title: Excess mortality in severe mental illness: 10-year population-based cohort study in rural Ethiopia.
abstract: BACKGROUND
  Evidence on mortality in severe mental illness (SMI) comes primarily from clinical samples in high-income countries.
  
  
  OBJECTIVE
  To describe mortality in people with SMI among a population cohort from a low-income country.
  
  
  METHODS
  We followed-up 919 adults (from 68 378 screened) with SMI over 10 years. Standardised mortality ratios (SMR) and years of life lost (YLL) as a result of premature mortality were calculated.
  
  
  RESULTS
  In total 121 patients (13.2%) died. The overall SMR was twice that of the general population; higher for men and people with schizophrenia. Patients died about three decades prematurely, mainly from infectious causes (49.6%). Suicide, accidents and homicide were also common causes of death.
  
  
  CONCLUSIONS
  Mortality is an important adverse outcome of SMI irrespective of setting. Addressing common natural and unnatural causes of mortality are urgent priorities. Premature death and mortality related to self-harm should be considered in the estimation of the global burden of disease for SMI.
authors: Abebaw Fekadu, MD, MSc, MRCPsych, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia and King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Girmay Medhin, MSc, PhD, Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; Derege Kebede, MD, DSc, WHO Regional Office for Africa, Brazzaville, Republic of Congo; Atalay Alem, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Anthony J. Cleare, BSc, MBBS, MRCPsych, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Martin Prince, MD, MSc, FRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department; Charlotte Hanlon, BMBS, MSc, MRCPsych, PhD, Teshome Shibre, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Abebaw
authors: A
authors: Fekadu
authors: Abebaw Fekadu, MD, MSc, MRCPsych, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia and King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Girmay Medhin, MSc, PhD, Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; Derege Kebede, MD, DSc, WHO Regional Office for Africa, Brazzaville, Republic of Congo; Atalay Alem, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Anthony J. Cleare, BSc, MBBS, MRCPsych, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Martin Prince, MD, MSc, FRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department; Charlotte Hanlon, BMBS, MSc, MRCPsych, PhD, Teshome Shibre, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Girmay
authors: G
authors: Medhin
authors: Abebaw Fekadu, MD, MSc, MRCPsych, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia and King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Girmay Medhin, MSc, PhD, Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; Derege Kebede, MD, DSc, WHO Regional Office for Africa, Brazzaville, Republic of Congo; Atalay Alem, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Anthony J. Cleare, BSc, MBBS, MRCPsych, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Martin Prince, MD, MSc, FRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department; Charlotte Hanlon, BMBS, MSc, MRCPsych, PhD, Teshome Shibre, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Derege
authors: D
authors: Kebede
authors: Abebaw Fekadu, MD, MSc, MRCPsych, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia and King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Girmay Medhin, MSc, PhD, Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; Derege Kebede, MD, DSc, WHO Regional Office for Africa, Brazzaville, Republic of Congo; Atalay Alem, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Anthony J. Cleare, BSc, MBBS, MRCPsych, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Martin Prince, MD, MSc, FRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department; Charlotte Hanlon, BMBS, MSc, MRCPsych, PhD, Teshome Shibre, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Atalay
authors: A
authors: Alem
authors: Abebaw Fekadu, MD, MSc, MRCPsych, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia and King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Girmay Medhin, MSc, PhD, Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; Derege Kebede, MD, DSc, WHO Regional Office for Africa, Brazzaville, Republic of Congo; Atalay Alem, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Anthony J. Cleare, BSc, MBBS, MRCPsych, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Martin Prince, MD, MSc, FRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department; Charlotte Hanlon, BMBS, MSc, MRCPsych, PhD, Teshome Shibre, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Anthony J
authors: AJ
authors: Cleare
authors: Abebaw Fekadu, MD, MSc, MRCPsych, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia and King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Girmay Medhin, MSc, PhD, Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; Derege Kebede, MD, DSc, WHO Regional Office for Africa, Brazzaville, Republic of Congo; Atalay Alem, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Anthony J. Cleare, BSc, MBBS, MRCPsych, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Martin Prince, MD, MSc, FRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department; Charlotte Hanlon, BMBS, MSc, MRCPsych, PhD, Teshome Shibre, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Martin
authors: M
authors: Prince
authors: Abebaw Fekadu, MD, MSc, MRCPsych, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia and King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Girmay Medhin, MSc, PhD, Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; Derege Kebede, MD, DSc, WHO Regional Office for Africa, Brazzaville, Republic of Congo; Atalay Alem, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Anthony J. Cleare, BSc, MBBS, MRCPsych, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Martin Prince, MD, MSc, FRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department; Charlotte Hanlon, BMBS, MSc, MRCPsych, PhD, Teshome Shibre, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Charlotte
authors: C
authors: Hanlon
authors: Abebaw Fekadu, MD, MSc, MRCPsych, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia and King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Girmay Medhin, MSc, PhD, Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; Derege Kebede, MD, DSc, WHO Regional Office for Africa, Brazzaville, Republic of Congo; Atalay Alem, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Anthony J. Cleare, BSc, MBBS, MRCPsych, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK; Martin Prince, MD, MSc, FRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department; Charlotte Hanlon, BMBS, MSc, MRCPsych, PhD, Teshome Shibre, MD, PhD, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors: Teshome
authors: T
authors: Shibre
mesh_terms: D000059:Accidents; D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D003863:Depression / Q000401:mortality*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006708:Homicide; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012424:Rural Population / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000401:mortality*; D017678:Sex Distribution; D013405:Suicide / Q000706:statistics & numerical data; D055815:Young Adult