Do adverse perinatal events predict mortality in schizophrenia during midlife?
We examined mortality in schizophrenia spectrum disorder (SSD) and non-schizophrenic psychosis (NSSD) compared to individuals without psychosis, and whether perinatal factors predict mortality.



Within Northern Finland Birth Cohort 1966 (n=10 933; 203 with SSD, 178 with NSSD), mortality was followed until end of 2011 by national register. Wantedness of pregnancy, mother's antenatal depression, smoking and age, parity, paternal socio-economic status (SES) and family type at birth were examined as predictors of mortality.



Mortality was higher in SSD (hazard ratio (HR) 3.60; 95% confidence interval (CI) 2.38-5.45) and NSSD (4.05; 2.65-6.17) compared to persons without psychoses after adjustment for gender. HR for natural death was 2.01 (0.82-4.91) in SSD and 4.63 (2.43-8.80) in NSSD after adjustment for gender. Corresponding figures for unnatural deaths were 4.71 (2.94-7.54) and 2.94 (1.56-5.55), respectively. Among non-psychotic persons, mother's depression, smoking and low SES predicted mortality after adjustment for gender and parental psychoses (and SES), whereas among psychosis those whose father was a farmer had lower risk of mortality compared to those with high SES.



Individuals with SSD had a higher risk of unnatural death and individuals with NSSD of natural and unnatural deaths. Perinatal factors seem to be more important predictors of mortality in individuals without psychoses than with psychoses. According to population-based long follow-up data, it is important to pay attention to somatic morbidity behind natural causes of death in psychoses and to prevent suicides in order to prevent excess mortality.
Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, OYS, P.O. Box 20, 90029 Oulu, Finland. Electronic address: nina.rautio@oulu.fi.
Nina
N
Rautio
Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland. Electronic address: jouko.miettunen@oulu.fi.
Jouko
J
Miettunen
Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Oulu Occupational Health, Hallituskatu 36 B, 90100 Oulu, Finland. Electronic address: erika.jaaskelainen@oulu.fi.
Erika
E
Jääskeläinen
Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland. Electronic address: tanja.nordstrom@oulu.fi.
Tanja
T
Nordström
Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland. Electronic address: matti.isohanni@oulu.fi.
Matti
M
Isohanni
Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Department of Psychiatry, South-Savo Hospital District, Porrassalmenkatu 35-37, 50100 Mikkeli, Finland; Psychiatric Services, Carea, Kymenlaakso Social and Health Services, Kotkantie 41, 48210 Kotka, Finland. Electronic address: jussi.seppala@oulu.fi.
Jussi
J
Seppälä
D000328:Adult; D002423:Cause of Death; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000401:mortality; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000401:mortality; D012042:Registries / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000453:epidemiology* / Q000401:mortality
Mortality; Perinatal circumstances; Psychoses