title: Mortality in schizophrenia and other psychoses: a 10-year follow-up of the ӔSOP first-episode cohort.
abstract: The excess mortality in people with psychotic disorders is a major public health concern, but little is known about the clinical and social risk factors which may predict this health inequality and help inform preventative strategies. We aimed to investigate mortality in a large epidemiologically characterized cohort of individuals with first-episode psychosis compared with the general population and to determine clinical and social risk factors for premature death. All 557 individuals with first-episode psychosis initially identified in 2 areas (Southeast London and Nottinghamshire, United Kingdom) were traced over a 10-year period in the ӔSOP-10 study. Compared with the general population, all-cause (standardized mortality ratio [SMR] 3.6, 95% confidence interval [CI] 2.6-4.9), natural-cause (SMR 1.7, 95% CI 1.0-2.7) and unnatural-cause (SMR 13.3, 95% CI 8.7-20.4) mortality was very high. Illicit drug use was associated with an increased risk of all-cause mortality (adj. rate ratio [RR] 2.31, 95% CI 1.06-5.03). Risk of natural-cause mortality increased with a longer time to first remission (adj. RR 6.61, 95% CI 1.33-32.77). Family involvement at first contact strongly reduced risk of unnatural-cause mortality (adj. RR 0.09, 95% CI 0.01-0.69). Our findings suggest that the mortality gap in people with psychotic disorders remains huge and may be wider for unnatural-cause mortality than previously reported. Efforts should now focus on further understanding and targeting these tractable clinical and social risk factors of excess mortality. Early intervention and dual diagnosis services may play a key role in achieving more rapid remission and carer involvement and addressing substance use problems to reduce excess mortality in psychosis.
authors.affiliation: ulrich.reininghaus@kcl.ac.uk.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Reininghaus
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, King's College, London, UK;
authors.forename: Rina
authors.initials: R
authors.lastname: Dutta
authors.affiliation: NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College, London, UK; Psychosis Studies Department, Institute of Psychiatry, King's College, London, UK;
authors.forename: Paola
authors.initials: P
authors.lastname: Dazzan
authors.affiliation: Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK;
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Doody
authors.affiliation: Department of Psychiatry, Trinity College, Dublin, Ireland;
authors.forename: Paul
authors.initials: P
authors.lastname: Fearon
authors.affiliation: NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College, London, UK; Psychosis Studies Department, Institute of Psychiatry, King's College, London, UK; Department of Psychiatry, University of New South Wales, Sydney, NSW, Australia;
authors.forename: Julia
authors.initials: J
authors.lastname: Lappin
authors.affiliation: Centre for Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK;
authors.forename: Margaret
authors.initials: M
authors.lastname: Heslin
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK;
authors.forename: Adanna
authors.initials: A
authors.lastname: Onyejiaka
authors.affiliation: Addictions Department, Institute of Psychiatry, King's College, London, UK;
authors.forename: Kim
authors.initials: K
authors.lastname: Donoghue
authors.affiliation: Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK;
authors.forename: Ben
authors.initials: B
authors.lastname: Lomas
authors.affiliation: Division of Psychiatry, University College London, London, UK;
authors.forename: James B
authors.initials: JB
authors.lastname: Kirkbride
authors.affiliation: NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College, London, UK; Psychosis Studies Department, Institute of Psychiatry, King's College, London, UK;
authors.forename: Robin M
authors.initials: RM
authors.lastname: Murray
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Croudace
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK; NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College, London, UK;
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Department of Psychiatry, University of Cambridge, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK;
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000453:epidemiology / Q000401:mortality*; D012042:Registries; D012306:Risk; D012559:Schizophrenia / Q000453:epidemiology / Q000401:mortality*; D013997:Time Factors; D055815:Young Adult
keywords: mortality/; psychosis/; risk factors; schizophrenia/