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Increased Mortality Among Patients Admitted With Major Psychiatric Disorders: A Register-Based Study Comparing Mortality in Unipolar Depressive Disorder, Bipolar Affective Disorder, Schizoaffective Disorder, and Schizophrenia
Abstract
CONTEXT: Persons suffering from severe mental disorder have an excess mortality compared to persons with no mental disorder. However, the magnitude of the excess mortality differs from one mental disorder to another, and the impact on mortality if a first-degree family member suffers from a mental disorder has never been examined in a population-based study. OBJECTIVE: Our objective was to examine and compare mortality rates after admission with schizophrenia, schizoaffective disorder, unipolar depressive disorder, or bipolar affective disorder and to examine the impact of family history of psychiatric admission on mortality. METHOD: We established a register-based cohort study of 5.5 million persons born in Denmark who were alive on or born after January 1, 1973 and alive on their 15th birthday. Mortality rate ratios were estimated by survival analysis, using Poisson regression. RESULTS: Unipolar depressive disorder, bipolar affective disorder, and schizoaffective disorder were associated with the same pattern of excess mortality. Schizophrenia had a lower mortality from unnatural causes of death and a higher mortality from natural causes compared to the 3 other disorders. Family history of psychiatric admission was associated with excess mortality. CONCLUSION: Patients suffering from the 4 disorders all had an excess mortality, but the pattern of excess mortality was not the same. There was an excess mortality associated with mental disorder in a first-degree family member, but this only explained a small part of the general excess mortality associated with the 4 mental disorders examined.
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“Notably, the SMR for cancer was only 1.37, which has also been observed in other studies (Laursen et al. 2007;Mortensen & Juel 1990, 1993).”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Laursen et al. 2007
In the citing paper
“Patients with bipolar disorder or schizophrenia seem to be a particular vulnerable patient group [6].”
From Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries. (2013) · cites this paper as [6]
In the citing paper
“Today, respiratory diseases are still more prevalent in people with SMI (8,(410)(411)(412)(413)(414)(415)(416)(417).”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [8]
In the citing paper
“In the population of bipolar spectrum disorders, deaths from cancer are not higher (8,288,416,417,454-456) or only slightly elevated (417,418,456) compared with the general population, despite the higher number of risk factors for cancer (such as obesity) in this 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 [8]
In the citing paper
“The excess mortality is not solely explained by increased risk of suicide and other external causes of death; it is also due to diseases and medical conditions.”
From Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden (2013) · cites this paper as [6]
In the citing paper
“A recent Danish study confirms that mortality from cardiovascular disease, malignant neoplasms, respiratory diseases and endocrine and metabolic conditions was more than twofold higher for both men and women with schizophrenia and affective disorders compared to the general population. [6].”
From Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden (2013) · cites this paper as [6]
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Feng, Y., Wang, S., Zhao, L., Guo, X., Shen, Z., Zhang, Y., Tarimo, C. S., Wang, C., Fu, H., Jiang, S., et al. (2025) · Public Health · doi:10.1016/j.puhe.2025.02.005 · Cited by 4
Kowalec, K., Lu, Y., Song, J., Dalman, C., Hultman, C. M., Larsson, H., Lichtenstein, P., & Sullivan, P. F. (2021) · Translational Psychiatry · doi:10.1038/s41398-021-01282-1 · Cited by 5
Antipsychotic use and unexpected death: a hospital-based case-control study
Mace, S., Dzahini, O., Cornelius, V. R., Anthony, D., Stewart, R. J., & Taylor, D. M. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12507 · Cited by 4
Omary, A., Richardson, U., & Chambers, T. (2021) · Archives of Suicide Research · doi:10.1080/13811118.2021.1989350 · Cited by 5
“Depression is a major risk factor for suicidal behaviors and is strongly correlated with suicidal ideation (SI), suicide plans (SP), and suicide attempts (SA) (Gill et al., 2018; Large, 2016; Laursen et al., 2007, 2016; Melhem et al., 2019; National Center for Injury Prevention and Control.”
BackgroundOral ziprasidone in the treatment of patients with bipolar disorders: a critical review
Sacchetti, E., Galluzzo, A., & Valsecchi, P. (2011) · Expert Review of Clinical Pharmacology · doi:10.1586/ecp.10.139 · Cited by 4
Spaces for mood care: prevention and intervention in digital, community and health systems
Bhui, K. S. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2018.14 · Cited by 3
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“People with schizophrenia spectrum disorders (SSD) face an elevated risk of developing cardiometabolic comorbidities, such as diabetes [1], metabolic syndrome, and cardiovascular disease [2], contributing to a premature mortality rate of 15–20 years [3–5].”
BackgroundLifestyle interventions for depression in primary care: a qualitative study
Panjer, J. A., Alma, M., Fokkema, T., Hendriks, T., Cath, D. C., Kik, J., Burger, H., & Berger, M. Y. (2025) · BJGP Open · doi:10.3399/bjgpo.2024.0233 · Cited by 3
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“As documented by many studies, these metabolic alterations collaborate for increased risk of mortality by cardiovascular causes, as well as increased risk of morbidity [5-7,9-11].”
Backgroundda Silva, A. P., Chiari, L. P. A., Guimarães, A. R., Honório, K. M., & da Silva, A. B. F. (2021) · Structural Chemistry · doi:10.1007/s11224-021-01742-w · Cited by 3
Cetkovich, M., Abadi, A. F., Camino, S., Bonetto, G. G., Herbst, L., Marengo, E., Torrente, F. M., Maresca, T., Bustin, J., Morra, C. A., et al. (2022) · Vertex Revista Argentina de Psiquiatría · doi:10.53680/vertex.v33i158.319 · Cited by 5
Mortality in Qatari individuals with mental illness: a retrospective cohort study
Ouanes, S., Hashem, L. A., Makki, I., Khan, F., Mahgoub, O., Wafer, A., Dulaimy, O., Amro, R., & Ghuloum, S. (2024) · Annals of General Psychiatry · doi:10.1186/s12991-024-00499-w · Cited by 3
“Suicide has been found to account for most of the elevated risk of unnatural death [2, 3, 7].”
BackgroundInfluentialHealthy lifestyle and risk of incidence, mortality and life expectancy of mental disorders
Tian, S., Wang, Q., Wu, T., Chang, S., Dun, W.-W., Zhang, L., Li, A., & Wang, G. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119592 · Cited by 4
Prevalence of QTc interval changes in acute psychiatric care: A cross-sectional study
Beyraghi, N., Rajabi, F., & Hajsheikholeslami, F. (2013) · International Journal of Psychiatry in Clinical Practice · doi:10.3109/13651501.2012.667112 · Cited by 3
Bipolar disorder, Type A behaviour and coronary disease
Glass, D. C., & Contrada, R. J. (2011) · Health Psychology Review · doi:10.1080/17437199.2010.531568 · Cited by 3
Atomoxetine-Associated Hemospermia
Raj, P. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0720d · Cited by 3
Carlborg, A., Thuresson, M., Ferntoft, L., & Bodegård, J. (2014) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125314560740 · Cited by 3
Chander, G. (2012) · Journal of AIDS and HIV Research · doi:10.5897/jahr12.026 · Cited by 3
“(2004) are in contrast to the literature on mortality among those with SMI in the non-HIV infected population, where SMI is associated with higher mortality rates (Daumit et al., 2010; Laursen et al., 2007).”
ResultMajor Depression: An Immune-Inflammatory Disorder
Noto, C. D. S., Rizzo, L. B., Mansur, R. B., Brietzke, E. M., & Maes, M. H. J. (2015) · Current topics in neurotoxicity · doi:10.1007/978-3-319-13602-8_8 · Cited by 3
Metadata
- Authors
- Laursen, T. M., Munk-Olsen, T., Nordentoft, M., & Mortensen, P. B.
- Affiliations
- Aarhus University (DK)
- Bispebjerg Hospital (DK)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2007-06-15
- Volume
- 68
- Issue
- 06
- Pages
- 899-907
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2006100396
- Cited by
- 380
- References
- 0
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 9 · 2023: 17 · 2022: 15 · 2021: 17 · 2020: 19 · 2019: 14 · 2018: 26 · 2017: 17 · 2016: 35 · 2015: 25 · 2014: 24 · 2013: 33 · 2012: 31
- FWCI
- 26.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Lundbeckfonden (R5-2006-227)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › 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
- excess mortality, severe mental illness, schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, first-degree relatives, causes of death, mortality rate ratio
- MeSH terms
- Adult, Aged, Aged, 80 and over, Bipolar Disorder, Cause of Death, Denmark, Depressive Disorder, Female, Humans, Male, Middle Aged, Mortality, Psychotic Disorders, Registries, Schizophrenia, Cohort Studies
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