Cited by 819Mental Health Treatment and AccessPsychiatric care and mental health servicesSuicide and Self-Harm Studies

The DOI matches its Crossref record; 54 of the 56 references it cites were found in a registry or an index; none of the 27 sources its claims cite is checked for support yet.

The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers

Open access

Abstract

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.

Overview

AI snapshot

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.

Integrity signals

Registry

Crossref · 10.1136/bmj.f2539

Cites

54 of 54 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 27 cited sources checked · 0 supported · 0 flagged

Show all 32 claims

  • Probably not a substantial claim. 11
  • The quote only partly states this claim. 2
  • It may state two separate claims as one. 10
20 of 20
  • 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”
5 of 5

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?

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

    Major

    The 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.

1 of 1

Citations

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Metadata

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)
OpenAlex
W2138691846
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
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
  • Health Sciences › Medicine › Psychiatry and Mental health › 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

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