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Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas
Open accessAbstract
Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio‐environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual‐focused, health system‐focused, and community level and policy‐focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.
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“Severe mental illness (e.g., schizophrenia and bipolar disorder) is emerging as a prominent health disparity category, given estimates that persons in this group die 8-25 years younger than the general population 10,11 .”
From Measuring and improving the quality of mental health care: a global perspective (2018) · cites this paper as [11]
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Metadata
- Authors
- Liu, N. H., Daumit, G. L., Dua, T., Aquila, R., Charlson, F., Cuijpers, P., Druss, B., Dudek, K., Freeman, M., Fujii, C., Gaebel, W., Hegerl, U., Levav, I., Munk Laursen, T., Ma, H., Maj, M., Elena Medina‐Mora, M., Nordentoft, M., Prabhakaran, D., Pratt, K., Prince, M., Rangaswamy, T., Shiers, D., Susser, E., Thornicroft, G., Wahlbeck, K., Fekadu Wassie, A., Whiteford, H., & Saxena, S.
- Affiliations
- World Health Organization (CH)
- Johns Hopkins University (US)
- Fountain House New York NY USA
- Queensland Centre for Mental Health Research (AU)
- Vrije Universiteit Amsterdam (NL)
- Emory University (US)
- National Department of Health Johannesburg South Africa
- National Institute of Mental Health (JP)
- Heinrich‐Heine‐University Düsseldorf Düsseldorf Germany
- University Hospital Leipzig (DE)
- University of Haifa (IL)
- Aarhus University Aarhus Denmark
- Institute of Mental Health Beijing P.R. China
- University of Naples Federico II (IT)
- National Institute of Psychiatry Ramón de la Fuente Muñiz Mexico City Mexico
- University of Copenhagen (DK)
- Public Health Foundation of India (IN)
- King's College London (GB)
- Schizophrenia Research Foundation Chennai India
- Healthy Active Lives Longsdon Stoke‐on‐Trent UK
- Columbia University (US)
- MIELI Suomen mielenterveys ry (FI)
- Addis Ababa University Addis Ababa Ethiopia
- ORCID
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2017-01-26
- Volume
- 16
- Issue
- 1
- Pages
- 30-40
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC5269481
- OpenAlex
- W2580206093
- Cited by
- 865
- References
- 85
- Citations by year
- 2026: 57 · 2025: 73 · 2024: 89 · 2023: 102 · 2022: 99 · 2021: 93 · 2020: 87 · 2019: 62 · 2018: 169 · 2017: 31
- FWCI
- 136.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- World Health Organization
- National Institute for Health and Care Research (NF-SI-0611-10053)
- Lundbeckfonden (R155-2014-1724)
- National Institute of Mental Health (K24MH093763)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- excess mortality, severe mental illness, multilevel models, risk factors, intervention framework, health system interventions, community-based intervention, policy priorities, research priorities
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