Causes of mortality in schizophrenia: an updated review of European studies
Open accessAbstract
BACKGROUND: The excess mortality in schizophrenia is still a phenomenon insufficiently studied on the cross-national level. It is important to analyse current studies on morality in schizophrenia since significant changes have recently taken place in psychiatric health care systems and guidelines of pharmacological treatment have been developed in European countries. SUBJECTS AND METHODS: This article reviews studies addressing mortality in schizophrenia in Europe that were published in English in the Pubmed database in 2009-2014. It aimed at determining countries where studies were conducted, methodologies and tools used, and current main mortality rates, as well as direction of causality in this group of patients. RESULTS: The recently published studies were conducted only in few European countries. The majority of data was obtained from general medical records and death records. The studies indicate that schizophrenia patients are characterized by higher mortality rate than the general population, with natural causes (cardiovascular diseases and cancers) and suicides predominating. The increasing mortality gap with significantly shorter life expectancy of patients with schizophrenia in comparison with the general population is considerable. CONCLUSIONS: Death records are a crucial tool in studies on mortality in schizophrenia patients; however they are insufficiently employed. Recent European reports do not show positive tendencies, indicating that standardized mortality rates in schizophrenia remain on the same level or even increase, particularly for deaths resulting from natural causes. Due to various methodologies used in studies, their direct comparison is difficult. This limitation warrants further discussion on methods used in future studies on schizophrenia mortality in Europe.
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Cardiometabolic risk factors such as cardiovascular disease and obesity are recognised major contributors to increased mortality in schizophrenia.
“While causes are multifactorial, cardiometabolic risk factors such as cardiovascular disease and obesity are recognised major contributors [1,2,10,11].”
From A systematic review of licensed weight-loss medications in treating antipsychotic-induced weight gain and obesity in schizophrenia and psychosis. (2022) · cites this paper as [2]
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“to recently published European studies [8].”
Walburg, F. S., de Joode, J. W., Brandt, H. E., van Tulder, M. W., Adriaanse, M. C., & van Meijel, B. (2022) · PLoS ONE · doi:10.1371/journal.pone.0271990 · Cited by 8 · see citing works
Erkrankungen des schizophrenen Formenkreises im Alter
Jagsch, C., & Hofer, A. (2018) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-018-1436-2 · Cited by 8 · see citing works
Lee, Y., Kim, H., Lee, J., Kang, D., Kim, G., Jin, S., Kim, J. H., Jeon, H. J., & Hur, K. Y. (2024) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2022.0431 · Cited by 7 · see citing works
“Similarly, in previous studies in Europe, approximately 25% of patients with schizophrenia die from cardiovascular disease [26] and predominant causes of higher mortality in individuals with schizophrenia were natural causes including cardiovascular disease, prevailing over external causes [27].”
Chandradasa, M., Ruwanpriya, S., de Silva, S., Rathnayake, L. C., & Kuruppuarachchi, K. A. L. A. (2021) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2021.102963 · Cited by 7 · see citing works
Pinho, S., Rocha, V., & Vieira‐Coelho, M. A. (2021) · Schizophrenia Research · doi:10.1016/j.schres.2021.03.012 · Cited by 7 · see citing works
A Systematic Review on the Potential of Aspirin to Reduce Cardiovascular Risk in Schizophrenia
Dao, J., Saran, S., Wang, M., Michael, C., Phan, N. T. N., & Bellon, A. (2023) · Brain Sciences · doi:10.3390/brainsci13020368 · Cited by 5 · see citing works
“It is important to mention that suicide, together with CVD and cancer, is among the leading causes of mortality in SCZ [50].”
BackgroundSchizophrenia Patients With Prevotella-Enterotype Have a Higher Risk of Obesity
Liang, Y., Shen, Y., Li, G., Yuan, Y., Zhang, M., & Gao, J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.864951 · Cited by 5 · see citing works
Boyda, D., McFeeters, D., Dhingra, K., & Kelleher, I. (2020) · Journal of Interpersonal Violence · doi:10.1177/0886260520912591 · Cited by 5 · see citing works
“, 2018), contemporary meta-analyses and reviews continue to illustrate a considerable and pervasive disproportion in the number of suicide-related deaths relative to the general population (Hjorthøj et al., 2017; Nordentoft et al., 2013; Piotrowski et al., 2017; Walker et al., 2015).”
BackgroundDeenik, J. (2019) · doi:10.26481/dis.20190522jd · Cited by 5 · see citing works
Increased mortality risk in people with schizophrenia in Lithuania 2001–2020
Drevinskaitė, M., Kačėnienė, A., Germanavičius, A., & Smailytė, G. (2025) · Schizophrenia · doi:10.1038/s41537-024-00549-y · Cited by 4 · see citing works
van der Lee, A. P. M., Hoogendoorn, A. W., de Haan, L., & Beekman, A. T. F. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03319-7 · Cited by 4 · see citing works
Health Perceptions and Risk of Metabolic Syndrome and Diabetes in Psychiatric Patients
Öztürk, Ş., Ata, E. E., & Sarıtaş, M. (2024) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.13147 · Cited by 3 · see citing works
Epigenetic Control in Schizophrenia
D’Addario, C., & Bartolomeo, M. D. (2025) · Sub-cellular biochemistry/Subcellular biochemistry · doi:10.1007/978-3-031-75980-2_5 · Cited by 3 · see citing works
Cyran, A., Piotrowski, P., Samochowiec, J., Samochowiec, A., Tyburski, E. M., Łaczmański, Ł., & Misiak, B. (2022) · Applied Sciences · doi:10.3390/app122110915 · Cited by 3 · see citing works
Sambrook, L., Balmer, A., Tait, J., Ashley‐Mudie, P., McIntyre, J. C., Shetty, A., Nathan, R., & Saini, P. (2025) · BJPsych Open · doi:10.1192/bjo.2025.30 · Cited by 3 · see citing works
Armoon, B., LESAGE, A. D., Giguère, C., Perry, K., Juster, R., & Guay, S. (2025) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2025.107627 · Cited by 2 · see citing works
Deciphering the paradoxical incidence of cancer in schizophrenia
Kuppili, P. P., & Nebhinani, N. (2018) · Australasian Psychiatry · doi:10.1177/1039856218797439 · Cited by 2 · see citing works
Al‐Dwaikat, T. N., Al‐Samouri, H. K., Dalky, H. F., Hamaideh, S. H., ALBashtawy, M., & Khatatbeh, H. (2024) · Journal of Clinical Nursing · doi:10.1111/jocn.17606 · Cited by 2 · see citing works
Bondre, A. P., Ranjan, A., Shrivastava, R., Tugnawat, D. K., Chaturvedi, N., Bhan, A., Gupta, S., Rozatkar, A. R., Nagendra, S., Dutt, S., et al. (2025) · JMIR Formative Research · doi:10.2196/67745 · Cited by 2 · see citing works
“Suicide is a common cause of premature mortality among people living with schizophrenia [3,4] and a recent systematic review has reported a point prevalence of nearly 30% of SIs in people with schizophrenia [5].”
Vanderhoof, T. S., Gurvits, T. V., Baker-Nolan, J. E., Borsook, D., & Elman, I. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00473 · Cited by 2 · see citing works
“In schizophrenia these risk factors are 2– 3-fold more prevalent then in the general population, afflicting over half of the patients (1, 2) thus contributing to the 15–20 years drop in their life expectancy (3, 4).”
BackgroundSuicidal attempt among patients with schizophrenia: A cross-sectional study from Morocco
Kassal, Y., Fritah, K., Naïla, N., Arji, N., Siham, B., Laboudi, F., Mesfioui, A., Ouanass, A., Tamouza, R., & Hessni, A. E. (2023) · E3S Web of Conferences · doi:10.1051/e3sconf/202341201023 · Cited by 2 · see citing works
“There is a strong correlation between psychiatric disorders and suicide [3,4,5].”
BackgroundSchizophrenia and Other Late-Life Psychoses
Bersani, F. S., Prevete, E., & Vicinanza, R. (2024) · Springer eBooks · doi:10.1007/978-3-030-74720-6_87 · Cited by 2 · see citing works
İpekçioğlu, D., & Kendirlioglu, B. K. (2019) · Bakirkoy Tip Dergisi / Medical Journal of Bakirkoy · doi:10.4274/btdmjb.galenos.2019.20190214042203 · Cited by 2 · see citing works
“Kuzey ve Batı Avrupa ülkelerinde yaşayan şizofreni hastalarında ölüm nedenlerinin araştırıldığı, 2009-2014 yılları arasında yapılmış olan çalışmaların dahil edildiği bir gözden geçirmede, kardiyovasküler sistem hastalıkları ve kanser doğal ölüm nedenlerinin başında bildirilmiştir (23).”
Living – and dying – with Schizophrenia in Australia
Looi, J. C., & Robson, S. (2025) · Australasian Psychiatry · doi:10.1177/10398562241307807 · Cited by 2 · see citing works
Touitou-Burckard, E., Gondek, T., Isayeva, U., Nielsen, R. E., Taipale, H. T., Tiihonen, J., Boyer, L., & Gandré, C. (2026) · PLoS ONE · doi:10.1371/journal.pone.0352089 · Cited by 1 · see citing works
Do South African Xhosa-Speaking People with Schizophrenia Really Fare Better?
Niehaus, D. J. H., Jordaan, E., Laubscher, R., Sutherland, T., Koen, L., & Potocnik, F. C. V. (2020) · GeroPsych · doi:10.1024/1662-9647/a000217 · Cited by 1 · see citing works
Jagsch, C., & Hofer, A. (2018) · Zeitschrift für Gerontologie und Geriatrie · Cited by 1 · see citing works
Kaasgaard, D. M., Stryhn, L., Larsen, P. V., Christensen, L. F., Elliott, A. F., Høgh, L., Thunberg, R., Sørensen, M. K., Martinsen, P., Hansen, H. K., et al. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e21670 · Cited by 1 · see citing works
Cohen, A. (2023) · doi:10.1093/med/9780198735588.003.0006 · Cited by 1 · see citing works
Managing Medical Comorbidities in Clinical Practice
Grover, S. (2022) · Journal of Mental Health and Human Behaviour · doi:10.4103/jmhhb.jmhhb_155_22 · Cited by 1 · see citing works
USING QCT TO DETECT DRUG-INDUCED OSTEOPOROSIS IN PATIENTS WITH MENTAL DISORDERS
Ananyeva, N. I., Likhonosova, S. E., Незнанов, Н. Г., Mazo, G. E., Nasyrova, R. F., Shnayder, N., Липатова, Л. В., Валерьевна, Р. К., Malyshko, L. V., Gadgieva, F. S., et al. (2019) · Diagnostic radiology and radiotherapy · doi:10.22328/2079-5343-2019-10-3-77-85 · Cited by 1 · see citing works
Cornevaux, J., Adriansen, A., Mathieu, O., Peyron, P., & Baccino, É. (2021) · La Revue de Médecine Légale · doi:10.1016/j.medleg.2021.10.002 · Cited by 1 · see citing works
Walburg, F. S. (2023) · doi:10.5463/thesis.85 · Cited by 1 · see citing works
Allgemeine Grundlagen (Modul 1)
Gäebel, W., Hasan, A., & Falkai, P. (2019) · Springer eBooks · doi:10.1007/978-3-662-59380-6_1
Broniarczyk-Czarniak, M., Orzechowska, A., & Gałecki, P. (2020) · Pharmacotherapy in Psychiatry and Neurology · doi:10.33450/fpn.2020.07.002
“Pozostali nie wykazują even shorter as evidenced in the studies (Piotrowski et al., 2017).”
BackgroundChen, R., Wang, Q., Xu, C., Wei, Q., Yang, H., Sutcliffe, J. S., Jiang, Y. W., Ji, Y., Cheng, F., Cook, E. H., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-240477/v1
Yang, C., Guo, K., Li, J., Shang, X., Fenfen, E., Wang, Y., Wang, S., Yang, K., Zhang, X., & Li, X. (2022) · Research Square · doi:10.21203/rs.3.rs-1460879/v1
P.365 Physical health knowledge and health-related behaviors in patients with psychosis
Jhon, M., Kim, S. W., & Lee, J. Y. (2019) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2019.09.383
Bayrak, N. G., Geniş, B., & Gürhan, N. (2022) · Etkili Hemşirelik Dergisi · doi:10.46483/deuhfed.953666
Schizophrenia and Other Late-Life Psychoses
Bersani, F. S., Prevete, E., & Vicinanza, R. (2023) · Springer eBooks · doi:10.1007/978-3-030-01782-8_87-1
Haczkiewicz, M., Hylén, U., & Msghina, M. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1593211
“The disorder typically debuts during young adulthood (3) and carries signi fi cant excess mortality (4) as well as disability, which, as quanti fi ed by Global Health Estimates 2019 (5) puts acute phase schizophrenia higher than an untreated spinal cord lesion at neck and severe multiple sclerosis.”
Chen, R., Siciliano, B., Wang, Q., Xu, C., Wei, Q., Yang, H., Sutcliffe, J. S., Jiang, Y. W., Ji, Y., Liu, C., et al. (2025) · Advanced Science · doi:10.1002/advs.202508519
Detection of Diabetes and Hypertension Comorbidities Among Adult Psychiatric Inpatients
Goldman, M. L., McDaniel, M., Mangurian, C. V., Corbeil, T., Dixon, L. B., Essock, S. M., Frimpong, E. Y., Mascayano, F., Olfson, M., Radigan, M., et al. (2025) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001852
Role of the endocannabinoid system in schizophrenia: From preclinical to human evidence
Martino, S. D., Białoń, M., Drago, F., Starowicz, K., & Micale, V. (2025) · Handbook of behavioral neuroscience · doi:10.1016/b978-0-443-13908-6.00030-x
Lechte, T., Bressington, D. T., & Mitchell, D. (2026) · Australasian Psychiatry · doi:10.1177/10398562251414526
- Authors
- Department of Psychiatry, W. M. U., Piotrowski, P., M. Gondek, T., Department of Psychiatry, W. M. U., Królicka-Deręgowska, A., Department of Psychiatry, W. M. U., Misiak, B., Department of Genetics, W. M. U., Adamowski, T., Department of Nervous System Diseases, F. O. H. S., Kiejna, A., & Institute of Psychology, U. O. L. S.
- Affiliations
- Wroclaw Medical University (PL)
- DSW Ideis University (PL)
- Venue
- Psychiatria Danubina
- Publisher
- Medicinska Naklada d.o.o.
- Published
- 2017-06-26
- Volume
- 29
- Issue
- 2
- Pages
- 108-120
- ISSN
- 0353-5053 (ISSN-L)
- OpenAlex
- W2734776459
- Cited by
- 107
- References
- 17
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 6 · 2023: 10 · 2022: 17 · 2021: 15 · 2020: 14 · 2019: 14 · 2018: 12
- FWCI
- 8.98
- Type
- journal article
- Language
- en
- Open access
- green
- hrcak.srce.hr
- Licence
- other-oa
- Locations
- Psychiatria Danubina (publishedVersion)
- PubMed (publishedVersion)
- University of Zagreb University Computing Centre (SRCE) (submittedVersion, other-oa)
- 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, causes of death, suicide, cardiovascular disease, cancer, life expectancy, standardized mortality ratio, death records, European studies
- MeSH terms
- Adult, Aged, Cause of Death, Cross-Cultural Comparison, Europe, Female, Humans, Life Expectancy, Male, Middle Aged, Risk Factors, Schizophrenia, Schizophrenic Psychology, Suicide
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