer, Heidi Taipale

Affiliations

  • Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
  • Assistance Publique, Hôpitaux de Marseille, Marseille, France; Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France.
  • Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
  • Institute of Social Studies, University of Lower Silesia, Wrocław, Poland.
  • Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark.
  • Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.
  • Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.
  • Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
  • Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
  • Aalborg University and Aalborg University Hospital, Aalborg, Denmark.
  • Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Abstract

BACKGROUND

How specific physical illnesses differentially contribute to the persistent mortality gap in severe mental illness (including schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder) remains poorly understood. Using a harmonised multi-country design, we aimed to analyse excess mortality across diagnoses and causes of death to identify high-burden and high-inequity mortality patterns to inform public health prioritisation and organisation of care.

METHODS

In this population-based multi-country cohort study using national health registers, we identified people diagnosed with severe mental illness at age 15-65 years in five European countries (Denmark, Finland, France, Poland, and Sweden) during 2004-23 to establish excess mortality before age 75 years in relation to country-specific general population mortality. We defined cause-specific mortality using ICD-10. Random effects meta-analysis was used to pool mortality estimates representing country-specific relative mortality inequities (sex-standardised and age-standardised mortality ratios), absolute excess burden (sex-standardised and age-standardised death rates per 10 000 person-years), and the severity of premature mortality (potential years-of-life-lost before age 75 years). Subgroup analyses were conducted to test for potential effect modification.

FINDINGS

Between Jan 1, 2004, and Dec 31, 2023, there were 4 861 795 people with severe mental illness, and 561 903 deaths from any cause. All-cause mortality was 2·6-fold higher in people with severe mental illness compared with the general population (pooled standardised mortality ratio [SMR] 2·64, 95% CI 2·25-3·11). Absolute excess mortality was highest in cardiovascular disease (schizophrenia spectrum disorders: standardised excess death rate 22·08 per 10 000 person-years, 95% CI 8·77-35·39; bipolar disorder: 8·36 per 10 000 person-years, 2·96-13·75; and major depressive disorder: 9·82 per 10 000 person-years, 3·18-16·45). Relative excess mortality was highest in respiratory diseases (schizophrenia spectrum disorders: SMR 6·49; 95% CI 5·52-7·64; bipolar disorder: 2·72, 2·04-3·63; and major depressive disorder: 3·48, 2·63-4·62), followed by endocrine and metabolic diseases (schizophrenia spectrum disorders: 5·09, 4·29-6·04; bipolar disorder: 2·60, 2·26-2·98; and major depressive disorder: 3·07, 1·84-5·12), and in gastrointestinal diseases (schizophrenia spectrum disorders: 3·47, 2·58-4·67; bipolar disorder: 2·34, 2·00-2·74; and major depressive disorder: 3·48, 2·63-4·62).

INTERPRETATION

The mortality gap was characterised by distinct patterns of absolute excess mortality and relative inequality across causes of death and severe mental illness diagnoses. Considering both dimensions of excess mortality can inform public health priorities that are not apparent from either measure alone or from focusing on cause-specific numbers of deaths. Reducing premature mortality will therefore require an integrated public health approach that combines universal strategies with targeted interventions to address both high-burden causes of death and those characterised by the greatest relative inequalities.

FUNDING

2024 European Partnership on Transforming Health and Care Systems.

MeSH

Bipolar Disorder, Mortality, Mental Disorders, Multiple Chronic Conditions, Cohort Studies, Cause Of Death, Public Health, Depressive Disorder, Schizophrenia, Sex, Diagnosis, Mortality, Premature, Depressive Disorder, Major