Causes of the excess mortality of schizophrenia
Open accessAbstract
Background: The excess mortality of schizophrenia is well recognised, but its precise causes are not well understood. Aims: To measure the standardised mortality ratio (SMR) and examine the reasons for any excess mortality in a community cohort with schizophrenia. Method: We carried out a 13-year follow-up of 370 patients with schizophrenia, identifying those who died and their circumstances. Results: Ninety-six per cent of the cohort was traced. There were 79 deaths. The SMRs for all causes (298), for natural (232) and for unnatural causes (1273), were significantly higher than those to be expected in the general population, as were the SMRs for disease of the circulatory, digestive, endocrine, nervous and respiratory systems, suicide and undetermined death. Smoking-related fatal disease was more prominent than in the general population. Conclusions: Some of the excess mortality of schizophrenia could be lessened by reducing patients' smoking and exposure to other environmental risk factors and by improving the management of medical disease, mood disturbance and psychosis.
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Excess mortality associated with mental disorders has been demonstrated to be predominantly due to 'natural' causes.
“Excess mortality associated with mental disorders has been demonstrated to be predominantly due to ‘natural’ causes [3], [5], [30], [31], [36]–[38]”
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 [5]
The Natural cause mortality section reports that natural causes accounted for 63% of excess mortality, and Overall mortality says about two-thirds of extra deaths were from natural causes. The study concerns people with schizophrenia; it does not establish the same predominance across mental disorders generally. Page numbers are not provided in the supplied passages. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOther studies found an increased or no different overall risk of cancer in patients with schizophrenia compared to the general population.
“On the other hand, other studies found an increased (9,21,28,(449)(450)(451) or no different (292,419,452,453) overall risk of cancer in patients with schizophrenia compared to the general population.”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [9]
People with psychosis still do not appear to be benefitting from improvements in healthcare available to the general population.
“people with psychosis still do not appear to be benefitting from improvements in healthcare available to the general population.9,34”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [34]
The mortality gap in people with schizophrenia and other psychoses remains high and may be wider for unnatural-cause mortality than reported in earlier studies.
“Our findings suggest that the mortality gap in people with schizophrenia and other psychoses remains high and may be wider for unnatural-cause mortality than reported in earlier studies”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [34]
Unemployment may have varied at the level of individual cases and therefore attenuated differences in mortality rates.
“this may have varied at the level of individual cases and therefore attenuated differences in mortality rates.34”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [34]
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- Authors
- Brown, S., Inskip, H., & Barraclough, B.
- Affiliations
- University of Southampton (GB)
- Corresponding author
- Brown, Steve
- ORCID
- Inskip, Hazel
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2000-09
- Volume
- 177
- Issue
- 3
- Pages
- 212-217
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2140154855
- Cited by
- 1,087
- References
- 33
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 17 · 2023: 14 · 2022: 22 · 2021: 24 · 2020: 27 · 2019: 34 · 2018: 33 · 2017: 40 · 2016: 39 · 2015: 40 · 2014: 56 · 2013: 59 · 2012: 78
- FWCI
- 9.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Southampton
- Medical Research Council
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- schizophrenia, excess mortality, standardized mortality ratio, causes of death, smoking-related mortality, suicide, circulatory diseases, respiratory diseases, endocrine disorders, gastrointestinal diseases, neurological disorders, environmental risk factors, comorbidities, community-based cohort
- MeSH terms
- Adolescent, Adult, Aged, Cause of Death, England, Female, Follow-Up Studies, Humans, Male, Middle Aged, Schizophrenia, Suicide, Cohort Studies, Health Behavior, Age Distribution, Sex Distribution
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