Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999–2006
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OBJECTIVE: To investigate whether the mortality gap has reduced in recent years between people with schizophrenia or bipolar disorder and the general population. DESIGN: Record linkage study. SETTING: English hospital episode statistics and death registration data for patients discharged 1999-2006. PARTICIPANTS: People discharged from inpatient care with a diagnosis of schizophrenia or bipolar disorder, followed for a year after discharge. MAIN OUTCOME MEASURES: Age standardised mortality ratios at each time, comparing the mortality in people with schizophrenia or bipolar disorder with mortality in the general population. Poisson test of trend was used to investigate trend in ratios over time. RESULTS: By 2006 standardised mortality ratios in the psychiatric cohorts were about double the population average. The mortality gap widened over time. For people discharged with schizophrenia, the ratio was 1.6 (95% confidence interval 1.5 to 1.8) in 1999 and 2.2 (2.0 to 2.4) in 2006 (P < 0.001 for trend). For bipolar disorder, the ratios were 1.3 (1.1 to 1.6) in 1999 and 1.9 (1.6 to 2.2) in 2006 (P = 0.06 for trend). Ratios were higher for unnatural than for natural causes. About three quarters of all deaths, however, were certified as natural, and increases in ratios for natural causes, especially circulatory disease and respiratory diseases, were the main components of the increase in all cause mortality. CONCLUSIONS: The total burden of premature deaths from natural causes in people with schizophrenia or bipolar disorder is substantial. There is a need for better understanding of the reasons for the persistent and increasing gap in mortality between discharged psychiatric patients and the general population, and for continued action to target risk factors for both natural and unnatural causes of death in people with serious mental illness.
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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 [4]
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 [4]
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 [4]
Only few studies investigated mortality for total national samples, and no studies have analyzed in detail mortality in different diagnostic groups for total national populations in several countries.
“Only few studies investigated mortality for total national samples, [3], [10], [12] and hitherto, no studies have analyzed in detail mortality in different diagnostic groups for total national populations in several countries.”
From Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden (2013) · cites this paper as [12]
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- Authors
- Hoang, U., Stewart, R., & Goldacre, M. J.
- Affiliations
- University of Oxford (GB)
- King's College London (GB)
- Corresponding author
- Hoang, U.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2011-09-13
- Volume
- 343
- Issue
- sep13 1
- Pages
- d5422-d5422
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC3172324
- OpenAlex
- W2127567394
- Cited by
- 222
- References
- 40
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 11 · 2023: 9 · 2022: 10 · 2021: 10 · 2020: 19 · 2019: 16 · 2018: 10 · 2017: 16 · 2016: 22 · 2015: 20 · 2014: 29 · 2013: 25 · 2012: 11
- FWCI
- 15.75
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Oxford University Research Archive (ORA) (University of Oxford) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- schizophrenia, bipolar disorder, mortality gap, all-cause mortality, severe mental illness, hospital discharge, natural death, circulatory diseases, respiratory diseases, unnatural causes of death, mortality trends
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Bipolar Disorder, Cause of Death, England, Female, Humans, Male, Middle Aged, Patient Discharge, Retrospective Studies, Schizophrenia, Sex Factors, Poisson Distribution
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