title: Functional status and all-cause mortality in serious mental illness.
abstract: BACKGROUND
  Serious mental illness can affect many aspects of an individual's ability to function in daily life. The aim of this investigation was to determine if the environmental and functional status of people with serious mental illness contribute to the high mortality risk observed in this patient group.
  
  
  METHODS
  We identified cases of schizophrenia, schizoaffective and bipolar disorder aged ≥ 15 years in a large secondary mental healthcare case register linked to national mortality tracing. We modelled the effect of activities of daily living (ADLs), living conditions, occupational and recreational activities and relationship factors (Health of the Nation Outcome Scale [HoNOS] subscales) on all-cause mortality over a 4-year observation period (2007-10) using Cox regression.
  
  
  RESULTS
  We identified 6,880 SMI cases (242 deaths) in the observation period. ADL impairment was associated with an increased risk of all-cause mortality (adjusted HR 1.9; 95% CI 1.3-2.8; p = 0.001, p for trend across ADL categories = 0.001) after controlling for a broad range of covariates (including demographic factors, physical health, mental health symptoms and behaviours, socio-economic status and mental health service contact). No associations were found for the other three exposures. Stratification by age indicated that ADLs were most strongly associated with mortality in the youngest (15 to <35 years) and oldest (≥ 55 years) groups.
  
  
  CONCLUSIONS
  Functional impairment in people with serious mental illness diagnoses is a marker of increased mortality risk, possibly in younger age groups as a marker of negative symptomatology.
authors.affiliation: Department of Health Service and Population Research, King's College London, Institute of Psychiatry, London, United Kingdom. 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 C
authors.initials: AC
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: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000401:mortality* / Q000503:physiopathology; D008875:Middle Aged; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult