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The Epidemiology of Excess Mortality in People with Mental Illness
Open accessAbstract
OBJECTIVE: to investigate the burden of excess mortality among people with mental illness in developed countries, how it is distributed, and whether it has changed over time. METHOD: we conducted a systematic search of MEDLINE, restricting our attention to peer-reviewed studies and reviews published in English relating to mortality and mental illness. Because of the large number of studies that have been undertaken during the last 30 years, we have selected a representative cross-section of studies for inclusion in our review. RESULTS: there is substantial excess mortality in people with mental illness for almost all psychiatric disorders and all main causes of death. Consistently elevated rates have been observed across settings and over time. The highest numbers of excess deaths are due to cardiovascular and respiratory diseases. With life expectancy increasing in the general population, the disparity in mortality outcomes for people with mental illness is increasing. CONCLUSIONS: without the development of alternative approaches to promoting and treating the physical health of people with mental illness, it is possible that the disparity in mortality outcomes will persist.
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“Lawrence et al. (2010) concluded that insufficient health service for schizophrenic patients with cardiovascular disease may explain part of the increased mortality from natural causes.”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Lawrence et al. 2010
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“CVD accounts for much of the excess mortality in psychiatric patients.442”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [442]
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BackgroundFrailty as a predictor of mortality in older adults within 5 years of psychiatric admission
Benraad, C. E. M., Haaksma, M. L., Karlietis, M. H. J., Voshaar, R. C. O., Spijker, J., Melis, R. J. F., & Rikkert, M. G. M. O. (2020) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5278 · Cited by 26
Happell, B., Stanton, R., Hoey, W., & Scott, D. S. (2014) · Mental health and physical activity · doi:10.1016/j.mhpa.2014.03.001 · Cited by 27
Murphy, A. L., Gardner, D. M., & Jacobs, L. M. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1746-3 · Cited by 28
Fairthorne, J., Hammond, G., Bourke, J., de Klerk, N. H., & Leonard, H. (2015) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2594-3 · Cited by 26
“These might be manifest in terms of higher smoking rates, substance abuse and increased alcohol consumption compared to other women (Lawrence et al. 2010).”
Mortality and causes of death among users of methadone maintenance treatment in Israel, 1999–2008
Rosca, P., Haklai, Z., Goldberger, N., Peres, Z., Margolis, A., & Ponizovsky, A. M. (2012) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2012.03.013 · Cited by 26
Starace, F., Mungai, F., Baccari, F., & Galeazzi, G. M. (2017) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-017-1468-8 · Cited by 27
A Practical Approach to Mental Health for the Diabetes Educator
Gonzalvo, J. D., Hamm, J. A., Eaves, S. M., Muñoz, C. E., de Groot, M., Hill‐Briggs, F., Cypress, M., & Streisand, R. M. (2019) · AADE in Practice · doi:10.1177/2325160319826929 · Cited by 26
“The burden of increased morbidity and mortality is linked to poor access to healthcare services, stigma, and poor identification of medical conditions within psychiatric services.(79) Finally, the number of pharmacological treatment options may contribute to the development of or exacerbate cardiometabolic problems.”
BackgroundMental health bias in physical care: An integrative review of the literature
Hallyburton, A., & Allison-Jones, L. L. (2023) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12911 · Cited by 32
Mortality Associated with Major Depression in a Canadian Community Cohort
Patten, S. B., Williams, J. V. A., Lavorato, D. H., Wang, J., Khaled, S. M., & Bulloch, A. G. (2011) · The Canadian Journal of Psychiatry · doi:10.1177/070674371105601104 · Cited by 25
Integrated physical and mental healthcare: an overview of models and their evaluation findings
Coates, D., Coppleson, D., & Schmied, V. A. (2020) · International Journal of Evidence-Based Healthcare · doi:10.1097/xeb.0000000000000215 · Cited by 27
Bendayan, R., Kraljević, Ž., Shaari, S., Das‐Munshi, J., Leipold, L., Chaturvedi, J., Mirza, L., Aldelemi, S., Searle, T., Chance, N., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-054414 · Cited by 23
Hjorth, P., Medici, C. R., Juel, A., Madsen, N. J., Vandborg, K., & Munk‐Jørgensen, P. (2017) · International Journal of Social Psychiatry · doi:10.1177/0020764017702172 · Cited by 24
The gap between available knowledge and its use in clinical psychiatry
Munk‐Jørgensen, P., Kristiansen, C. B., Uwawke, R., Larsen, J. I., Okkels, N., Christiansen, B., & Hjorth, P. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12512 · Cited by 22
Hanna, M. R., Caspi, A., Houts, R., Moffitt, T. E., & Torvik, F. A. (2024) · Psychological Medicine · doi:10.1017/s0033291724002575 · Cited by 22
“…Sarfati, Peterson, Stanley, & Collings, 2014; Grigoletti et al., 2009; Kisely, Smith, Lawrence, & Maaten, 2005; Lawrence, Hancock, & Kisely, 2013; Lawrence, Kisely, & Pais, 2010; Mitchell et al., 2013; Moussavi et al., 2007; Scott et al., 2016; Wahlbeck, Westman, Nordentoft, Gissler, & Laursen,…”
Cardiovascular disease and excess mortality in depression: physical activity as a game changer
Gerber, M., Claussen, M., Cody, R., Imboden, C., Ludyga, S., Scherr, J., Seifritz, E., & von Känel, R. (2021) · German Journal of Sports Medicine · doi:10.5960/dzsm.2021.498 · Cited by 21
Mental health services in the Dominican Republic from the perspective of health care providers
Caplan, S., Little, T. V., Reyna, P., Lovera, A. S., Garces-King, J., Queen, K., & Nahar, R. (2016) · Global Public Health · doi:10.1080/17441692.2016.1213308 · Cited by 1
Coates, D., Coppleson, D., & Travaglia, J. (2021) · Journal of Interprofessional Care · doi:10.1080/13561820.2020.1862771 · Cited by 26
“People with mental illness have poorer physical health outcomes and a lower life expectancy than the general population (Chang et al., 2011; Hayes et al., 2015; Lawrence et al., 2013, 2010).”
BackgroundMortality in substance‐induced psychosis: a register‐based national cohort study
Hjorthøj, C. R., Madsen, T., Starzer, M. S. K., Erlangsen, A., & Nordentoft, M. (2021) · Addiction · doi:10.1111/add.15598 · Cited by 20
Maaroganye, K., Mohapi, M., Krüger, C., & Rheeder, P. (2013) · African Journal of Psychiatry · doi:10.4314/ajpsy.v16i6.53 · Cited by 20
Leinonen, T., Martikainen, P., Laaksonen, M., & Lahelma, E. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0747-2 · Cited by 21
“The contribution of circulatory diseases is nevertheless considerable due to the large absolute number of deaths [20–22].”
BackgroundInfluentialDetection of subclinical atherosclerosis and diastolic dysfunction in patients with schizophrenia
Ünsal, C., Alpsoy, Ş., Türeli, H. O., Oran, M., Yeşilyurt, S., Arslan, M., Topçu, B., Karakaya, O., & Kurt, E. (2013) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s52030 · Cited by 20
“Thus, providing physical health care in addition to mental health care is an important part of the treatment of patients with schizophrenia.(4,14) The following measurements have been recommended for early diagnosis of comorbid physical diseases during the follow-up of patients with schizophrenia: fasting glucose, bod…”
Investigating oral health among individuals with depression: NHANES 2015–2016
Almohaimeed, B., Dube, S. R., & Luo, R. (2022) · The Saudi Dental Journal · doi:10.1016/j.sdentj.2022.01.001 · Cited by 24
“Like many psychological disorders, depression affects individuals’ physical health and well-being and has been associated to many chronic diseases such as cancer, cardiovascular disease (CVD), diabetes and respiratory disease (Clarke and Currie, 2009; Lawrence et al., 2013, 2010).”
McMillan, R. M., & Jordens, C. F. C. (2022) · Medicine Health Care and Philosophy · doi:10.1007/s11019-022-10070-7 · Cited by 19
“Depressive disorders have been ranked as the leading cause of disability worldwide (World Health Organization 2017) and are associated with elevated rates of mortality from various natural and unnatural causes (Lawrence et al. 2010).”
BackgroundPhysical activity and sedentary behaviour of adults with mental illness
Chapman, J. J., Fraser, S. J., Brown, W. J., & Burton, N. W. (2015) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2015.07.017 · Cited by 19
“One (1) table and two (2) figures are referred to in the manuscript.”
BackgroundCause-Specific Mortality of Psychiatric Inpatients and Outpatients in a General Hospital in Korea
Park, S., Kim, S. Y., & Hong, J. P. (2012) · Asia Pacific Journal of Public Health · doi:10.1177/1010539512452755 · Cited by 19
“For natural causes of death, the highest numbers of excess deaths are a result of cardiovascular and respiratory diseases.(5) Previous studies suggest a general pattern of elevated mortality rates across all treatment settings: the highest mortality rates are seen in psychiatric patients who require inpatient speciali…”
BackgroundAssociation of Mental Health with Health Care Use and Cost: A Population Study
Cawthorpe, D., Wilkes, T. C., Guyn, L., Li, B., & Lu, M. (2011) · The Canadian Journal of Psychiatry · doi:10.1177/070674371105600807 · Cited by 19
Andrade, C. (2013) · Bipolar Disorders · doi:10.1111/bdi.12130 · Cited by 18
“Cardiovascular disease accounts for much of the excess mortality in persons with mental illness (23).”
BackgroundSteylen, P., der Heijden, F. M. M. A. V., Kok, H., Sijben, N., & Verhoeven, W. M. A. (2013) · International Journal of Psychiatry in Clinical Practice · doi:10.3109/13651501.2013.779000 · Cited by 17
González, C. O., Barrios, J. A., García‐Carretero, M. Á., Salazar, A., Almenara‐Abellán, J. L., & Lagares, C. (2019) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12572 · Cited by 20
Sara, G. E., Chen, W., Large, M. M. B., Ramanuj, P., Curtis, J., McMillan, F., Mulder, C. L., Currow, D. C., & Burgess, P. M. (2021) · Epidemiology and Psychiatric Sciences · doi:10.1017/s204579602100007x · Cited by 18
“Disadvantage, lifestyle, increased prevalence of chronic illness, medication side effects, reduced help-seeking and the accessibility and quality of health care all contribute to this mortality gap (Lawrence et al., 2010; Liu et al., 2017; Firth et al., 2019).”
Szkultecka-Dębek, M., Walczak, J., Augustyńska, J., Miernik, K., Stelmachowski, J., Pieniążek, I., Obrzut, G., Pogroszewska, A., Paulić, G., Damir, M., et al. (2015) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/1745017901511010158 · Cited by 18
“It is known that the suicide rate is increased among patients with schizophrenia; other reasons for the mortality excess include cardiovascular disease, stroke, chronic lung disease and infections [26, 43].”
BackgroundInfluentialWilkes, T. C., Guyn, L., Li, B., Lu, M., & Cawthorpe, D. (2012) · The Permanente Journal · doi:10.7812/tpp/11-149 · Cited by 18
Stolz, P. A., Wehring, H. J., Liu, F., Love, R. C., Ellis, M., DiPaula, B. A., & Kelly, D. L. (2019) · Psychiatric Quarterly · doi:10.1007/s11126-018-9621-4 · Cited by 18
Høye, A., Nesvåg, R., Reichborn‐Kjennerud, T., & Jacobsen, B. K. (2016) · Bipolar Disorders · doi:10.1111/bdi.12389 · Cited by 18
“9 among women are thus in line with a series of similar studies from other Nordic countries (2-7).”
BackgroundResult
Metadata
- Authors
- Lawrence, D., Kisely, S., & Pais, J.
- Affiliations
- The Kids Research Institute Australia (AU)
- Professor and Director, The University of Queensland, Health LinQ: The Queensland Centre for Health Data Services, Brisbane, Australia; Professor, Department of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia
- The University of Queensland (AU)
- Corresponding author
- Lawrence, David
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2010-12
- Volume
- 55
- Issue
- 12
- Pages
- 752-760
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- OpenAlex
- W149077341
- Cited by
- 258
- References
- 103
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 14 · 2023: 19 · 2022: 16 · 2021: 18 · 2020: 25 · 2019: 16 · 2018: 15 · 2017: 12 · 2016: 19 · 2015: 18 · 2014: 22 · 2013: 24 · 2012: 15
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- eSpace (Curtin University) (submittedVersion)
- Griffith Research Online (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- excess mortality, mental illness, cardiovascular disease, respiratory diseases, life expectancy, mortality disparities, physical health of people with mental illness, causes of death
- MeSH terms
- Mental Disorders, Cardiovascular Diseases, Cause of Death, Humans, Respiratory Tract Diseases, Risk Factors, Schizophrenia, Mood Disorders
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