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Is the Differential Mortality Gap Worsening Over Time?

Sukanta Saha, MSc, MCN; David Chant, PhD; John McGrath, MD, PhD, FRANZCP

Arch Gen Psychiatry. 2007;64(10):1123-1131.

Context  Despite improvements in mental health services in recent decades, it is unclear whether the risk of mortality in schizophrenia has changed over time.

Objective  To explore the distribution of standardized mortality ratios (SMRs) for people with schizophrenia.

Data Sources  Broad search terms were used in MEDLINE, PsychINFO, Web of Science, and Google Scholar to identify all studies that investigated mortality in schizophrenia, published between January 1, 1980, and January 31, 2006. References were also identified from review articles, reference lists, and communication with authors.

Study Selection  Population-based studies that reported primary data on deaths in people with schizophrenia.

Data Extraction  Operationalized criteria were used to extract key study features and mortality data.

Data Synthesis  We examined the distribution of SMRs and pooled selected estimates using random-effects meta-analysis. We identified 37 articles drawn from 25 different nations. The median SMR for all persons for all-cause mortality was 2.58 (10%-90% quantile, 1.18-5.76), with a corresponding random-effects pooled SMR of 2.50 (95% confidence interval, 2.18-2.43). No sex difference was detected. Suicide was associated with the highest SMR (12.86); however, most of the major causes-of-death categories were found to be elevated in people with schizophrenia. The SMRs for all-cause mortality have increased during recent decades (P = .03).

Conclusions  With respect to mortality, a substantial gap exists between the health of people with schizophrenia and the general community. This differential mortality gap has worsened in recent decades. In light of the potential for second-generation antipsychotic medications to further adversely influence mortality rates in the decades to come, optimizing the general health of people with schizophrenia warrants urgent attention.

Author Affiliations: Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol (Mr Saha and Drs Chant and McGrath), and Department of Psychiatry, The University of Queensland, St Lucia (Drs Chant and McGrath), Australia.

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