A Systematic Review of Mortality in Schizophrenia: Is the Differential Mortality Gap Worsening Over Time?
Abstract
CONTEXT: Despite improvements in mental health services in recent decades, it is unclear whether the risk of mortality in schizophrenia has changed over time. OBJECTIVE: To explore the distribution of standardized mortality ratios (SMRs) for people with schizophrenia. DATA SOURCES: Broad search terms were used in MEDLINE, PsychINFO, Web of Science, and Google Scholar to identify all studies that investigated mortality in schizophrenia, published between January 1, 1980, and January 31, 2006. References were also identified from review articles, reference lists, and communication with authors. STUDY SELECTION: Population-based studies that reported primary data on deaths in people with schizophrenia. DATA EXTRACTION: Operationalized criteria were used to extract key study features and mortality data. DATA SYNTHESIS: We examined the distribution of SMRs and pooled selected estimates using random-effects meta-analysis. We identified 37 articles drawn from 25 different nations. The median SMR for all persons for all-cause mortality was 2.58 (10%-90% quantile, 1.18-5.76), with a corresponding random-effects pooled SMR of 2.50 (95% confidence interval, 2.18-2.43). No sex difference was detected. Suicide was associated with the highest SMR (12.86); however, most of the major causes-of-death categories were found to be elevated in people with schizophrenia. The SMRs for all-cause mortality have increased during recent decades (P = .03). CONCLUSIONS: With respect to mortality, a substantial gap exists between the health of people with schizophrenia and the general community. This differential mortality gap has worsened in recent decades. In light of the potential for second-generation antipsychotic medications to further adversely influence mortality rates in the decades to come, optimizing the general health of people with schizophrenia warrants urgent attention.
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Research into the health effects of recession has suggested that consequences will be most severe for the poorest groups in society and will have the most impact where social safety-nets are lacking and public hardship grows rapidly.
“Research into the health effects of recession has suggested that consequences will be most severe for the poorest groups in society and will have the most impact where social safety-nets are lacking and public hardship grows rapidly.64,65”
From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [64]
Cause-specific SMRs for schizophrenia were higher than 1 except for cerebrovascular disease, which was based on only three studies.
“An elevated mortality rate among persons with schizophrenia was indicated by cause-specific SMRs that were higher than 1, except for the SMR for cerebrovascular disease, which was based on only three studies.”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Saha et al. 2007
SMRs for schizophrenia increased significantly during the seventies, eighties, and nineties: from 1.84 to 2.98 to 3.20.
“Another interesting result was that the SMRs increased significantly during three recent decades, i.e., the seventies, eighties, and nineties; from 1.84, to 2.98, to 3.20, respectively.”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Saha et al. 2007
Saha et al. 2007 systematic review of 37 studies found overall SMR 2.58, with 10% and 90% quantiles 1.18 and 5.76.
“The overall SMR was 2.58, with 10% and 90% quantiles of 1.18 and 5.76, respectively.”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Saha et al. 2007
The risk of suicide is approximately 13-fold higher for persons with schizophrenia compared to the general population.
“a recent meta-analysis estimated that the risk of suicide was approximately 13-fold higher for persons with schizophrenia as compared to the general population (Saha et al. 2007).”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Saha et al. 2007
Evidence suggests antipsychotics are responsible for some of the excess mortality among persons with schizophrenia, especially since introduction in the late 1990s of second-generation antipsychotics.
“Evidence has suggested that antipsychotics are responsible for some of the excess mortality among persons with schizophrenia, especially since the introduction in the late 1990s of second-generation antipsychotics (Saha et al. 2007).”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Saha et al. 2007
Other studies found an increased or no different overall risk of cancer in patients with schizophrenia compared to the general population.
“On the other hand, other studies found an increased (9,21,28,(449)(450)(451) or no different (292,419,452,453) overall risk of cancer in patients with schizophrenia compared to the general population.”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [28]
The mortality gap in severe mental illness appears to be widening.
“This mortality gap translates into a 10-20 year shortened life expectancy (3,4) and appears to be widening (5).”
People with schizophrenia and other psychotic disorders die earlier than their peers in the general population, by around 15-20 years according to recent estimates.
“People with schizophrenia and other psychotic disorders die earlier than their peers in the general population, with recent estimates suggesting by around 15–20 years.1–10”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [9]
Evidence as to whether excess mortality in psychotic disorders is predominantly due to unnatural or natural causes remains equivocal.
“Evidence as to whether excess mortality is predominantly due to unnatural or natural causes of death remains equivocal.2,7,9,12”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [9]
Most studies conducted to date have compared mortality in psychosis with that in the national rather than local population, thereby ignoring geographical variation in mortality rates.
“Further, most studies conducted to date have compared mortality in psychosis with that in the national rather than local population,9 thereby ignoring geographical variation in mortality rates.17,18”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [9]
The mortality gap in people with schizophrenia and other psychoses remains high and may be wider for unnatural-cause mortality than reported in earlier studies.
“Our findings suggest that the mortality gap in people with schizophrenia and other psychoses remains high and may be wider for unnatural-cause mortality than reported in earlier studies”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [9]
Consistent evidence has accrued that people with psychotic disorder have higher mortality rates than the general population.
“Over the past decades, consistent evidence has accrued that people with psychotic disorder have higher mortality rates than the general population.1–9”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [9]
SMRs for unnatural-cause mortality and suicide in the ӔSOP cohort are markedly higher than the median SMRs of 7.5 for unnatural causes and 12.9 for suicide reported by Saha et al.
“The SMRs for unnatural-cause mortality (and suicide) that we found in the ӔSOP cohort are markedly higher than the median SMRs of 7.5 for unnatural causes (and 12.9 for suicide) reported in the systematic review by Saha et al,9”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [9]
Period effects suggest a widening mortality gap, with greater relative all-cause mortality risk for the decade of follow-up for this cohort than reported for earlier decades.
“we noted period effects suggestive of a widening mortality gap, insofar as a greater relative all-cause mortality risk was observed for the decade of follow-up for this cohort than that reported for earlier de- cades.4,9,12,35,36”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [9]
People with psychosis still do not appear to be benefitting from improvements in healthcare available to the general population.
“people with psychosis still do not appear to be benefitting from improvements in healthcare available to the general population.9,34”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [9]
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- Authors
- Saha, S., Chant, D., & McGrath, J.
- Affiliations
- Park Centre for Mental Health (AU)
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2007-10-01
- Volume
- 64
- Issue
- 10
- Pages
- 1123
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2149288810
- Cited by
- 2,065
- References
- 90
- Citations by year
- 2026: 41 · 2025: 51 · 2024: 82 · 2023: 74 · 2022: 104 · 2021: 119 · 2020: 119 · 2019: 126 · 2018: 123 · 2017: 174 · 2016: 152 · 2015: 151 · 2014: 138 · 2013: 144 · 2012: 118
- FWCI
- 49.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- schizophrenia, mortality, standardized mortality ratio, all-cause mortality, suicide, causes of death, mortality trends, atypical antipsychotics, health disparities, mental illness
- MeSH terms
- Cause of Death, Cross-Cultural Comparison, Data Collection, Female, Forecasting, Health Status, Humans, Male, Mortality, Risk Factors, Schizophrenia, Sex Factors, Suicide, Antipsychotic Agents, Meta-Analysis as Topic, Developed Countries
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