Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort
Open accessAbstract
The excess mortality in people with psychotic disorders is a major public health concern, but little is known about the clinical and social risk factors which may predict this health inequality and help inform preventative strategies. We aimed to investigate mortality in a large epidemiologically characterized cohort of individuals with first-episode psychosis compared with the general population and to determine clinical and social risk factors for premature death. All 557 individuals with first-episode psychosis initially identified in 2 areas (Southeast London and Nottinghamshire, United Kingdom) were traced over a 10-year period in the ӔSOP-10 study. Compared with the general population, all-cause (standardized mortality ratio [SMR] 3.6, 95% confidence interval [CI] 2.6-4.9), natural-cause (SMR 1.7, 95% CI 1.0-2.7) and unnatural-cause (SMR 13.3, 95% CI 8.7-20.4) mortality was very high. Illicit drug use was associated with an increased risk of all-cause mortality (adj. rate ratio [RR] 2.31, 95% CI 1.06-5.03). Risk of natural-cause mortality increased with a longer time to first remission (adj. RR 6.61, 95% CI 1.33-32.77). Family involvement at first contact strongly reduced risk of unnatural-cause mortality (adj. RR 0.09, 95% CI 0.01-0.69). Our findings suggest that the mortality gap in people with psychotic disorders remains huge and may be wider for unnatural-cause mortality than previously reported. Efforts should now focus on further understanding and targeting these tractable clinical and social risk factors of excess mortality. Early intervention and dual diagnosis services may play a key role in achieving more rapid remission and carer involvement and addressing substance use problems to reduce excess mortality in psychosis.
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Written from the paper’s full text.
TL;DR
In a 10-year follow-up of 549 first-episode psychosis cases from the ӔSOP cohort, all-cause mortality was 3.6 times higher than in the local general population, with especially marked excess unnatural-cause and suicide mortality. Illicit drug use, longer time to first remission, and lack of family involvement at first contact were linked to higher mortality risk.
Key findings
- Of 549 cases, 39 (7.1%; 717.3 per 100 000 person-years) died: 15 from natural causes, 21 from unnatural causes, and 3 from unknown causes.
- Compared with the local general population, SMRs were 3.6 (95% CI 2.6–4.9) for all-cause mortality, 1.7 (95% CI 1.0–2.7) for natural-cause mortality, 13.3 (95% CI 8.7–20.4) for unnatural-cause mortality, and 20.0 (95% CI 11.7–34.5) for suicide.
- Illicit drug use was associated with increased all-cause mortality (adj. RR 2.31, 95% CI 1.06–5.03) and unnatural-cause mortality (adj. RR 3.78, 95% CI 1.11–12.89 in the adjusted model; text notes attenuation to adj. RR 3.25, 95% CI 0.96–11.03 after confounding by family involvement).
- Longer time to first remission (>2 years) increased natural-cause mortality risk (adj. RR 6.61, 95% CI 1.33–32.77), while full family involvement at first contact strongly reduced unnatural-cause mortality risk (adj. RR 0.09, 95% CI 0.01–0.69).
Methods
- ӔSOP-10 traced 557 individuals with first-episode psychosis initially identified in Southeast London and Nottinghamshire over a mean 10.0 years (SD = 2.3); after exclusions, 549 were analyzed.
- Deaths and emigration were identified via the Office for National Statistics and General Register Office; underlying causes were classified from ICD-10 death certificates into natural, unnatural, and unknown causes, with clinical-record information from an extended WHO Life Chart.
- Analyses included crude mortality rates, Kaplan–Meier plots, Cox regression, Poisson regression for risk factors, and indirect standardization to calculate SMRs against local general-population rates by age band, sex, and study center.
Limitations
- The paper states that baseline clinical and social factors may have varied over time, mortality was statistically rare leading to wide CIs and imprecise estimates, and unmeasured confounding by smoking, obesity, lifestyle, medication, and healthcare access/quality cannot be ruled out; alcohol use at baseline was not measured as a risk factor.
- The paper also notes that findings may not be directly comparable with studies of more severe and enduring psychosis rather than first-episode cohorts.
- Evident from the text: the observational design cannot establish causality, and several covariates had missing data (e.g., DUP n = 41, time to first remission n = 123, illicit drug use n = 88, family involvement n = 64), which may affect precision or bias.
Model-written summary. Check it against the paper before relying on it.
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Cites
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Claims the paper makes
0 of 60 cited sources checked · 0 supported · 0 flagged
- Findingown data
Among natural-cause deaths, 3 (0.6%, 55.2 per 100 000 person-years) were probable alcohol-related.
“and 3 (0.6%, 55.2 per 100 000 person-years) from probable alcohol-related causes”
Quote in the paperNot a substantial claim - Findingown data
All-cause SMRs were of similar magnitude in London and Nottingham.
“All-cause SMRs were of similar magnitude in the 2 study sites (London and Nottingham)”
Quote in the paperNot a substantial claim - Findingown data
Mortality rates for all causes, natural causes, and unnatural causes of death were similar in London and Nottingham.
“Mortality rates for all causes, natural causes, and unnatural causes of death were similar in London and Nottingham.”
Quote in the paperNot a substantial claim - Findingown data
Long time to first remission was associated with a shorter time to all- and natural-cause death in Kaplan-Meier survival curves.
“There was evidence from Kaplan–Meier survival curves that a long DUP (see supplementary figure 3) and a long time to first remission (see supplementary figure 4) were associated with a shorter time to all- and natural-cause death.”
Quote in the paperSubstantial claim - Findingown data
Of the 549 cases, 21 (3.8%, 386.3 per 100 000 person-years) died due to unnatural causes.
“21 (3.8%, 386.3 per 100 000 person-years) due to unnatural causes”
Quote in the paperSubstantial claim
- Findingown data
Illicit drug use in the year prior to baseline was associated with a shorter time to all-cause death, controlling for age and sex.
“In addition, illicit drug use in the year prior to baseline was associated with a shorter time to all- and unnatural-cause death, while controlling for age and sex (see supplementary table 4, supplementary figure 5).”
Quote in the paperSubstantial claim - Findingown data
Long DUP was associated with a shorter time to all- and natural-cause death in Kaplan-Meier survival curves.
“There was evidence from Kaplan–Meier survival curves that a long DUP (see supplementary figure 3) and a long time to first remission (see supplementary figure 4) were associated with a shorter time to all- and natural-cause death.”
Quote in the paperSubstantial claim - Findingown data
The association between full family involvement and reduced unnatural-cause mortality held when further adjusted for illicit drug use.
“This association held when we further adjusted for illicit drug use (χ2 = 2.65, P = .10).”
Quote in the paperNot a substantial claim - Findingown data
The rate ratio for a long time to first remission and increased risk of natural-cause mortality held after controlling for age and sex as well as DUP.
“However, the rate ratio for a long time to first remission and increased risk of natural-cause mortality held after controlling for age and sex (see table 4) as well as DUP (LRT, χ2 = 0.01, P = .92).”
Quote in the paperSubstantial claim - Findingown data
There was some evidence that the association between illicit drug use and unnatural-cause mortality was confounded by lack of family involvement at first contact.
“However, we found some evidence that the association between illicit drug use and unnatural-cause mortality was confounded by lack of family involvement at first contact (LRT, χ2 = 7.22, P = .03).”
Quote in the paperNot a substantial claim - Findingown data
Women experienced a lower risk of unnatural-cause mortality over time than men, based on Kaplan-Meier survival curves and Cox regression.
“with Kaplan–Meier survival curves and findings from Cox regression suggesting that women experienced a lower risk of unnatural-cause mortality over time than men”
Quote in the paperNot a substantial claim - Findingown data
Of 17 cases with unnatural-cause death and reliable baseline illicit drug use information, 12 (70.6%) had reported baseline illicit drug use in the previous year.
“Of the 17 cases with unnatural-cause death for whom we had reliable information on baseline illicit drug use (81.0% of 21 who had died from unnatural causes), 12 (70.6% of 17) had reported at baseline having used illicit drugs in the previous”
Quote in the paperNot a substantial claim - Findingown data
The most common unnatural cause of death was suicide (n = 13, 2.4%, 239.1 per 100 000 person-years).
“The most common unnatural cause of death was suicide (n = 13, 2.4%, 239.1 per 100 000 person-years)”
Quote in the paperNot a substantial claim - Findingown data
Of the 549 cases, 3 (0.6%, 55.2 per 100 000 person-years) died due to unknown causes.
“3 (0.6%, 55.2 per 100 000 person-years) due to unknown causes of death.”
Quote in the paperNot a substantial claim - Findingown data
All-cause SMRs lessened for cases in higher age bands.
“and lessened for cases in higher age bands.”
Quote in the paperNot a substantial claim - Findingown data
Unnatural-cause mortality rate was lower in women than in men.
“All-cause and unnatural-cause mortality rates were lower in women (487.0 per 100 000 person-years) than in men (881.0 per 100 000 person-years)”
Quote in the paperNot a substantial claim - Findingown data
Compared with the local general population, unnatural-cause mortality in the first-episode psychosis cohort was increased (SMR 13.3, 95% CI 8.7-20.4).
“unnatural-cause (SMR 13.3, 95% CI 8.7–20.4) mortality was very high.”
- Also stated in: § Mortality in the ӔSOP Cohort Compared With the Local General Population · plain
“compared with a 13-fold increase in unnatural-cause mortality.”
Quote in the paperSubstantial claim - Also stated in: § Mortality in the ӔSOP Cohort Compared With the Local General Population · plain
- Findingown data
Poisson regression modeling revealed a decreased risk of unnatural-cause mortality in women compared with men after controlling for age at baseline.
“Poisson regression modeling revealed a decreased risk of unnatural-cause mortality in women compared with men after controlling for age at baseline”
Quote in the paperNot a substantial claim - Findingown data
Family involvement at first contact strongly reduced risk of unnatural-cause mortality (adj. RR 0.09, 95% CI 0.01-0.69).
“Family involvement at first contact strongly reduced risk of unnatural-cause mortality (adj. RR 0.09, 95% CI 0.01–0.69).”
- Also stated in: § All-, Natural- and Unnatural-Cause Mortality by Clinical and Social Factors · plain
“Finally, a significantly reduced risk of unnatural-cause mortality was found in cases with full family involvement compared with those with no family involvement at first contact with services, while controlling for age and sex.”
Quote in the paperSubstantial claim - Also stated in: § All-, Natural- and Unnatural-Cause Mortality by Clinical and Social Factors · plain
- Findingown data
There was some evidence that the increase in risk of suicide was more marked in London (SMR 28.3, 95% CI 15.7-51.1) than in Nottingham (SMR 7.7, 95% CI 1.9-30.8), though CIs were very wide and overlapped to a degree.
“there was some evidence that the increase in risk of suicide was more marked in London (SMR 28.3, 95% CI 15.7–51.1) than in Nottingham (SMR 7.7, 95% CI 1.9–30.8), though CIs were very wide and overlapped to a degree.”
Quote in the paperNot a substantial claim - Findingown data
Risk of suicide as the most common unnatural cause of death in the cohort was 20-fold raised compared with the local general population (SMR 20.0, 95% CI 11.7-34.5).
“When we further examined risk of suicide as the most common unnatural cause of death in the cohort, this was 20-fold raised compared with that in the local general population (SMR 20.0, 95% CI 11.7–34.5).”
Quote in the paperSubstantial claim - Findingown data
There was no evidence that SMRs for suicide varied by sex and age.
“Although we found no evidence that SMRs for suicide varied by sex and age”
Quote in the paperNot a substantial claim - Findingown data
Risk of natural-cause mortality increased with a longer time to first remission (adj. RR 6.61, 95% CI 1.33-32.77).
“Risk of natural-cause mortality increased with a longer time to first remission (adj. RR 6.61, 95% CI 1.33–32.77).”
- Also stated in: § All-, Natural- and Unnatural-Cause Mortality by Clinical and Social Factors · plain
“However, the rate ratio for a long time to first remission and increased risk of natural-cause mortality held after controlling for age and sex (see table 4) as well as DUP (LRT, χ2 = 0.01, P = .92).”
Quote in the paperSubstantial claim - Also stated in: § All-, Natural- and Unnatural-Cause Mortality by Clinical and Social Factors · plain
- Findingown data
Of the 549 first-episode psychosis cases not excluded, 39 (7.1%, 717.3 per 100 000 person-years) had died.
“Of the remaining 549 cases, 39 (7.1% of the sample, 717.3 per 100 000 person-years) cases had died”
Quote in the paperSubstantial claim - Findingown data
Among natural-cause deaths, 3 (0.6%, 55.2 per 100 000 person-years) were definite alcohol-related.
“3 (0.6%, 55.2 per 100 000 person-years) of these having died from definite alcohol-related causes”
Quote in the paperNot a substantial claim - Findingown data
Compared with the local general population, all-cause mortality in the first-episode psychosis cohort was increased (SMR 3.6, 95% CI 2.6-4.9).
“Compared with the general population, all-cause (standardized mortality ratio [SMR] 3.6, 95% confidence interval [CI] 2.6–4.9), natural-cause (SMR 1.7, 95% CI 1.0–2.7) and unnatural-cause (SMR 13.3, 95% CI 8.7–20.4) mortality was very high.”
- Also stated in: § Mortality in the ӔSOP Cohort Compared With the Local General Population · plain
“There was an almost 4-fold increase in all-cause mortality in the cohort compared with that in the general population (SMR 3.6, 95% CI 2.6–4.9).”
Quote in the paperSubstantial claim - Also stated in: § Mortality in the ӔSOP Cohort Compared With the Local General Population · plain
- Findingown data
There was no evidence of confounding of the association between drug use and all-cause mortality by DUP, time to first remission, and family involvement at first contact.
“There was no evidence of confounding of the association between drug use and all-cause mortality by DUP (LRT, χ2 = 4.48, P = .11), time to first remission (LRT, χ2 = 2.31, P = .13), and family involvement at first contact (LRT, χ2 = 5.27, P = .15).”
Quote in the paperNot a substantial claim - Findingown data
Of the 549 cases, 15 (2.7%, 275.9 per 100 000 person-years) died due to natural causes.
“15 (2.7%, 275.9 per 100 000 person-years) due to natural causes”
Quote in the paperNot a substantial claim - Findingown data
Findings from Cox regression indicated that the association between time to first remission and natural-cause death over time held after controlling for age at baseline and sex.
“Findings from Cox regression further indicated that the association between time to first remission and natural-cause death over time held after controlling for age at baseline and sex (see supplementary table 4).”
Quote in the paperSubstantial claim - Findingown data
Illicit drug use was associated with an increased risk of all-cause mortality (adj. RR 2.31, 95% CI 1.06-5.03).
“Illicit drug use was associated with an increased risk of all-cause mortality (adj. rate ratio [RR] 2.31, 95% CI 1.06–5.03).”
- Also stated in: § All-, Natural- and Unnatural-Cause Mortality by Clinical and Social Factors · plain
“Further, illicit drug use was associated with a 2- to 3-fold increased risk of all- and unnatural-cause mortality while controlling for age and sex.”
Quote in the paperSubstantial claim - Also stated in: § All-, Natural- and Unnatural-Cause Mortality by Clinical and Social Factors · plain
- Findingown data
Cases with natural causes of death predominantly died from diseases of the digestive system (n = 7, 1.3%, 128.8 per 100 000 person-years).
“Cases with natural causes of death predominantly died from diseases of the digestive system (n = 7, 1.3%, 128.8 per 100 000 person-years)”
Quote in the paperNot a substantial claim - Findingown data
Illicit drug use was associated with a 2- to 3-fold increased risk of unnatural-cause mortality while controlling for age and sex.
“Further, illicit drug use was associated with a 2- to 3-fold increased risk of all- and unnatural-cause mortality while controlling for age and sex.”
Quote in the paperSubstantial claim - Findingown data
Younger cases had significantly reduced risk of natural-cause mortality after adjusting for sex.
“The sex-adjusted rate ratio for the effect of age at baseline indicated significantly reduced risk of all-cause and natural-cause mortality in younger cases.”
Quote in the paperNot a substantial claim - Findingown data
There were no statistically significant differences in risk of mortality by broad ethnic group.
“There were no statistically significant differences in risk of mortality by broad ethnic group.”
Quote in the paperNot a substantial claim - Findingown data
Younger cases had significantly reduced risk of all-cause mortality after adjusting for sex.
“The sex-adjusted rate ratio for the effect of age at baseline indicated significantly reduced risk of all-cause and natural-cause mortality in younger cases.”
Quote in the paperSubstantial claim - Findingown data
After controlling for age and sex, the association between a long time to first remission and increased risk of all-cause mortality was reduced and no longer significant.
“Similarly, after controlling for these variables, the association between a long time to first remission and increased risk of all-cause mortality was reduced and no longer significant.”
Quote in the paperNot a substantial claim - Findingown data
Compared with the local general population, natural-cause mortality in the first-episode psychosis cohort was increased (SMR 1.7, 95% CI 1.0-2.7).
“natural-cause (SMR 1.7, 95% CI 1.0–2.7)”
- Also stated in: § Mortality in the ӔSOP Cohort Compared With the Local General Population · hedged
“When broken down by natural and unnatural causes of death, the increase in natural-cause mortality was approximately 2-fold, compared with a 13-fold increase in unnatural-cause mortality.”
Quote in the paperSubstantial claim - Also stated in: § Mortality in the ӔSOP Cohort Compared With the Local General Population · hedged
- Findingown data
All-cause mortality rate was lower in women (487.0 per 100 000 person-years) than in men (881.0 per 100 000 person-years).
“All-cause and unnatural-cause mortality rates were lower in women (487.0 per 100 000 person-years) than in men (881.0 per 100 000 person-years)”
Quote in the paperNot a substantial claim - Findingown data
All-cause SMR was slightly more pronounced in men (SMR 4.1, 95% CI 2.8-5.9) than in women (SMR 2.8, 95% CI 1.6-5.1).
“slightly more pronounced in men (SMR 4.1, 95% CI 2.8–5.9) than in women (SMR 2.8, 95% CI 1.6–5.1)”
Quote in the paperNot a substantial claim - Findingown data
At follow-up, 3 cases (0.6%, 55.2 per 100 000 person-years) had died from accidental poisoning.
“At follow-up, 3 cases (0.6%, 55.2 per 100 000 person-years) had died from accidental poisoning”
Quote in the paperNot a substantial claim - Findingown data
There was evidence of a longer time to unnatural death for cases with full family involvement at first contact with services.
“There was also evidence of a longer time to unnatural death for cases with full family involvement at first contact with services (see supplementary table 4, supplementary figure 6).”
Quote in the paperNot a substantial claim - Findingown data
Illicit drug use in the year prior to baseline was associated with a shorter time to unnatural-cause death, controlling for age and sex.
“In addition, illicit drug use in the year prior to baseline was associated with a shorter time to all- and unnatural-cause death, while controlling for age and sex (see supplementary table 4, supplementary figure 5).”
Quote in the paperNot a substantial claim - Findingown data
Risk of suicide was increased 20-fold.
“and a 20-fold increase in risk of suicide.”
Quote in the paperSubstantial claim - Findingown data
Women had a significantly reduced risk of unnatural-cause mortality compared with men.
“a significantly reduced risk of unnatural-cause mortality was observed in women compared with men.”
Quote in the paperSubstantial claim - Findingown data
All-cause mortality in the cohort was raised almost 4-fold compared with the general population.
“All-cause mortality in the cohort was raised almost 4-fold.”
- Also stated in: § Comparison With Previous Research · boosted
“Our findings add to this by demonstrating an almost 4-fold increase in all-cause mortality in the ӔSOP cohort compared with the general population.”
Quote in the paperSubstantial claim - Also stated in: § Comparison With Previous Research · boosted
- Findingown data
Two cases had died from heroin intoxication.
“2 cases had died from heroin intoxication”
Quote in the paperNot a substantial claim - Findingcitation
Unnatural-cause mortality rates remained high across the follow-up period.
“unnatural-cause mortality rates remained high across the follow-up period”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40] 2010, Reassessing the long-term risk of suicide after a first episode of psychosis, Arch Gen Psychiatry source
Not checked in the free run.
- Findingown data
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.”
Quote in the paperNot a substantial claim0 of 2 sources checked - Findingown data
Natural-cause mortality was increased approximately 2-fold.
“an approximately 2-fold increase in natural-cause mortality was observed”
Quote in the paperSubstantial claim - Findingown data
All-cause SMRs lessened with increasing age of cases in the sample.
“all-cause SMRs lessened with increasing age of cases in our sample”
Quote in the paperNot a substantial claim - Findingown data
All-cause and unnatural-cause mortality rates remained broadly similar across the follow-up period.
“All- and unnatural-cause mortality rates remained broadly similar across the follow-up period.”
Quote in the paperNot a substantial claim - Findingown data
There was no difference in mortality rates by employment status as assessed at baseline.
“we observed no difference in mortality rates by employment status as assessed at baseline”
Quote in the paperNot a substantial claim - Findingown data
Suicide was the leading cause of death in the cohort.
“with suicide being the leading cause of death”
Quote in the paperSubstantial claim - Findingown data
At least one-fifth of natural-cause deaths were alcohol-related.
“at least one-fifth of natural-cause deaths were alcohol-related.”
Quote in the paperNot a substantial claim - Findingown data
There was no difference in all-, natural-, and unnatural-cause mortality between nonaffective and affective psychoses.
“we found no difference in all-, natural-, and unnatural-cause mortality between nonaffective and affective psychoses.”
Quote in the paperSubstantial claim - Findingown data
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”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] 2007, A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?, Arch Gen Psychiatry source
Not checked in the free run.
- Findingown data
Full family involvement at first contact reduced risk of unnatural-cause mortality.
“full family involvement at first contact reduced risk of unnatural-cause mortality.”
- Also stated in: § Comparison With Previous Research · plain
“Our finding that family involvement at first contact reduces risk of unnatural-cause mortality”
Quote in the paperSubstantial claim - Also stated in: § Comparison With Previous Research · plain
- Findingown data
More cases in the cohort had died from unnatural than natural causes.
“More cases had died from unnatural than natural causes”
Quote in the paperSubstantial claim - Findingown data
Unnatural-cause mortality was increased 13-fold.
“compared with a 13-fold increase in unnatural-cause mortality”
Quote in the paperSubstantial claim - Findingown data
A longer time to first remission is associated with a higher risk of natural-cause mortality.
“The longer the time to first remission, the higher the risk of natural-cause mortality”
- Also stated in: § Comparison With Previous Research · hedged
“We found evidence that a long time to first remission may increase risk of natural-cause mortality in our sample.”
Quote in the paperSubstantial claim - Also stated in: § Comparison With Previous Research · hedged
- Findingown data
Illicit drug use increased unnatural-cause mortality risk.
“illicit drug use increased all-cause and (at least partially explained by lack of family involvement at first contact) unnatural-cause mortality risk”
- Also stated in: § Comparison With Previous Research · plain
“illicit drug use is associated with a 2- to 3-fold increased risk of all- and unnatural-cause mortality”
Quote in the paperSubstantial claim - Also stated in: § Comparison With Previous Research · plain
- Findingown data
A considerable proportion of cases who had died from unnatural causes at follow-up had reported having used cannabis only at baseline.
“a considerable proportion of cases who had died from unnatural causes at follow-up had reported having used cannabis only at baseline.”
Quote in the paperNot a substantial claim - Findingown data
Illicit drug use increased all-cause mortality risk.
“illicit drug use increased all-cause”
- Also stated in: § Comparison With Previous Research · plain
“illicit drug use is associated with a 2- to 3-fold increased risk of all- and unnatural-cause mortality”
Quote in the paperSubstantial claim - Also stated in: § Comparison With Previous Research · plain
- Premisecitation
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”
Quote in the paperSubstantial claim0 of 10 sources checked- cites [1] 2012, A critical review of major mortality risk factors for all-cause mortality in first-episode schizophrenia: clinical and research implications, J Psychopharmacol source
Not checked in the free run.
- cites [2] 2013, Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study, Am J Psychiatry source
Not checked in the free run.
- cites [3] 2013, Avoidable mortality in people with schizophrenia or bipolar disorder in England, Acta Psychiatr Scand source
Not checked in the free run.
- cites [4] 2011, Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999–2006, BMJ source
Not checked in the free run.
- cites [5] 2011, Increasing mortality in schizophrenia: are women at particular risk? A follow-up of 1111 patients admitted during 1980–2006 in Northern Norway, Schizophr Res source
Not checked in the free run.
- cites [6] 2014, Excess early mortality in schizophrenia, Annu Rev Clin Psychol source
Not checked in the free run.
- cites [7] 2012, Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia, Gen Hosp Psychiatry source
Not checked in the free run.
- cites [8] 2013, Increasing mortality gap for patients diagnosed with schizophrenia over the last three decades—a Danish nationwide study from 1980 to 2010, Schizophr Res source
Not checked in the free run.
- cites [9] 2007, A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?, Arch Gen Psychiatry source
Not checked in the free run.
- cites [10] 2011, Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders, Br J Psychiatry source
Not checked in the free run.
- Premisecitation
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”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [9] 2007, A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?, Arch Gen Psychiatry source
Not checked in the free run.
- cites [17] 2008, The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States, PLoS Med source
Not checked in the free run.
- cites [18] 2013, Exploring geographic variation in US mortality rates using a spatial durbin approach, Popul Space Place
Not checked in the free run.
- Premisecitation
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”
Quote in the paperSubstantial claim0 of 9 sources checked- cites [1] 2012, A critical review of major mortality risk factors for all-cause mortality in first-episode schizophrenia: clinical and research implications, J Psychopharmacol source
Not checked in the free run.
- cites [2] 2013, Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study, Am J Psychiatry source
Not checked in the free run.
- cites [3] 2013, Avoidable mortality in people with schizophrenia or bipolar disorder in England, Acta Psychiatr Scand source
Not checked in the free run.
- cites [4] 2011, Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999–2006, BMJ source
Not checked in the free run.
- cites [5] 2011, Increasing mortality in schizophrenia: are women at particular risk? A follow-up of 1111 patients admitted during 1980–2006 in Northern Norway, Schizophr Res source
Not checked in the free run.
- cites [6] 2014, Excess early mortality in schizophrenia, Annu Rev Clin Psychol source
Not checked in the free run.
- cites [7] 2012, Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia, Gen Hosp Psychiatry source
Not checked in the free run.
- cites [8] 2013, Increasing mortality gap for patients diagnosed with schizophrenia over the last three decades—a Danish nationwide study from 1980 to 2010, Schizophr Res source
Not checked in the free run.
- cites [9] 2007, A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?, Arch Gen Psychiatry source
Not checked in the free run.
- Interpretationcitation
Unemployment may have varied at the level of individual cases and therefore attenuated differences in mortality rates.
“this may have varied at the level of individual cases and therefore attenuated differences in mortality rates.34”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [34] 2000, Causes of the excess mortality of schizophrenia, Br J Psychiatry source
Not checked in the free run.
- Premisecitation
The reduced risk of unnatural-cause mortality observed in women compared with men is consistent with most earlier studies.
“The reduced risk of unnatural-cause mortality that we observed in women compared with men is consistent with most earlier studies investigating this issue to date.40,52”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [40] 2010, Reassessing the long-term risk of suicide after a first episode of psychosis, Arch Gen Psychiatry source
Not checked in the free run.
- cites [52] National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, 2006, Suicide in schizophrenia: findings from a national clinical survey, J Psychiatr Pract source
Not checked in the free run.
- Study design and conductreasoning
Restricting analyses to baseline factors allowed establishing temporal priority of these factors over the mortality outcome.
“restricting our analyses to baseline factors allowed us to establish temporal priority of these overmortality outcome.”
Quote in the paperSubstantial claim - Study design and conductcitation
Attrition bias has been reported to be minimal for the 10-year follow-up period.
“for which attrition bias has been reported to be minimal for the 10-year follow-up period.28”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] 2014, Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study, Psychol Med source
Not checked in the free run.
- Interpretationreasoning
The study's findings may not be directly comparable with those reported in the wider literature because many earlier studies included patients with more severe and enduring psychosis rather than first-episode cases.
“Given many earlier studies have not been cohorts comprising first-episode cases but included patients with more severe and enduring psychosis, our findings may not be directly comparable with those reported in the wider literature.”
Quote in the paperNot a substantial claim- Rests on an assumption: Many earlier studies included patients with more severe and enduring psychosis rather than first-episode cases.
- Interpretationcitation
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”
Quote in the paperSubstantial claim0 of 2 sources checked - Study design and conductnone given
Unmeasured confounding by smoking, obesity, other unhealthy lifestyle factors, medication, and access to or quality of healthcare cannot be ruled out.
“we cannot rule out the possibility of unmeasured confounding by other important factors such as smoking, obesity and other unhealthy lifestyle factors, medication, and access to, or quality of, healthcare.”
Quote in the paperNot a substantial claim - Interpretationcitation
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”
Quote in the paperNot a substantial claim0 of 5 sources checked- cites [4] 2011, Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999–2006, BMJ source
Not checked in the free run.
- cites [9] 2007, A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?, Arch Gen Psychiatry source
Not checked in the free run.
- cites [12] 2012, Mortality in first-contact psychosis patients in the U.K.: a cohort study, Psychol Med source
Not checked in the free run.
- cites [35] 1997, Excess mortality of schizophrenia. A meta-analysis, Br J Psychiatry source
Not checked in the free run.
- cites [36] 2000, Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study, BMJ source
Not checked in the free run.
- Study design and conductreasoning
No firm conclusions can be drawn about alcohol use as a risk factor for mortality.
“no firm conclusions can be drawn about alcohol use as a risk factor for morality.”
Quote in the paperNot a substantial claim - Study design and conductnone given
The study was based on a large, epidemiologically characterized cohort of unselected first-episode cases presenting to mental health services within defined catchment areas.
“A notable strength of this study is that it was based on a large, epidemiologically characterized cohort of unselected first-episode cases presenting to mental health services within defined catchment areas”
Quote in the paperSubstantial claim - Interpretationreasoning
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.”
Quote in the paperNot a substantial claim0 of 2 sources checked - Interpretationown data
Some of the elevated risk of unnatural-cause mortality was due to accidental poisoning by heroin.
“some of the elevated risk of unnatural-cause mortality was due to accidental poisoning by this drug”
Quote in the paperNot a substantial claim - Interpretationreasoning
It remains difficult to disentangle whether family fragmentation exacerbated illicit drug use and increased risk of unnatural-cause mortality, or vice versa.
“it remains difficult to disentangle whether it is family fragmentation that may have exacerbated illicit drug use and, in turn, increased risk of unnatural-cause mortality, or vice versa, illicit drug use rendered families more fragmented and, thereby, individuals more vulnerable to death from unnatural causes.”
Quote in the paperNot a substantial claim - Study design and conductnone given
Alcohol use at baseline was one of the most important unmeasured factors in this study.
“One of the most important unmeasured factors in the context of this study was alcohol use at baseline.”
Quote in the paperNot a substantial claim - Study design and conductown data
The study was able to compare mortality in this cohort with that in the local general population of the defined catchment areas, addressing variation in general population mortality by place.
“We were further able to compare mortality in this cohort with that in the local general population of the defined catchment areas, thereby addressing the issue that mortality rates in the general population vary (markedly) by place”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [17] 2008, The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States, PLoS Med source
Not checked in the free run.
- cites [18] 2013, Exploring geographic variation in US mortality rates using a spatial durbin approach, Popul Space Place
Not checked in the free run.
- Interpretationown data
Lack of family involvement at first contact with services partially explained the association between illicit drug use and unnatural-cause mortality.
“we found some evidence that a lack of family involvement at first contact with services confounded to a degree the association between illicit drug use and unnatural-cause mortality.”
Quote in the paperNot a substantial claim
- May combine two claims. 12
- The quote only partly states this claim. 2
- Classified as probably not a substantial claim. 11
May combine two claims.
Findingown dataWhile a long DUP was associated with an increased risk of all- and natural-cause mortality in unadjusted analyses, this association was attenuated and ceased to be statistically significant when adjusting for age at baseline and sex.
“While a long DUP was associated with an increased risk of all- and natural-cause mortality in unadjusted analyses, this association was attenuated and ceased to be statistically significant when adjusting for age at baseline and sex.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataNatural-cause SMRs were equally elevated in London and Nottingham as well as in men and women, but not statistically significant at conventional levels.
“Natural-cause SMRs were equally elevated in London and Nottingham as well as in men and women, but not statistically significant at conventional levels (ie, P < .05).”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataYounger cases (16-29 years) had lower natural-cause mortality rate (265.6 per 100 000 person-years) than older cases (30-65 years).
“Younger cases had lower mortality rates for all causes (466.3 per 100 000 person-years) and natural causes (265.6 per 100 000 person-years).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataMortality rates for all causes, natural causes, and unnatural causes of death were slightly lower in cases from a Black and Minority Ethnic (BME) group than in white British cases, but CIs were wide.
“Mortality rates for all causes, natural causes, and unnatural causes of death were slightly lower in cases from a Black and Minority Ethnic (BME) group than in white British cases, but CIs for these point estimates were wide.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThere was some limited variation in mortality rates by time since first presentation to services, but overall these were broadly similar over the follow-up period.
“While there was some limited variation in mortality rates by time since first presentation to services, overall, these were broadly similar over the follow-up period”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataYounger cases (16-29 years) had lower all-cause mortality rate (466.3 per 100 000 person-years) than older cases (30-65 years).
“Younger cases had lower mortality rates for all causes (466.3 per 100 000 person-years) and natural causes (265.6 per 100 000 person-years).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThere was no strong evidence that unnatural-cause SMRs varied by place, sex, or age and these SMRs remained high for older cases (aged 60-74 years).
“There was no strong evidence that unnatural-cause SMRs varied by place, sex, or age and these SMRs remained high for older cases (ie, aged 60–74 years).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThere was some weak evidence that the increase in natural-cause mortality was higher in age bands 30-44 years and 45-59 years than in age bands 16-29 years and 60-74 years; however, CIs were wide and overlapped across age bands.
“There was some weak evidence that the increase in natural-cause mortality was higher in age bands 30–44 years and 45–59 years than in age bands 16–29 years and 60–74 years; however, CIs were wide and overlapped across age bands.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThere was some evidence of a more marked excess of suicide in London than in Nottingham.
“with some evidence of there being a more marked excess of suicide in London than in Nottingham.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductcitationUnderlying cause of death was further ascertained based on extensive information collated from clinical records at follow-up using an extended version of the WHO Life Chart.
“The underlying cause of death recorded on copies of death certificates was further ascertained based on extensive information collated from clinical records at follow-up using an extended version of the World Health Organization (WHO) Life Chart.28,30”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [28] 2014, Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study, Psychol Med source
Not checked in the free run.
- cites [30] 1996, Long-term follow-up of schizophrenia in 16 countries. A description of the International Study of Schizophrenia conducted by the World Health Organization, Soc Psychiatry Psychiatr Epidemiol source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationConflicting results have been recently reported as to whether illicit drug use contributes to excess mortality in psychosis.
“Conflicting results have been recently reported as to whether illicit drug use contributes to excess mortality in psychosis.2,25,26”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [2] 2013, Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study, Am J Psychiatry source
Not checked in the free run.
- cites [25] Oregon Department of Human Services, 2008
Not checked in the free run.
- cites [26] 2011, The impact of substance use disorders on the course of schizophrenia—a 15-year follow-up study: dual diagnosis over 15 years, Schizophr Res source
Not checked in the free run.
May combine two claims.
Interpretationown dataThe mortality gap in people with psychotic disorders remains huge and may be wider for unnatural-cause mortality than previously reported.
“Our findings suggest that the mortality gap in people with psychotic disorders remains huge and may be wider for unnatural-cause mortality than previously reported.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductcitationPrincipal underlying causes of death were determined according to ICD-10 as recorded on death certificates obtained from ONS.
“For all identified deaths, principal underlying causes of death were determined according to the International Classification of Diseases, 10th revision (ICD-10),29 as recorded on copies of death certificates obtained from ONS.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [29] World Health Organization, 1992
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationEvidence 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”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [2] 2013, Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study, Am J Psychiatry source
Not checked in the free run.
- cites [7] 2012, Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia, Gen Hosp Psychiatry source
Not checked in the free run.
- cites [9] 2007, A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?, Arch Gen Psychiatry source
Not checked in the free run.
- cites [12] 2012, Mortality in first-contact psychosis patients in the U.K.: a cohort study, Psychol Med source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductown dataSMRs were calculated based on observed deaths in the cohort and expected deaths for each study center by age band and sex derived from ONS mortality rates and population estimates.
“Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) for all, natural, and unnatural causes of death were calculated based on the observed number of deaths in the cohort and the expected number of deaths for each study center by age band and sex derived from ONS all-, natural-, and unnatural-cause mortality rates (in the population at risk) and population estimates.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductreasoningPoisson regression modeling controlled for potential confounders based on change in magnitude of effect and association with outcome.
“Poisson regression modeling was conducted to quantify the effect of these characteristics on risk of all-, natural-, and unnatural-cause mortality in people with first-episode psychosis while controlling for potential confounders based on (a) the level of change in the magnitude of effect of interest and (b) whether potential confounders were associated with the outcome”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataThe 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”
Quote in the paperSubstantial claim0 of 2 sources checkedMay combine two claims.
Interpretationown dataThe findings support a role for illicit drug use as both a risk factor and a principal underlying cause of death, and for alcohol use as a principal underlying cause of death.
“our findings are in support of such a role for illicit drug use as both risk factor and principal underlying cause, as well as for alcohol use as a principal underlying cause”
Quote in the paperSubstantial claim- Rests on an assumption: Mortality is multi-factorial.
May combine two claims.
Interpretationown dataThe burden of excess mortality occurs at younger ages, and people with psychosis die younger than the general population.
“it suggests that the burden of excess mortality occurs at younger ages and confirms the fact that people with psychosis die younger than the general population.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationFindings on the association between exposure to antipsychotic medication and natural-cause mortality remain inconsistent.
“overall, findings on the association between exposure to antipsychotic medication and natural-cause mortality remain inconsistent.2,48,49”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [2] 2013, Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study, Am J Psychiatry source
Not checked in the free run.
- cites [48] 2009, Influence of antipsychotics on mortality in schizophrenia: systematic review, Schizophr Res source
Not checked in the free run.
- cites [49] 2006, Schizophrenia, neuroleptic medication and mortality, Br J Psychiatry source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationWahlbeck et al noted that variation in unnatural-cause mortality by sex may result from differences in help-seeking behavior.
“Wahlbeck et al 10 noted that variation in unnatural-cause mortality by sex may result from differences in help-seeking behavior”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [10] 2011, Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders, Br J Psychiatry source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationcitationA longer time to remission likely involves prolonged periods and higher dose of exposure to antipsychotic medication, which have been posited to increase natural-cause mortality via metabolic mechanisms.
“a longer time to remission is likely to involve prolonged periods (and higher dose) of exposure to antipsychotic medication, which have been posited to increase natural-cause mortality via metabolic mechanisms.46–48”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [46] 1999, Antipsychotic-induced weight gain: a comprehensive research synthesis, Am J Psychiatry source
Not checked in the free run.
- cites [47] 2006, The metabolic effects of antipsychotic medications, Can J Psychiatry source
Not checked in the free run.
- cites [48] 2009, Influence of antipsychotics on mortality in schizophrenia: systematic review, Schizophr Res source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenClinical and social factors may have varied over time.
“clinical and social factors may have varied over time.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataMortality as an outcome was rare in this cohort, so confidence intervals were wide and point estimates of rate ratios and SMRs were imprecise.
“mortality as an outcome, though markedly elevated compared with the local general population, was, from a purely statistical viewpoint, rare in this cohort, such that CIs were wide, introducing imprecision in point estimates of rate ratios and SMRs.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Mortality has rarely been investigated in unselected cohorts of first-episode cases of all psychotic disorders.
“In addition, mortality has rarely been investigated in unselected cohorts of first-episode cases of all psychotic disorders.”
The paper relies on this without support.
Evidence on modifiable clinical and social risk factors which may predict premature death in this population remains very limited.
“Overall, evidence on modifiable clinical and social risk factors which may predict premature death in this population remains very limited.”
“but little is known about the clinical and social risk factors which may predict this health inequality and help inform preventative strategies.”
The paper relies on this without support.
The excess mortality in people with psychotic disorders is a major public health concern.
“The excess mortality in people with psychotic disorders is a major public health concern”
The paper relies on this without support.
Mortality is multi-factorial.
“mortality is likely to be multi-factorial”
The authors state this as an assumption.
Family involvement may be relevant in reducing unnatural-cause mortality beyond first contact.
“assuming family involvement may be relevant in reducing unnatural-cause mortality beyond first contact”
The paper relies on this without support.
Many earlier studies included patients with more severe and enduring psychosis rather than first-episode cases.
“Given many earlier studies have not been cohorts comprising first-episode cases but included patients with more severe and enduring psychosis”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
People with SMI have a two to three times higher risk for premature death than the general population.
“People with severe mental illness (SMI) -defined as schizophrenia, bipolar disorder or major depressive disorder (MDD)have a two to three times higher risk for premature death than the general population 1,2 .”
From Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‐analysis (2016) · cites this paper as [2]
People with severe mental illness experience a two-to-three times higher mortality rate than the general population.
“People with severe mental illness (SMI), including schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder (MDD), experience a twothree times higher mortality rate than the general population (1,2).”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Natural-cause rate for younger cases is misstated
MinorThe text gives 265.6 per 100 000 person-years for younger cases, but Table 1 gives 66.6 for cases aged 16-29 years. The value 265.6 appears in the table's women's row instead.
“Younger cases had lower mortality rates for all causes (466.3 per 100 000 person-years) and natural causes (265.6 per 100 000 person-years).”
“| 16–29 years | 301 | 14 (4.7) | 466.3 (276.2–787.3) | 2 (0.7) | 66.6 (16.7–266.3) |”
Reported person-years do not produce the all-cause mortality rate
MinorWith 39 deaths over 5183.9 person-years, the all-cause rate is 752.3 per 100 000 person-years, not 717.3. The reported rate implies approximately 5437 person-years.
“over a combined total of 5183.9 years of follow-up”
“39 (7.1% of the sample, 717.3 per 100 000 person-years)”
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Self-citationPhysical health and schizophrenia
Mitchell, A. J., & Malone, D. (2006) · Current Opinion in Psychiatry · doi:10.1097/01.yco.0000228767.71473.9e · Cited by 112 · see citing works
Hepgul, N., Pariante, C. M., Dipasquale, S., DiForti, M., Taylor, H., Marques, T. R., Morgan, C., Dazzan, P., Murray, R. M., & Mondelli, V. (2012) · Psychological Medicine · doi:10.1017/s0033291711002947 · Cited by 112 · see citing works
Self-citationAvoidable mortality in people with schizophrenia or bipolar disorder in <scp>E</scp>ngland
Hoang, U., Goldacre, M. J., & Stewart, R. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12045 · Cited by 109 · see citing works
Early risk factors for suicide in an epidemiological first episode psychosis cohort
Dutta, R., Murray, R. M., Allardyce, J., Jones, P. B., & Boydell, J. E. (2010) · Schizophrenia Research · doi:10.1016/j.schres.2010.11.021 · Cited by 102 · see citing works
Self-citationExploring Geographic Variation in US Mortality Rates Using a Spatial Durbin Approach
Yang, T., Horse, A. J. Y., & Shoff, C. M. (2013) · Population Space and Place · doi:10.1002/psp.1809 · Cited by 88 · see citing works
Suicide in schizophrenia: findings from a national clinical survey
HUNT, I. M., KAPUR, N., WINDFUHR, K., ROBINSON, J., BICKLEY, H., FLYNN, S., PARSONS, R., BURNS, J., SHAW, J., & APPLEBY, L. (2006) · Journal of Psychiatric Practice · doi:10.1097/00131746-200605000-00002 · Cited by 84 · see citing works
Beary, M., Hodgson, R., & Wildgust, H. J. (2012) · Journal of Psychopharmacology · doi:10.1177/0269881112440512 · Cited by 79 · see citing works
Neeleman, J. (2001) · International Journal of Epidemiology · doi:10.1093/ije/30.1.154 · Cited by 79 · see citing works
Dickerson, F., Boronow, J. J., Stallings, C. R., Origoni, A. E., & Yolken, R. H. (2007) · Schizophrenia Bulletin · doi:10.1093/schbul/sbm005 · Cited by 65 · see citing works
Mortality in chronic schizophrenia during decreasing number of psychiatric beds in Finland
Salokangas, R. K. R. (2002) · Schizophrenia Research · doi:10.1016/s0920-9964(01)00281-x · Cited by 55 · see citing works
Mortality in first-contact psychosis patients in the UK: a cohort study
Dutta, R., Murray, R. M., Allardyce, J., Jones, P. B., & Boydell, J. E. (2012) · Psychological Medicine · doi:10.1017/s0033291711002807 · Cited by 53 · see citing works
Self-citationMortality in schizophrenia: clinical and serological predictors
Dickerson, F., Stallings, C., Origoni, A., Schroeder, J., Khushalani, S., & Yolken, R. (2014) · Schizophrenia Bulletin · doi:10.1093/schbul/sbt113 · Cited by 50 · see citing works
Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia
Morden, N. E., Lai, Z., Goodrich, D. E., MacKenzie, T., McCarthy, J. F., Austin, K., Welsh, D. E., Bartels, S., & Kilbourne, A. M. (2012) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2012.02.009 · Cited by 44 · see citing works
Høye, A., Jacobsen, B. K., & Hansen, V. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.07.021 · Cited by 37 · see citing works
Five-year mortality of Finnish schizophrenia patients in the era of deinstitutionalization
Rantanen, H., Koivisto, A., Salokangas, R. K. R., Helminen, M., Oja, H., Pirkola, S. P., Wahlbeck, K., & Joukamaa, M. I. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0414-1 · Cited by 36 · see citing works
Schizophrenia, Antipsychotics, and the Metabolic Syndrome: Is There a Silver Lining?
Remington, G. J. (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.7.1132 · Cited by 30 · see citing works
Schizophrenia, Antipsychotics, and the Metabolic Syndrome: Is There a Silver Lining?
Remington, G. J. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.7.1132 · Cited by 24 · see citing works
Incidence of hospitalised schizophrenia in Finland since 1980: decreasing and increasing again
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Flagged first, then by citations
Research works printed but not linked: 4
- World Health Organization, Life Tables for WHO Member States
- Oregon Department of Human Services, 2008, Measuring Premature Mortality Among Oregonians
- World Health Organization, 1992, The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines
- StataCorp, 2011, Stata Statistical Software: Release 12
Cited by
Sorted by citations
Vancampfort, D., Stubbs, B., Mitchell, A. J., De Hert, M., Wampers, M., Ward, P. B., Rosenbaum, S., & Correll, C. U. (2015) · World Psychiatry · doi:10.1002/wps.20252 · Cited by 1,271 · see citing works
Vancampfort, D., Correll, C. U., Galling, B., Probst, M., De Hert, M., Ward, P. B., Rosenbaum, S., Gaughran, F., Lally, J., & Stubbs, B. (2016) · World Psychiatry · doi:10.1002/wps.20309 · Cited by 659 · see citing works
Reininghaus, U., Kempton, M. J., Valmaggia, L., Craig, T. K. J., Garety, P., Onyejiaka, A., Gayer-Anderson, C., So, S. H., Hubbard, K., Beards, S., et al. (2016) · Schizophrenia Bulletin · doi:10.1093/schbul/sbv190 · Cited by 304 · see citing works
Self-citationCardiorespiratory fitness in severe mental illness: a systematic review and meta-analysis
Vancampfort, D., Rosenbaum, S., Schuch, F., Ward, P. B., Richards, J., Mugisha, J., Probst, M., & Stubbs, B. (2017) · Sports Medicine · doi:10.1007/s40279-016-0574-1 · Cited by 224 · see citing works
Mortality in schizophrenia: 30-year nationwide follow-up study
Tanskanen, A., Tiihonen, J., & Taipale, H. (2018) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12913 · Cited by 134 · see citing works
Chan, S. K. W., Chan, S. W. Y., Pang, H. H., Yan, K. K., Hui, C. L. M., Chang, W. C., Lee, E. H. M., & Chen, E. Y. H. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.0185 · Cited by 95 · see citing works
Autism and psychosis: Clinical implications for depression and suicide
Upthegrove, R., Abu-Akel, A., Chisholm, K., Lin, A., Zahid, S., Pelton, M., Apperly, I., Hansen, P. C., & Wood, S. J. (2018) · Schizophrenia Research · doi:10.1016/j.schres.2017.08.028 · Cited by 60 · see citing works
Lee, K., Abraham, S., & Cleaver, R. (2022) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2022.07.006 · Cited by 53 · see citing works
Persson, M., Belfrage, H., & Kristiansson, M. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1251-0 · Cited by 11 · see citing works
Ren, J., Duan, Y., Wang, J., Sun, Y., Wang, M., Geng, Z., Meng, X., & Wang, Z. (2023) · Brazilian Journal of Psychiatry · doi:10.47626/1516-4446-2022-2918 · Cited by 8 · see citing works
- Authors
- Reininghaus, U., Dutta, R., Dazzan, P., Doody, G. A., Fearon, P., Lappin, J., Heslin, M., Onyejiaka, A., Donoghue, K., Lomas, B., Kirkbride, J. B., Murray, R. M., Croudace, T., Morgan, C., & Jones, P. B.
- Affiliations
- King's College London (GB)
- University of Nottingham (GB)
- Trinity College Dublin (IE)
- University College London (GB)
- University of York (GB)
- University of Cambridge (GB)
- Corresponding author
- Reininghaus, Ulrich
- ORCID
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-09-27
- Volume
- 41
- Issue
- 3
- Pages
- 664-673
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC4393685
- OpenAlex
- W2170663130
- Semantic Scholar
- cb8c361ce71b38ddbab762e8fa275c4e463fed59
- Cited by
- 156
- References
- 50
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 14 · 2023: 8 · 2022: 13 · 2021: 15 · 2020: 20 · 2019: 18 · 2018: 16 · 2017: 15 · 2016: 19 · 2015: 12
- FWCI
- 11.71
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Schizophrenia Bulletin (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- Discovery Research Portal (University of Dundee) (publishedVersion, cc-by)
- Repository@Nottingham (University of Nottingham) (publishedVersion, cc-by)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Lirias (KU Leuven) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Eli Lilly and Company
- South London and Maudsley NHS Foundation Trust
- Wellcome Trust (101272, 095844/Z/11/Z, WT087417, HEALTH-F2-2009-241909, 101272/Z/13/Z, 087417, 095844)
- National Institute for Health and Care Research (RP-PG-0606-1335, NIHR-PDF-201104065, PDF-2011-04-065)
- Royal Society (101272/ Z/13/Z)
- Academy of Medical Sciences (AMS-CSF4-Dutta)
- King's College London
- European Commission (241909)
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (451‐13‐022)
- Medical Research Council (G0500817)
- 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
- excess mortality, first-episode psychosis
- MeSH terms
- Adolescent, Adult, Aged, Cause of Death, England, Female, Follow-Up Studies, Humans, London, Male, Middle Aged, Psychotic Disorders, Registries, Risk, Schizophrenia, Time Factors, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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