title: Associations between symptoms and all-cause mortality in individuals with serious mental illness.
abstract: OBJECTIVE
  To determine if aggression, hallucinations or delusions, and depression contribute to excess mortality risk observed in individuals with serious mental illness (SMI).
  
  
  METHODS
  We identified SMI cases (schizophrenia, schizoaffective and bipolar disorder) aged≥15years in a large secondary mental healthcare case register linked to national mortality tracing. We modelled the effect of specific symptoms (HoNOS subscales) on all-cause mortality using Cox regression.
  
  
  RESULTS
  We identified 6880 SMI cases (242 deaths) occurring 2007-2010. Bipolar disorder was associated with reduced mortality risk compared to schizophrenia (HR 0.7; 95% CI 0.4-0.96; p=0.028). Mortality was not significantly associated with hallucinations and delusions or overactive-aggressive behaviour, but was associated with physical illness/disability. There was a positive association between mortality and subclinical depression among individuals with schizophrenia (HR 1.5; 1.1-2.2; p=0.019) but a negative association with subclinical and more severe depression among those with schizoaffective disorder (HR 0.1; 0.02-0.4; p=0.001 and 0.3; 0.1-0.8; p=0.021, respectively).
  
  
  CONCLUSIONS
  The recognised increased risk of mortality in SMI did not appear to be influenced by severity of hallucinations, delusions, or overactive-aggressive behaviour. Physical illness and lifestyle may need to be addressed and the relationship between depression and mortality requires further investigation.
authors.affiliation: King's College London, Institute of Psychiatry, Section of Epidemiology, Dept of Health Service and Population Research, London, UK. richard.hayes@kcl.ac.uk
authors.forename: Richard D
authors.initials: RD
authors.lastname: Hayes
authors.forename: Chin-Kuo
authors.initials: CK
authors.lastname: Chang
authors.forename: Andrea
authors.initials: A
authors.lastname: Fernandes
authors.forename: Aysha
authors.initials: A
authors.lastname: Begum
authors.forename: David
authors.initials: D
authors.lastname: To
authors.forename: Matthew
authors.initials: M
authors.lastname: Broadbent
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.forename: Robert
authors.initials: R
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology*; D001714:Bipolar Disorder / Q000401:mortality* / Q000523:psychology; D003702:Delusions / Q000401:mortality* / Q000523:psychology; D003863:Depression / Q000401:mortality* / Q000523:psychology; D005260:Female; D006212:Hallucinations / Q000401:mortality* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012559:Schizophrenia / Q000401:mortality*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index