title: Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas.
abstract: Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio-environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.
authors.affiliation: World Health Organization, Geneva, Switzerland.|University of California, Berkeley, CA, USA.
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Liu
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Gail L
authors.initials: GL
authors.lastname: Daumit
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Tarun
authors.initials: T
authors.lastname: Dua
authors.affiliation: Fountain House, New York, NY, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Aquila
authors.affiliation: Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Charlson
authors.affiliation: Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Druss
authors.affiliation: Fountain House, New York, NY, USA.
authors.forename: Kenn
authors.initials: K
authors.lastname: Dudek
authors.affiliation: National Department of Health, Johannesburg, South Africa.
authors.forename: Melvyn
authors.initials: M
authors.lastname: Freeman
authors.affiliation: National Institute of Mental Health, Tokyo, Japan.
authors.forename: Chiyo
authors.initials: C
authors.lastname: Fujii
authors.affiliation: Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gaebel
authors.affiliation: Universitätsklinikum Leipzig, Leipzig, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
authors.affiliation: University of Haifa, Haifa, Israel.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Levav
authors.affiliation: Aarhus University, Aarhus, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Munk Laursen
authors.affiliation: Institute of Mental Health, Beijing, P.R. China.
authors.forename: Hong
authors.initials: H
authors.lastname: Ma
authors.affiliation: Department of Psychiatry, University of Naples SUN, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Maj
authors.affiliation: National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
authors.forename: Maria
authors.initials: M
authors.lastname: Elena Medina-Mora
authors.affiliation: University of Copenhagen, Copenhagen, Denmark.
authors.forename: Merete
authors.initials: M
authors.lastname: Nordentoft
authors.affiliation: Public Health Foundation of India, Haryana, India.
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.affiliation: Fountain House, New York, NY, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Pratt
authors.affiliation: Institute of Psychiatry, King's College London, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.affiliation: Schizophrenia Research Foundation, Chennai, India.
authors.forename: Thara
authors.initials: T
authors.lastname: Rangaswamy
authors.affiliation: Healthy Active Lives, Longsdon, Stoke-on-Trent, UK.
authors.forename: David
authors.initials: D
authors.lastname: Shiers
authors.affiliation: Columbia University, New York, NY, USA.
authors.forename: Ezra
authors.initials: E
authors.lastname: Susser
authors.affiliation: Institute of Psychiatry, King's College London, London, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
authors.affiliation: Finnish Association for Mental Health, Helsinki, Finland.
authors.forename: Kristian
authors.initials: K
authors.lastname: Wahlbeck
authors.affiliation: Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Abe
authors.initials: A
authors.lastname: Fekadu Wassie
authors.affiliation: Queensland Centre for Mental Health Research, Wacol, QLD, Australia.
authors.forename: Harvey
authors.initials: H
authors.lastname: Whiteford
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
keywords: Excess mortality; bipolar disorder; community level and policy-focused interventions; depression; health system-focused interventions; individual-focused interventions; physical health; risk factors; schizophrenia; severe mental disorders