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Excess mortality of schizophrenia

A meta-analysis

Published online by Cambridge University Press:  02 January 2018

Steve Brown
Steve Brown*
Affiliation:
Department of Psychiatry, University of Southampton, Royal South Hants Hospital, Brinton's Terrace, Southampton SO14 0YG
*
Dr Steve Brown, Wolston Park Hospital, Wacol 4076, Queensland, Australia
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Abstract

Background

This paper presents a structured review of the published information on the mortality of schizophrenia.

Method

A meta-analysis of the literature.

Results

Schizophrenia has a significantly increased mortality from natural and unnatural causes. Twenty-eight percent of the excess mortality is attributable to suicide and 12% to accidents. The rest of the excess mortality is from the same broad range of conditions which cause deaths in the general population. Further interpretation is hampered by confounding variables, wide confidence intervals and reservations about generalising from individual cohorts.

Conclusions

The available evidence suggests that schizophrenia is associated with a large increased mortality from suicide and a moderate increased mortality from natural causes. A number of possible interventions have been identified, but we do not yet have reliable means of detecting any changes in mortality which might result.

Type
Review Articles
Information
The British Journal of Psychiatry , Volume 171 , Issue 6 , December 1997 , pp. 502 - 508
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

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References

Allebeck, P., Varia, A. & Wistedt, B. (1986) Suicide and violent death among patients with schizophrenia. Acta Psychiatrica Scandinavica, 74, 43–49.CrossRefGoogle ScholarPubMed
Allebeck, P., & Wistedt, B. (1986) Mortality in schizophrenia. A ten year follow-up based on the Stockholm county inpatient register. Archives of General Psychiatry, 43, 650–653.CrossRefGoogle Scholar
Alström, C. H. (1942) Mortality in mental hospitals with especial regard to tuberculosis. Acta Psychiatrica and Neurologica Scandinavica, suppl. 24.Google Scholar
Amaddeo, F., Bisoffi, G., Bonizato, P., et al (1995) Mortality among patients with psychiatric illness. A ten year case register study in an area with a community based system of care. British Journal of Psychiatry, 166, 783–788.Google Scholar
Anderson, C., Connelly, J., Johnstone, E. C., et al (1991) Disabilities and circumstances of schizophrenic patients – a follow-up study: V. Cause of death. British Journal of Psychiatry, 159, (suppl. 13). 30–33.CrossRefGoogle Scholar
Babigian, H. M. & Odoroff, C. L. (1969) The mortality experience of a population with psychiatric illness. American Journal of Psychiatry, 126, 470–480.CrossRefGoogle ScholarPubMed
Baxter, D. N. (1996) The mortality experience of individuals on the Salford case register I. All-cause mortality. British Journal of Psychiatry, 168, 772–779.CrossRefGoogle ScholarPubMed
Black, D. W. (1988) Mortality in schizophrenia – The lowa record-linkage study: A comparison with general population mortality. Psychosomatics, 29, 55–60.CrossRefGoogle Scholar
Bleuler, E. (1950) Dementia Praecox or the Group Schizophrenias (first published in German, 1911). New York: International Universities Press.Google Scholar
Bleuler, M. (1978) The Schizophrenic Disorders. New Haven: Yale University Press.Google Scholar
Brook, O. H. (1985) Mortality in the long-stay population of Dutch mental hospitals. Acta Psychiatrica Scandinavica. 71, 626–635.CrossRefGoogle ScholarPubMed
Burleigh, M. (1994) Death and Deliverance – Euthanasia in Germany 1900–45. Cambridge: Cambridge University Press.Google Scholar
Caldwell, C. B. & Gottesman, I. I. (1990) Schizophrenics kill themselves too: A review of risk factors for suicide. Schizophrenia Bulletin, 16, 571–588.CrossRefGoogle Scholar
Copas, J. B. & Robin, A. (1982) Suicide in psychiatric inpatients. British Journal of Psychiatry, 141, 503–511.Google Scholar
Crammer, J. L. (1992) Extraordinary deaths of asylum inpatients during the 1914–1918 war. Medical History, 36, 430–441.CrossRefGoogle ScholarPubMed
Dickersin, K. & Berlin, J. A. (1992) Meta-analysis: state of the science. Epidemiologic Reviews. 14, 154–176.CrossRefGoogle ScholarPubMed
Dupont, A., Jenson, O. M., Stromgren, E., et al (1986) Incidence of cancer in patients diagnosed as schizophrenic in Denmark. In Psychiatric Case Registers in Public Health (1963) (eds Ten Horn, G. H., Giel, R., Gulbinat, W. H., et al). Amsterdam: Elsevier.Google Scholar
Eastwood, M. R., Stiasny, S., Meier, H. M. R., et al (1982) Mental illness and mortality. Comprehensive Psychiatry, 23, 377–385.CrossRefGoogle ScholarPubMed
Edlund, M. J., Conrad, C. & Morris, M. (1989) Accidents among schizophrenic outpatients. Comprehensive Psychiatry, 30, 522–526.Google Scholar
Farr, W. (1841) Report on the mortality of lunatics. Journal of the Royal Statistical Society, IV, 17–33.Google Scholar
Gardener, M. J. & Altman, D. G. (1989) Statistics with Confidence. London: British Medical Journal.Google Scholar
Giel, R., Dijk, S. & van Weerden Dijkstra, J. R. (1978) Mortality in the long-stay population of all Dutch mental hospitals. Acta Psychiatrica Scandinavica, 57, 361–368.CrossRefGoogle ScholarPubMed
Graunt, J. (1662) Natural and political observations mentioned in a following index, and made upon the bills of mortality. In Three Hundred Years of Psychiatry 1538–1860 (1963) (eds Hunter, R. A. & Macalpine, I.). p. 166. London: Oxford University Press.Google Scholar
Hassall, C., Prior, P. & Cross, K. W. (1988) A preliminary study of excess mortality using a psychiatric case register. Journal of Epidemiology and Community Health, 42, 286–289.Google Scholar
Haugland, G., Craig, T. J., Goodman, A. B., et al (1983) Mortality in the era of deinstitutionalisation. American Journal of Psychiatry. 140, 848–852.Google Scholar
Henderson, D. & Gillespie, R. D. (1952) A Textbook of Psychiatry. London: Oxford University Press.Google Scholar
Herrman, H. E., Baldwin, J. W. & Christie, D. (1983) A record-linkage study of mortality and general hospital discharge in patients diagnosed as schizophrenic. Psychological Medicine. 13, 581–593.Google Scholar
Kraepelin, E. (1919) Dementia Praecox and Paraphrenia. Edinburgh: Livingstone.Google Scholar
Lesage, A. D., Trapani, V. & Tansella, M. (1990) Excess mortality by natural causes of Italian schizophrenic patients. European Archives of Psychiatry and Neurological Sciences, 239, 361–365.CrossRefGoogle ScholarPubMed
Licht, R. W., Mortensen, P. B., Gouliaev, G., et al (1993) Mortality in Danish psychiatric long-stay patients. 1972–1982. Acta Psychiatrica Scandinavica, 87, 336–341.CrossRefGoogle ScholarPubMed
Malzburg, B. (1934) Mortality among Patients with Mental Disease. New York: Utica State Hospital Press.Google Scholar
Martin, R. L., Cloninger, R., Guze, S. B., et al (1985) Mortality in a follow-up of 500 psychiatric outpatients. II. Cause-specific mortality. Archives of General Psychiatry, 42, 58–66.CrossRefGoogle Scholar
Mortensen, P. B. (1989) The incidence of cancer in schizophrenic patients. Journal of Epidemiology and Community Health, 43, 43–47.CrossRefGoogle ScholarPubMed
Mortensen, P. & Juel, K. (1990) Mortality and causes of death in schizophrenic patients in Denmark. Acta Psychiatrica Scandinavica. 81, 372–377.CrossRefGoogle ScholarPubMed
Mortensen, P. & Juel, K. (1993) Mortality and causes of death in first admitted schizophrenic patients. British Journal of Psychiatry, 163, 183–189.CrossRefGoogle ScholarPubMed
Munk-Jørgensen, P. & Mortensen, P. B. (1992) Incidence and other aspects of the epidemiology of schizophrenia in Denmark, 1971–87. British Journal of Psychiatry, 161, 489–495.Google Scholar
Newman, S. C. & Bland, R. C. (1991) Mortality in a cohort of patients with schizophrenia: A record linkage study. Canadian Journal of Psychiatry, 36, 239–245.CrossRefGoogle Scholar
Nyman, A. K. & Jonsson, H. (1986) Patterns of self-destructive behaviour in schizophrenia. Acta Psychiatrica Scandinavica, 73, 252–262.CrossRefGoogle ScholarPubMed
Office of Population Census and Surveys (1995) 1993 Mortality Statistics. Cause. London. HMSO.Google Scholar
Ødegàrd, Ø. (1936) Mortality in Norwegian mental hospitals from 1916 to 1933. Acta Psychiatrica Scandinavica, 11, 323–356.Google Scholar
Pokorny, A. D. (1983) Predicting suicide in psychiatric patients. Report of a prospective study. Archives of General Psychiatry. 40, 249–257.Google Scholar
Riley, M. D., McCarty, D. J., Couper, D. J., et al (1995) The 1984 Tasmanian insulin treated diabetes mellitus prevalence cohort: An eight and a half year mortality follow-up. Diabetes Research and Clinical Practice, 29, 27–35.CrossRefGoogle Scholar
Rutstein, D. D., Berenberg, W., Chalmers, T. C., et al (1976) Measuring the quality of medical care. A clinical method. New England Journal of Medicine, 294, 582–588.CrossRefGoogle ScholarPubMed
Saku, M., Tokudome, S., Ikeda, M., et al (1995) Mortality in psychiatric patients, with a specific focus on cancer mortality associated with schizophrenia. International Journal of Epidemiology, 24, 366–372.Google Scholar
Sims, A. C. P. (1973) Importance of a high tracing-rate in long-term medical follow-up studies. Lancet, ii. 433–435.CrossRefGoogle Scholar
Stewart, L. A. & Parmar, M. K. (1993) Meta-analysis of the literature or of individual patient data: is there a difference? Lancet. 341, 418–421.Google Scholar
Swayze, V. W. (1995) Frontal leucotomy and related psychosurgical procedures in the era before antipsychotics (1935–54): A historical overview. American Journal of Psychiatry, 152, 505–515.Google Scholar
Thompson, S. G. (1993) Controversies in meta-analysis: the case of the trials of serum cholesterol reduction. Statistical Methods in Medical Research, 2, 173–192.CrossRefGoogle ScholarPubMed
Turner, T. H. (1990) Rich and mad in Victorian England: Diagnostic analysis of the casebooks of Ticehurst House. In Lectures on the History of Psychiatry (eds Murray, R. & Turner, T.), p. 30. London: Gaskell.Google Scholar
Weiner, B. P. & Marvit, R. C. (1977) Schizophrenia in Hawaii: analysis of cohort mortality risk in a multi-ethnic population. British Journal of Psychiatry, 131, 497–503.Google Scholar
Wilkinson, D. G. (1982) The suicide rate in schizophrenia. British Journal of Psychiatry, 140, 138–141.CrossRefGoogle ScholarPubMed
Wood, J. B., Evenson, R. C., Cho, D. W., et al (1985) Mortality variations among public mental health patients. Acta Psychiatrica Scandinavica, 72, 218–229.CrossRefGoogle ScholarPubMed
Zilber, N., Schufman, N. & Lerner, Y. (1989) Mortality among psychiatric patients – the groups at risk. Acta Psychiatrica Scandinavica, 79, 248–256.Google Scholar
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