All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study.

Chang, Chin-Kuo; Hayes, Richard D; Broadbent, Matthew; Fernandes, Andrea C; Lee, William; Hotopf, Matthew; Stewart, Robert

doi:10.1186/1471-244x-10-77

Cited by 258Mental Health Treatment and AccessSchizophrenia research and treatmentSuicide and Self-Harm Studies

All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study.

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Chang, Chin-Kuo, Hayes, Richard D, Broadbent, Matthew, Fernandes, Andrea C, Lee, William, Hotopf, Matthew, Stewart, Robert·2010·BMC Psychiatry

DOI 10.1186/1471-244x-10-77PMC PMC2958993

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Abstract

BACKGROUND: Higher mortality has been found for people with serious mental illness (SMI, including schizophrenia, schizoaffective disorders, and bipolar affective disorder) at all age groups. Our aim was to characterize vulnerable groups for excess mortality among people with SMI, substance use disorders, depressive episode, and recurrent depressive disorder. METHODS: A case register was developed at the South London and Maudsley National Health Services Foundation Trust (NHS SLAM), accessing full electronic clinical records on over 150,000 mental health service users as a well-defined cohort since 2006. The Case Register Interactive Search (CRIS) system enabled searching and retrieval of anonymised information since 2008. Deaths were identified by regular national tracing returns after 2006. Standardized mortality ratios (SMRs) were calculated for the period 2007 to 2009 using SLAM records for this period and the expected number of deaths from age-specific mortality statistics for the England and Wales population in 2008. Data were stratified by gender, ethnicity, and specific mental disorders. RESULTS: A total of 31,719 cases, aged 15 years old or more, active between 2007-2009 and with mental disorders of interest prior to 2009 were detected in the SLAM case register. SMRs were 2.15 (95% CI: 1.95-2.36) for all SMI with genders combined, 1.89 (1.64-2.17) for women and 2.47 (2.17-2.80) for men. In addition, highest mortality risk was found for substance use disorders (SMR = 4.17; 95% CI: 3.75-4.64). Age- and gender-standardised mortality ratios by ethnic group revealed huge fluctuations, and SMRs for all disorders diminished in strength with age. The main limitation was the setting of secondary mental health care provider in SLAM. CONCLUSIONS: Substantially higher mortality persists in people with serious mental illness, substance use disorders and depressive disorders. Furthermore, mortality risk differs substantially with age, diagnosis, gender and ethnicity. Further research into specific risk groups is required.

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In a sensitivity analysis of SMR data, the use of London comparators did not meaningfully change findings.
“However, in a sensitivity analysis of SMR data, the use of London comparators did not meaningfully change findings [23].”
From Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London (2011) · cites this paper as [23]
The authors previously reported excess mortality for people with diagnoses of SMI, as well as for depressive and substance use disorders, drawing on data from the SLAM BRC Case Register, by standardized mortality ratios (SMRs).
“We reported excess mortality for people with diagnoses of SMI, as well as for depressive and substance use disorders, drawing on data from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) Case Register, which covers comprehensive secondary mental healthcare provision to a large geographically defined community, by standardized mortality ratios (SMRs) [23].”
From Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London (2011) · cites this paper as [23]

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RESEARCH ARTICLE Open Access
Chang, C.-C., Lui, C.-C., Lee, C.-C., Chen, S.-D., Chang, W.-N., Lu, C.-H., Chen, N.-C., Chang, A. Y. W., Chan, S. H. H., & Chuang, Y.-C. (2013)
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A retrospective and comprehensive analysis of excess life-years lost, mortality risk, and cause of death among severe mental illness in China
Fang, X., Yu, H., Wu, C., Tan, J., Sun, F., Qian, N., Zhou, H., Zhou, J., & Zhang, X. (2025) · BMC Medicine · doi:10.1186/s12916-025-04380-9 · Cited by 5 · see citing works

Authors: Chang, C.-K., Hayes, R. D., Broadbent, M., Fernandes, A. C., Lee, W., Hotopf, M., & Stewart, R.
Affiliations: King's College London (GB)
Corresponding author: Chang, Chin-Kuo
ORCID: Chang, Chin-Kuo
Hayes, Richard D
Broadbent, Matthew
Fernandes, Andrea C
Lee, William
Hotopf, Matthew
Stewart, Robert
Venue: BMC Psychiatry
Publisher: Springer Science and Business Media LLC
Published: 2010-09-30
Volume: 10
Issue: 1
Pages: 77-77
ISSN: 1471-244X (ISSN-L)
DOI: 10.1186/1471-244x-10-77
PMC: PMC2958993
OpenAlex: W2021645266
Cited by: 258
References: 31
Citations by year: 2026: 7 · 2025: 6 · 2024: 11 · 2023: 13 · 2022: 20 · 2021: 12 · 2020: 19 · 2019: 17 · 2018: 19 · 2017: 23 · 2016: 24 · 2015: 29 · 2014: 17 · 2013: 20 · 2012: 10
FWCI: 17.93
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/2.0 (tdm)
Locations: BMC Psychiatry (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Research Portal (King's College London) (submittedVersion)
Funders: South London and Maudsley NHS Foundation Trust
National Institute for Health and Care Research (NF-SI-0507-10088)
King's College London
Medical Research Council
Topics: Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Keywords: all-cause mortality, severe mental illness, substance use disorders, depressive disorders, schizophrenia, bipolar disorder, schizoaffective disorder, standardized mortality ratio, ethnic differences in mortality, gender differences in mortality, age differences in mortality, mental health service users
MeSH terms: Adolescent, Adult, Aged, Mental Disorders, Bipolar Disorder, Cause of Death, Depressive Disorder, England, Female, Humans, London, Male, Middle Aged, Recurrence, Schizophrenia, Wales, Cohort Studies, Age Distribution, Sex Distribution, Substance-Related Disorders

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All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study.

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