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Mortality in schizophrenia: clinical and serological predictors

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Dickerson, Faith, Stallings, Cassie, Origoni, Andrea, Schroeder, Jennifer, Khushalani, Sunil, Yolken, Robert·2014·Schizophrenia Bulletin
DOI 10.1093/schbul/sbt113PMC PMC4059441
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Abstract

Persons with schizophrenia have a reduced life expectancy largely due to death from natural causes. Factors that have been previously associated with excess mortality include cigarette smoking and antipsychotic medication. The role of other environmental factors such as exposure to infectious agents has been the subject of only limited investigation. We prospectively assessed a cohort of persons with schizophrenia with a clinical evaluation and a blood sample from which antibodies to human herpes viruses and Toxoplasma gondii were measured. Mortality was determined with data from the National Death Index following a period of up to 11 years. We examined the role of demographic, serological, and clinical factors on mortality. A total of 25 (5%) of 517 persons died of natural causes. The standardized mortality ratio was 2.80 (95% CI 0.89, 6.38). After adjusting for age and gender, mortality from natural causes was predicted in separate models by cigarette smoking (relative risk [RR] = 4.66, P = .0029); lower cognitive score (RR = 0.96, P = .013); level of antibodies to Epstein-Barr virus (RR = 1.22, P = .0041) and to Herpes Simplex virus type 1 (RR = 1.19, P = .030); immunologic disease (RR = 3.14, P = .044); and genitourinary disease (RR = 2.70; P = .035). Because cigarette smoking confers an almost 5-fold risk of mortality, smoking cessation is an urgent priority. Having an elevated level of antibodies to Epstein-Barr virus and to Herpes Simplex virus type 1 are also significant predictors of death from natural causes.

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  • There was no difference in mortality risk between BME and white British groups beyond what would be expected by chance.

    “Although mortality risk was slightly lower in cases from the BME compared with the white British group, in contrast to earlier research,23,24 we found no difference beyond what would be expected by chance.”

    From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [23]

  • The absence of systematic differences across ethnic groups may be accounted for by social and health disparities in BME populations being offset through greater attention to medical treatment of physical health problems in patients in the care of mental health services.

    “the absence of systematic differences across ethnic groups or, as has been reported earlier, an even lower mortality risk in BME groups,23,24 may be accounted for by social and health disparities in BME populations being offset through the, relatively speaking, greater attention to medical treatment of physical health problems in patients in the care of mental health services.”

    From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [23]

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  1. [17]17. First M, Gibbon M, Spitzer RL, Williams JBW. User’s Guide for the SCID-I, Structured Clinical Interview for DSM IV Axis I Disorders. New York: Biometrics Research; 1996. [Google Scholar]

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Authors
Dickerson, F., Stallings, C., Origoni, A., Schroeder, J., Khushalani, S., & Yolken, R.
Affiliations
  • Sheppard Pratt Health System (US)
  • Johns Hopkins University (US)
Corresponding author
Dickerson, Faith
ORCID
Venue
Schizophrenia Bulletin
Publisher
Oxford University Press (OUP)
Published
2013-08-13
Volume
40
Issue
4
Pages
796-803
ISSN
  • 0586-7614 (ISSN-L)
  • 1745-1701
DOI
10.1093/schbul/sbt113
PMC
PMC4059441
OpenAlex
W2154240268
Cited by
50
References
42
Citations by year
2026: 1 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 5 · 2018: 6 · 2017: 3 · 2016: 4 · 2015: 9 · 2014: 1
FWCI
3.30
Type
journal article
Language
en
Open access
Locations
  • Schizophrenia Bulletin (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Keywords
schizophrenia, mortality
MeSH terms
Adult, Antibodies, Protozoan, Antibodies, Viral, Cognition Disorders, Herpesvirus 4, Human, Female, Herpesviridae, Herpesviridae Infections, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Schizophrenia, Schizophrenic Psychology, Smoking, Toxoplasma, Toxoplasmosis, United States, Cohort Studies, Herpesvirus 1, Human, Mortality, Premature

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