The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers
Open accessAbstract
OBJECTIVE: To examine the mortality experience of psychiatric patients in Western Australia compared with the general population. DESIGN: Population based study. SETTING: Western Australia, 1985-2005. PARTICIPANTS: Psychiatric patients (292,585) registered with mental health services in Western Australia. MAIN OUTCOME MEASURES: Trends in life expectancy for psychiatric patients compared with the Western Australian population and causes of excess mortality, including physical health conditions and unnatural causes of death. RESULTS: When using active prevalence of disorder (contact with services in previous five years), the life expectancy gap increased from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females between 1985 and 2005. Additionally, 77.7% of excess deaths were attributed to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%). Suicide was the cause of 13.9% of excess deaths. CONCLUSIONS: Despite knowledge about excess mortality in people with mental illness, the gap in their life expectancy compared with the general population has widened since 1985. With most excess deaths being due to physical health conditions, public efforts should be directed towards improving physical health to reduce mortality in people with mental illness, in addition to ongoing efforts to prevent suicide.
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Written from the paper’s full text.
TL;DR
In Western Australia from 1985 to 2005, the life expectancy gap between psychiatric patients and the general population widened from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females. Most excess deaths were attributed to physical health conditions rather than suicide.
Key findings
- Among 292,585 psychiatric patients in contact with Western Australian mental health services between 1983 and 2007, of whom 47,669 died, the life expectancy gap increased from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females between 1985 and 2005.
- Overall, 77.7% of excess deaths were attributed to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%); suicide accounted for 13.9% of excess deaths. Sex-specific results showed cardiovascular disease as the main cause of 26.2% of excess deaths in male psychiatric patients and 35.3% in female psychiatric patients, cancer for 13.6% in males and 13.3% in females, and suicide for 16.6% in males and 10.1% in females.
- The largest increases in the life expectancy gap were for other psychoses (14.8 to 22.7 years for males and 14.1 to 22.6 years for females) and stress or adjustment reactions (7.3 to 13.2 years for males and −0.2 to 9.3 years for females). Alcohol or drug disorders had the lowest life expectancy, with a gap exceeding 20 years at each time point.
- General population life expectancy increased from 73.1 to 79.1 years for males and from 79.3 to 83.8 years for females, while the gap for all mental disorders combined widened.
Methods
- Retrospective population-based record-linkage study in Western Australia using the mental health information system and death registrations; 292,585 people had contact with mental health services between 1983 and 2007, with 47,669 deaths, and results covered 1985–2005.
- The primary cohort used an “active” case definition: people with ongoing contact with mental health services or contact in the preceding five years. Life expectancy at birth was calculated with abridged life tables using five-year age groups and five-year death windows, then compared with Western Australian population life tables.
- Excess mortality by cause was calculated as observed deaths minus expected deaths, with expected deaths derived from Western Australian cause-specific death rates by age group, sex, and time period applied to cohort person-years; analyses used SAS.
Limitations
- The paper states reliance on administrative data of contacts with services: not all people with mental illness have contact with services, and the register excludes people with undiagnosed or untreated disorders and those treated only by general practitioners or private psychiatrists and psychologists.
- The paper states that changes in service delivery and diagnostic practices could influence life expectancy trends, and that changes in cause-of-death coding over time could affect cause-specific excess estimates; for example, HIV has been coded as a cause of death in Australia only since 1996, and ICD-10 replaced ICD-9 from 1999, though an Australian Bureau of Statistics analysis suggested little impact on rates.
- Evident from the design: this is an observational record-linkage study, so it cannot establish causality, and the paper does not report individual-level adjustment for potential confounders such as socioeconomic status, lifestyle factors, or medication effects.
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 27 cited sources checked · 0 supported · 0 flagged
- Findingown data§ Results · p. 4
Among male psychiatric patients, other accidents and injuries accounted for 8.1% of excess deaths.
“Other accidents and injuries accounted for another 8.1% of excess deaths in males and 7.0% in females.”
Quote in the paperNot a substantial claim - Findingown data§ Abstract · p. 2
77.7% of excess deaths among psychiatric patients were attributed to physical health conditions.
“Additionally, 77.7% of excess deaths were attributed to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%).”
- Also stated in: § Possible causes of poor health outcomes in people with mental illness · p. 5 · plain
“Our data show that almost 80% of excess deaths in people with mental illness are due to physical health conditions.”
Quote in the paperSubstantial claim - Also stated in: § Possible causes of poor health outcomes in people with mental illness · p. 5 · plain
- Findingown data§ Results · p. 4
Among female psychiatric patients, suicide was the cause of 10.1% of excess deaths.
“Suicide was the cause of 16.6% of excess deaths in males and 10.1% in females.”
Quote in the paperNot a substantial claim - Findingown data§ Results · p. 4
Among psychiatric patients, males and females with alcohol or drug disorders had the lowest life expectancy in 1985.
“Among psychiatric patients, males and females with alcohol or drug disorders had the lowest life expectancy in 1985, and the gap in life expectancy exceeded 20 years at each time point.”
Quote in the paperNot a substantial claim - Findingown data§ Results · p. 4
Among female psychiatric patients, cardiovascular disease was the main cause of 35.3% of excess deaths.
“Overall, most excess deaths were due to physical health conditions, with cardiovascular disease (including stroke) the main cause of 26.2% of excess deaths in male psychiatric patients and 35.3% in female psychiatric patients, and cancer the main cause of 13.6% of excess deaths in males and 13.3% in females (table 3⇓).”
Quote in the paperNot a substantial claim
- Findingown data§ Results · p. 4
Among psychiatric patients with alcohol or drug disorders, the life expectancy gap exceeded 20 years at each time point.
“Among psychiatric patients, males and females with alcohol or drug disorders had the lowest life expectancy in 1985, and the gap in life expectancy exceeded 20 years at each time point.”
Quote in the paperNot a substantial claim - Findingown data§ Results · p. 4
Among male psychiatric patients, cardiovascular disease was the main cause of 26.2% of excess deaths.
“Overall, most excess deaths were due to physical health conditions, with cardiovascular disease (including stroke) the main cause of 26.2% of excess deaths in male psychiatric patients and 35.3% in female psychiatric patients, and cancer the main cause of 13.6% of excess deaths in males and 13.3% in females (table 3⇓).”
Quote in the paperNot a substantial claim - Findingown data§ Results · p. 4
Among male psychiatric patients, cancer was the main cause of 13.6% of excess deaths.
“Overall, most excess deaths were due to physical health conditions, with cardiovascular disease (including stroke) the main cause of 26.2% of excess deaths in male psychiatric patients and 35.3% in female psychiatric patients, and cancer the main cause of 13.6% of excess deaths in males and 13.3% in females (table 3⇓).”
Quote in the paperNot a substantial claim - Findingown data§ Results · p. 4
Among psychiatric patients in Western Australia (using active prevalence of disorder), the life expectancy gap compared with the general population for females increased from 10.4 years in 1985 to 12.0 years in 2005.
“For all mental disorders combined, the gap in life expectancy for males increased from 13.5 years in 1985 to 15.9 years in 2005 and for females from 10.4 years in 1985 to 12.0 years in 2005.”
- Also stated in: § Discussion · p. 5 · boosted
“Our study shows that the size of the gap in life expectancy for people with psychiatric disorders in Western Australia increased between 1985 and 2005, from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · p. 5 · boosted
- Findingown data§ Abstract · p. 2
Cardiovascular disease accounted for 29.9% of excess deaths among psychiatric patients.
“Additionally, 77.7% of excess deaths were attributed to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%).”
Quote in the paperNot a substantial claim - Findingown data§ Abstract · p. 2
Suicide was the cause of 13.9% of excess deaths among psychiatric patients.
“Suicide was the cause of 13.9% of excess deaths.”
Quote in the paperNot a substantial claim - Findingown data§ Results · p. 4
Among male psychiatric patients, suicide was the cause of 16.6% of excess deaths.
“Suicide was the cause of 16.6% of excess deaths in males and 10.1% in females.”
Quote in the paperNot a substantial claim - Findingown data§ Results · p. 4
Among female psychiatric patients, cancer was the main cause of 13.3% of excess deaths.
“Overall, most excess deaths were due to physical health conditions, with cardiovascular disease (including stroke) the main cause of 26.2% of excess deaths in male psychiatric patients and 35.3% in female psychiatric patients, and cancer the main cause of 13.6% of excess deaths in males and 13.3% in females (table 3⇓).”
Quote in the paperNot a substantial claim - Findingown data§ Abstract · p. 2
Cancer accounted for 13.5% of excess deaths among psychiatric patients.
“Additionally, 77.7% of excess deaths were attributed to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%).”
Quote in the paperNot a substantial claim - Findingown data§ Results · p. 4
Among psychiatric patients in Western Australia (using active prevalence of disorder), the life expectancy gap compared with the general population for males increased from 13.5 years in 1985 to 15.9 years in 2005.
“For all mental disorders combined, the gap in life expectancy for males increased from 13.5 years in 1985 to 15.9 years in 2005 and for females from 10.4 years in 1985 to 12.0 years in 2005.”
- Also stated in: § Discussion · p. 5 · boosted
“Our study shows that the size of the gap in life expectancy for people with psychiatric disorders in Western Australia increased between 1985 and 2005, from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · p. 5 · boosted
- Findingown data§ Results · p. 4
With the exception of females with stress or adjustment reactions, all psychiatric disorders were associated with a significant gap in life expectancy throughout the study.
“With the exception of females with stress or adjustment reactions, all disorders were associated with a significant gap in life expectancy throughout the study.”
Quote in the paperSubstantial claim - Findingown data§ What this study adds · p. 7
The majority of excess mortality in people with mental illness was attributed to common physical health conditions such as cardiovascular disease, respiratory disease, and cancer.
“The majority of excess mortality in people with mental illness was attributed to common physical health conditions such as cardiovascular disease, respiratory disease, and cancer”
Quote in the paperSubstantial claim - Findingown data§ What this study adds · p. 7
The increase in the gap in life expectancy between people with mental illness and the general population of Western Australia between 1985 and 2005 was particularly large for people with stress or adjustment disorder.
“The gap in life expectancy between people with mental illness and the general population of Western Australia increased between 1985 and 2005, particularly for people with stress or adjustment disorder, affective psychoses, and other psychoses”
Quote in the paperSubstantial claim - Findingown data§ What this study adds · p. 7
The increase in the gap in life expectancy between people with mental illness and the general population of Western Australia between 1985 and 2005 was particularly large for people with other psychoses.
“The gap in life expectancy between people with mental illness and the general population of Western Australia increased between 1985 and 2005, particularly for people with stress or adjustment disorder, affective psychoses, and other psychoses”
Quote in the paperSubstantial claim - Findingown data§ What this study adds · p. 7
The gap in life expectancy between people with mental illness and the general population of Western Australia increased between 1985 and 2005.
“The gap in life expectancy between people with mental illness and the general population of Western Australia increased between 1985 and 2005, particularly for people with stress or adjustment disorder, affective psychoses, and other psychoses”
Quote in the paperSubstantial claim - Findingown data§ Results · p. 4
The largest increases in the life expectancy gap were seen for people with other psychoses: from 14.8 to 22.7 years for males and from 14.1 to 22.6 years for females.
“The largest increases in the life expectancy gap were seen for people with other psychoses (14.8 to 22.7 years for males and 14.1 to 22.6 years for females) and stress or adjustment reactions (7.3 to 13.2 years for males and -0.2 to 9.3 years for females, table 2).”
Quote in the paperNot a substantial claim - Findingown data§ Results · p. 4
The active prevalence of disorder (proportion of the population in contact with mental health services in the preceding five years) increased over time for some disorders, particularly affective psychoses and stress or adjustment reactions.
“The active prevalence of disorder (proportion of the population in contact with mental health services in the preceding five years) increased over time for some disorders (fig 1⇓), in particular affective psychoses and stress or adjustment reactions.”
Quote in the paperNot a substantial claim - Findingown data§ What this study adds · p. 7
The increase in the gap in life expectancy between people with mental illness and the general population of Western Australia between 1985 and 2005 was particularly large for people with affective psychoses.
“The gap in life expectancy between people with mental illness and the general population of Western Australia increased between 1985 and 2005, particularly for people with stress or adjustment disorder, affective psychoses, and other psychoses”
Quote in the paperSubstantial claim - Premiseown data§ Results · p. 4
In the Western Australian general population, life expectancy for females increased from 79.3 years in 1985 to 83.8 years in 2005.
“In the general population, life expectancy for males increased from 73.1 years in 1985 to 79.1 years in 2005 and for females from 79.3 years to 83.8 years (table 2⇓).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [32]
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- Premisecitation§ Results · p. 4
In the Western Australian general population, life expectancy for males increased from 73.1 years in 1985 to 79.1 years in 2005.
“In the general population, life expectancy for males increased from 73.1 years in 1985 to 79.1 years in 2005 and for females from 79.3 years to 83.8 years (table 2⇓).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [32]
Not checked in the free run.
- Interpretationown data§ Discussion · p. 5
The gap in life expectancy between psychiatric patients and the general population is worse than that for other disadvantaged groups, such as lifelong smokers and Indigenous Australians.
“Our findings suggest that the gap in life expectancy between psychiatric patients and the general population is worse than that for other disadvantaged groups. For instance, for lifelong smokers-a population that receives considerable public health attention and intervention-life expectancy is around 10 years less than non-lifelong smokers. 36 The gap in life expectancy between Indigenous (Abor”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [36]
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- Study design and conductcitation§ Mental health information system · p. 3
The mental health information system register is comprehensive in its coverage of contacts with mental health services in Western Australia.
“The register is comprehensive in its coverage of contacts with these services in Western Australia 18 ; a validation study of selected diagnoses in the register found a high sensitivity and specificity for schizophrenia and affective psychosis diagnoses. 19”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18]
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- Study design and conductcitation§ Mental health information system · p. 3
A validation study of selected diagnoses in the register found high sensitivity and specificity for schizophrenia and affective psychosis diagnoses.
“The register is comprehensive in its coverage of contacts with these services in Western Australia 18 ; a validation study of selected diagnoses in the register found a high sensitivity and specificity for schizophrenia and affective psychosis diagnoses. 19”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19]
Not checked in the free run.
- Interpretationown data§ Discussion · p. 5
Outcomes for people with mental illness have worsened since the 1990s despite increasing knowledge about the impacts of such illness.
“By examining gaps in life expectancy rather than mortality rates and by revealing that these gaps have increased over time, the results of this study are significant in that they show that outcomes for people with mental illness have worsened since the 1990s despite increasing knowledge about the impacts of such illness.”
Quote in the paperSubstantial claim - Premisecitation§ Limitations of this study · p. 6
An analysis of time trends in causes of death published by the Australian Bureau of Statistics suggests that the introduction of ICD-10 had little impact on rates.
“However, an analysis of time trends in causes of death published by the Australian Bureau of Statistics suggests that the introduction of ICD-10 had little impact on rates. 27”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27]
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- Interpretationown data§ Conclusions · p. 6
The most common causes of death in the general population-heart disease, respiratory disease, and cancer-are also the most common causes of excess deaths in people with mental illness.
“The most common causes of death in the general population-heart disease, respiratory disease, and cancer-are also the most common causes of excess deaths in people with mental illness.”
Quote in the paperSubstantial claim - Interpretationown data§ Discussion · p. 5
The increased gap in life expectancy is largely driven by increasing life expectancy in the general population rather than a reduction in life expectancy in psychiatric patients.
“The increased gap is largely driven by increasing life expectancy in the general population rather than a reduction in life expectancy in psychiatric patients.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 11
- The quote only partly states this claim. 2
- May combine two claims. 10
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ Results · p. 4Among female psychiatric patients, other accidents and injuries accounted for 7.0% of excess deaths.
“Other accidents and injuries accounted for another 8.1% of excess deaths in males and 7.0% in females.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown data§ Results · p. 4The largest increases in the life expectancy gap were seen for people with stress or adjustment reactions: from 7.3 to 13.2 years for males and from -0.2 to 9.3 years for females.
“The largest increases in the life expectancy gap were seen for people with other psychoses (14.8 to 22.7 years for males and 14.1 to 22.6 years for females) and stress or adjustment reactions (7.3 to 13.2 years for males and -0.2 to 9.3 years for females, table 2).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown data§ Discussion · p. 5The widest gap in life expectancy was seen in people with alcohol and drug disorders, and this gap of more than 20 years was maintained throughout the period of study.
“The widest gap in life expectancy was seen in people with alcohol and drug disorders, and this gap of more than 20 years was maintained throughout the period of study.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingcitation§ Improving health outcomes for people with mental illness · p. 6Psychiatric patients in this study represented over 5% of the Western Australian population, including a large proportion of people who had only short contacts with services.
“Psychiatric patients in this study represented over 5% of the Western Australia population, including a large proportion of people who had only short contacts with services. 59”
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Findingown data§ Results · p. 4The life expectancy gap increased for both males and females with adjustment reaction, affective and other psychoses, and depression.
“In terms of individual diagnoses, the gap increased for both males and females with adjustment reaction, affective and other psychoses, and depression (figures 2⇓ and 3⇓).”
Quote in the paperSubstantial claimThe quote only partly states this claim.
Findingnone given§ What this study adds · p. 7Significant gaps in life expectancy remained for psychiatric disorders other than stress or adjustment disorder, affective psychoses, and other psychoses.
“Significant gaps in life expectancy remained for other psychiatric disorders”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoning§ Limitations of this study · p. 6Changes to some ICD codes would not affect the findings that psychiatric patients experienced a large gap in mortality and that the majority of excess mortality was attributable to physical health conditions, including cancer and cardiovascular disease.
“Furthermore, changes to some ICD codes would not affect our findings that psychiatric patients in general, and in each psychiatric diagnostic group, experienced a large gap in mortality, and that the majority of excess mortality was attributable to physical health conditions, including cancer and cardiovascular disease.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Possible causes of poor health outcomes in people with mental illness · p. 5The side effects of drugs, particularly the metabolic side effects of antipsychotics, have received considerable attention.
“The side effects of drugs, particularly the metabolic side effects of antipsychotics, have also received considerable attention. 48 49”
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Premisecitation§ Possible causes of poor health outcomes in people with mental illness · p. 5Higher rates of substance use and a higher prevalence of unhealthy lifestyles, including poorer diets and less exercise, have been well documented in people with mental illness.
“Higher rates of substance use have been well documented in people with mental illness, including tobacco, alcohol, and illegal drugs, 42-44 as well as a higher prevalence of unhealthy lifestyles, including poorer diets and less exercise. 45-47”
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Interpretationcitation§ Improving health outcomes for people with mental illness · p. 6The opportunity for people with mental illness to contribute to their families and communities is being foreshortened by premature mortality.
“The opportunity for them to do so is being foreshortened by premature mortality. 60”
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May combine two claims.
Premisecitation§ Possible causes of poor health outcomes in people with mental illness · p. 5Studies that adjusted for socioeconomic status still found significantly worse morbidity and mortality for people with mental illness, showing that social deprivation and disadvantage are not the sole determinants of poor health outcomes in people with mental illness.
“However, studies that adjusted for socioeconomic status still found significantly worse morbidity and mortality for people with mental illness, 2 8 showing that social deprivation and disadvantage are not the sole determinants of poor health outcomes in people with mental illness.”
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Premisenone given§ Discussion · p. 5The Nordic countries have some of the most comprehensive and equitable healthcare and social welfare in the world.
“Given that the Nordic countries have some of the most comprehensive and equitable healthcare and social welfare in the world, our results may be more typical of the experience in other places.”
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Premisecitation§ Possible causes of poor health outcomes in people with mental illness · p. 5Inequalities in access to, and use of, healthcare are well documented.
“Finally, inequalities in access to, and use of, healthcare are well documented. 50”
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Interpretationreasoning§ Limitations of this study · p. 6The register does not cover people with undiagnosed and untreated disorders or those only treated by general practitioners or private psychiatrists and psychologists.
“For instance, the register does not cover people with undiagnosed and untreated disorders and those who are only treated by general practitioners or private psychiatrists and psychologists.”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ Possible causes of poor health outcomes in people with mental illness · p. 5Socioeconomic disadvantage is more common in people with mental illness and is associated with health risk behaviours and reduced access to healthcare.
“Socioeconomic disadvantage is also more common in people with mental illness and is associated with health risk behaviours and reduced access to healthcare. 51”
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Interpretationreasoning§ Limitations of this study · p. 6The study data are representative of people in contact with mental health services, not all people with mental illness, because not all people with mental illness have contact with services.
“Not all people with mental illness have contact with services, and these data have to be considered representative of the population of people in contact with services, not all people with mental illness.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Discussion · p. 5The Nordic study showed a slight reduction in the life expectancy gap.
“In contrast with the Nordic study, which showed a slight reduction in the life expectancy gap, we found that the overall gap in life expectancy increased by 2.4 years for males and by 1.6 years for females between 1985 and 2005.”
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Premisecitation§ Discussion · p. 5The magnitude of increase in life expectancy between 1985 and 2005 in Western Australia is consistent with that seen in the United Kingdom, the United States, and many European countries.
“While life expectancy in Western Australia is high among developed countries, the magnitude of increase in life expectancy between 1985 and 2005 in Western Australia is consistent with that seen in the United Kingdom, the United States, and many European countries. 35”
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Premisecitation§ Possible causes of poor health outcomes in people with mental illness · p. 5Excess morbidity or mortality associated with mental illness is recognised as a complex multifactorial problem.
“Excess morbidity or mortality associated with mental illness is recognised as a complex multifactorial problem. 40 41”
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Study design and conductcitation§ Record linkage · p. 3The proportion of invalid and missed links using probabilistic record linkage was estimated at 0.11%.
“The proportion of invalid and missed links using this method has been estimated at 0.11%. 22”
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The authors state this as an assumption.
In psychiatric patients under age 15, the mortality rate is equal to the general population mortality rate for that age group.
“Because of the small numbers of psychiatric patients under the age of 15 years, we assumed that the mortality rate in psychiatric patients before age 15 was equal to the mortality rate in the general population for that age group.”
The paper relies on this without support.
Little attention has focused on the mortality rates of people with mental illness in Australia, and there are few interventions designed to reduce the morbidity and mortality associated with common physical illnesses in people with mental illness.
“While inequalities in the health experiences of Indigenous Australians have justifiably attracted substantial public investment, 38 little attention has focused on the mortality rates of people with mental illness in Australia, and there are few interventions designed to reduce the morbidity and mortality associated with common physical illnesses in people with mental illness.”
The authors state this as an assumption.
The most severe cases at any point in time are most likely to receive treatment.
“if it is assumed that the most severe cases at any point in time are most likely to receive treatment”
The authors state this as an assumption.
The most severe cases have the worst mortality outcomes.
“assuming that the most severe cases have the worst mortality outcomes”
The paper relies on this without support.
Substance misuse is a well established risk factor for cardiovascular disease and many cancers.
“Substance misuse is a well established risk factor for cardiovascular disease and many cancers”
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?
About 60% of excess mortality in schizophrenia is due to physical illnesses, with cardiovascular disease being dominant.
“About 60% of the excess mortality is due to physical illnesses, with cardiovascular disease being dominant.”
The mortality gap translates to a 10-20 year shortened life expectancy.
“This mortality gap translates to a 10-20 year shortened life expectancy 3,4”
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 [4]
The mortality gap in severe mental illness translates into a 10-20 year shortened life expectancy.
“This mortality gap translates into a 10-20 year shortened life expectancy (3,4) and appears to be widening (5).”
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.
Physical conditions are not the majority for every disorder
MajorThe table attributes 53.3% of excess deaths among males with stress or adjustment reactions to suicide alone, so physical conditions cannot account for a majority of excess deaths in that group.
“physical conditions represent the majority of excess deaths for all psychiatric disorders.”
“| Suicide | 16.6 | 6.1 | 19.8 | 46.4 | 5.3 | 16.2 | 53.3 | 22.7 | 33.4 |”
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- Authors
- Lawrence, D., Hancock, K. J., & Kisely, S.
- Affiliations
- The Kids Research Institute Australia (AU)
- Griffith University (AU)
- Corresponding author
- Lawrence, D.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2013-05-21
- Volume
- 346
- Issue
- may21 1
- Pages
- f2539-f2539
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3660620
- OpenAlex
- W2138691846
- Semantic Scholar
- 9d6e4ca994e400d3d58b9806747ebbf0bdbef6d9
- Cited by
- 819
- References
- 56
- Citations by year
- 2026: 25 · 2025: 42 · 2024: 57 · 2023: 52 · 2022: 65 · 2021: 75 · 2020: 84 · 2019: 78 · 2018: 69 · 2017: 76 · 2016: 78 · 2015: 59 · 2014: 46 · 2013: 13
- FWCI
- 96.81
- 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)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- Griffith Research Online (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- life expectancy gap, psychiatric patients, excess mortality, physical health conditions, cardiovascular disease, cancer, suicide, mental illness, Western Australia, mortality trends
- MeSH terms
- Aged, Aged, 80 and over, Mental Disorders, Cause of Death, Chronic Disease, Female, Humans, Life Expectancy, Male, Retrospective Studies, Suicide, Western Australia
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.
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