Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-20T00:34:33.580Z Has data issue: false hasContentIssue false
  • English
  • Français

Mortality in first-contact psychosis patients in the UK: a cohort study

Published online by Cambridge University Press:  13 December 2011

R. Dutta ,
R. M. Murray ,
J. Allardyce ,
P. B. Jones  and
J. E. Boydell
R. Dutta*
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
R. M. Murray
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
J. Allardyce
Affiliation:
Department of Psychiatry, Maastricht University, Maastricht, The Netherlands
P. B. Jones
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, UK
J. E. Boydell
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
*
*Address for correspondence: R. Dutta, MRCPsych, Ph.D., Department of Psychosis Studies, Box No. 63, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email: rina.2.dutta@kcl.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The excess mortality following first-contact psychosis is well recognized. However, the causes of death in a complete incidence cohort and mortality patterns over time compared with the general population are unknown.

Method

All 2723 patients who presented for the first time with psychosis in three defined catchment areas of the UK in London (1965–2004, n=2056), Nottingham (1997–1999, n=203) and Dumfries and Galloway (1979–1998, n=464) were traced after a mean of 11.5 years follow-up and death certificates were obtained. Data analysis was by indirect standardization.

Results

The overall standardized mortality ratio (SMR) for first-contact psychosis was 184 [95% confidence interval (CI) 167–202]. Most deaths (84.2%, 374/444) were from natural causes, although suicide had the highest SMR (1165, 95% CI 873–1524). Diseases of the respiratory system and infectious diseases had the highest SMR of the natural causes of death (232, 95% CI 183–291). The risk of death from diseases of the circulatory system was also elevated compared with the general population (SMR 139, 95% CI 117–164) whereas there was no such difference for neoplasms (SMR 111, 95% CI 86–141). There was strong evidence that the mortality gap compared with the general population for all causes of death (p<0.001) and all natural causes (p=0.01) increased over the four decades of the study. There was weak evidence that cardiovascular deaths may be increasing relative to the general population (p=0.07).

Conclusions

People with first-contact psychosis have an overall mortality risk that is nearly double that of the general population. Most excess deaths are from natural causes. The widening of the mortality gap over the last four decades should be of concern to all clinicians involved in delivering healthcare.

Keywords

Bipolar disordercohort studymortalitypsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 8 , August 2012 , pp. 1649 - 1661
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahmad, O, Boschi-Pinto, C, Lopez, AD, Murray, CJL, Lozano, R, Inoue, M (2001). Age Standardization of Rates: A New WHO Standard. GPE Discussion Paper. World Health Organization: Geneva.Google Scholar
Anderson, RN, Miniño, AM, Hoyert, DL, Rosenberg, HM (2001). Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. National Vital Statistics Report 49, 1–32.Google ScholarPubMed
Baker, A, Richmond, R, Haile, M, Lewin, TJ, Carr, VJ, Taylor, RL, Jansons, S, Wilhelm, K (2006). A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. American Journal of Psychiatry 163, 1934–1942.CrossRefGoogle ScholarPubMed
Bertelsen, M, Jeppesen, PIA, Petersen, L, Thorup, A, Øhlenschlaeger, J, Quach, PL, Christensen, TO, Krarup, G, Jørgensen, PER, Nordentoft, M (2007). Suicidal behaviour and mortality in first-episode psychosis: the OPUS trial. British Journal of Psychiatry 191, Suppl., s140–s146.CrossRefGoogle Scholar
Black, DW, Warrack, G, Winokur, G (1985). The Iowa record-linkage study. I. Suicides and accidental deaths among psychiatric patients. Archives of General Psychiatry 42, 71–75.CrossRefGoogle ScholarPubMed
Blasco-Fontecilla, H, Baca-Garcia, E, de Leon, J (2010). Do atypical antipsychotic drugs reduce the risk of ischemic heart disease and mortality? Possible role of 5-HT2A receptor blockade. Schizophrenia Research 119, 160–163.Google Scholar
Boydell, J, van Os, J, Lambri, M, Castle, D, Allardyce, J, McCreadie, RG, Murray, RM (2003). Incidence of schizophrenia in south-east London between 1965 and 1997. British Journal of Psychiatry 182, 45–49.Google Scholar
Bradford, DW, Kim, MM, Braxton, LE, Marx, CE, Butterfield, M, Elbogen, EB (2008). Access to medical care among persons with psychotic and major affective disorders. Psychiatric Services 59, 847–852.CrossRefGoogle ScholarPubMed
Brown, S, Birtwistle, J, Roe, L, Thompson, C (1999). The unhealthy lifestyle of people with schizophrenia. Psychological Medicine 29, 697–701.Google Scholar
Brown, S, Kim, M, Mitchell, C, Inskip, H (2010). Twenty-five year mortality of a community cohort with schizophrenia. British Journal of Psychiatry 196, 116–121.CrossRefGoogle ScholarPubMed
Castle, D, Wessely, S, Der, G, Murray, RM (1991). The incidence of operationally defined schizophrenia in Camberwell, 1965–84. British Journal of Psychiatry 159, 790–794.CrossRefGoogle ScholarPubMed
Cooper, JE, Goodhead, D, Craig, T, Harris, M, Howat, J, Korer, J (1987). The incidence of schizophrenia in Nottingham. British Journal of Psychiatry 151, 619–626.Google Scholar
Cradock-O'Leary, J, Young, AS, Yano, EM, Wang, M, Lee, ML (2002). Use of general medical services by VA patients with psychiatric disorders. Psychiatric Services 53, 874–878.Google Scholar
Dalton, SO, Mellemkjær, L, Thomassen, L, Mortensen, PB, Johansen, C (2005). Risk for cancer in a cohort of patients hospitalized for schizophrenia in Denmark, 1969–1993. Schizophrenia Research 75, 315–324.Google Scholar
Dutta, R, Boydell, J, Kennedy, N, van Os, J, Fearon, P, Murray, RM (2007). Suicide and other causes of mortality in bipolar disorder: a longitudinal study. Psychological Medicine 37, 839–847.CrossRefGoogle ScholarPubMed
Dutta, R, Murray, RM, Allardyce, J, Jones, PB, Boydell, J (2011). Early risk factors for suicide in an epidemiological first episode psychosis cohort. Schizophrenia Research 126, 11–19.Google Scholar
Dutta, R, Murray, RM, Hotopf, M, Allardyce, J, Jones, PB, Boydell, J (2010). Reassessing the long-term risk of suicide after a first episode of psychosis. Archives of General Psychiatry 67, 1230–1237.Google Scholar
El-Adl, M, Burke, J, Little, K (2009). First-episode psychosis: primary care experience and implications for service development. Psychiatric Bulletin 33, 165–168.Google Scholar
Graber, MA, Bergus, G, Dawson, JD, Wood, GB, Levy, BT, Levin, I (2000). Effect of a patient's psychiatric history on physicians' estimation of probability of disease. Journal of General Internal Medicine 15, 204–206.Google Scholar
Harris, EC, Barraclough, B (1998). Excess mortality of mental disorder. British Journal of Psychiatry 173, 11–53.Google Scholar
Haupt, DW, Rosenblatt, LC, Kim, E, Baker, RA, Whitehead, R, Newcomer, JW (2009). Prevalence and predictors of lipid and glucose monitoring in commercially insured patients treated with second-generation antipsychotic agents. American Journal of Psychiatry 166, 345–353.CrossRefGoogle ScholarPubMed
Heila, H, Haukka, J, Suvisaari, J, Lonnqvist, J (2005). Mortality among patients with schizophrenia and reduced psychiatric hospital care. Psychological Medicine 35, 725–732.Google Scholar
Hiroeh, U, Appleby, L, Mortensen, PB, Dunn, G (2001). Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. Lancet 358, 2110–2112.CrossRefGoogle ScholarPubMed
Janssen, F, Kunst, AE (2004). ICD coding changes and discontinuities in trends in cause-specific mortality in six European countries, 1950–99. Bulletin of the World Health Organization 82, 904–913.Google ScholarPubMed
Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, JP, Mallett, RM, Harrison, GL, Jones, PB (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP Study. Archives of General Psychiatry 63, 250–258.CrossRefGoogle ScholarPubMed
Kirkpatrick, B, Tek, C, Allardyce, J, Morrison, G, McCreadie, RG (2002). Summer birth and deficit schizophrenia in Dumfries and Galloway, southwestern Scotland. American Journal of Psychiatry 159, 1382–1387.Google Scholar
Knol, W, van Marum, RJ, Jansen, PAF, Souverein, PC, Schobben, AFAM, Egberts, ACG (2008). Antipsychotic drug use and risk of pneumonia in elderly people. Journal of the American Geriatrics Society 56, 661–666.CrossRefGoogle ScholarPubMed
Lakka, HM, Laaksonen, DE, Lakka, TA, Niskanen, LK, Kumpusalo, E, Tuomilehto, J, Salonen, JT (2002). The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. Journal of the American Medical Association 288, 2709–2716.Google Scholar
Lichtermann, D, Ekelund, J, Pukkala, E, Tanskanen, A, Lonnqvist, J (2001). Incidence of cancer among persons with schizophrenia and their relatives. Archives of General Psychiatry 58, 573–578.CrossRefGoogle ScholarPubMed
Marder, SR, Essock, SM, Miller, AL, Buchanan, RW, Casey, DE, Davis, JM, Kane, JM, Lieberman, JA, Schooler, NR, Covell, N, Stroup, S, Weissman, EM, Wirshing, DA, Hall, CS, Pogach, L, Pi-Sunyer, X, Bigger, JT Jr, Friedman, A, Kleinberg, D, Yevich, SJ, Davis, B, Shon, S (2004). Physical health monitoring of patients with schizophrenia. American Journal of Psychiatry 161, 1334–1349.Google Scholar
McGuffin, P, Farmer, A, Harvey, I (1991). A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764–770.Google Scholar
Mortensen, PB, Juel, K (1993). Mortality and causes of death in first admitted schizophrenic patients. British Journal of Psychiatry 163, 183–189.CrossRefGoogle ScholarPubMed
Neeleman, J (2001). A continuum of premature death. Meta-analysis of competing mortality in the psychosocially vulnerable. International Journal of Epidemiology 30, 154–162.Google Scholar
Office for National Statistics (2009). 21st century mortality database (http://www.statistics.gov.uk/STATBASE/ssdataset.asp?vlnk=6922). Accessed 10 February 2009.Google Scholar
Ösby, U, Correia, N, Brandt, L, Ekbom, A, Sparen, P (2000). Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. British Medical Journal 321, 483–484.Google Scholar
Remington, G (2006). Schizophrenia, antipsychotics, and the metabolic syndrome: is there a silver lining? American Journal of Psychiatry 163, 1132–1134.Google Scholar
Roshanaei-Moghaddam, B, Katon, W (2009). Premature mortality from general medical illnesses among persons with bipolar disorder: a review. Psychiatric Services 60, 147–156.CrossRefGoogle ScholarPubMed
Saha, S, Chant, D, McGrath, J (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry 64, 1123–1131.Google Scholar
Spitzer, RL, Endicott, J, Robins, E (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Tiihonen, J, Lönnqvist, J, Wahlbeck, K, Klaukka, T, Niskanen, L, Tanskanen, A, Haukka, J (2009). 11-Year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 374, 620–627.CrossRefGoogle ScholarPubMed
Tsai, SP, Wen, CP (1986). A review of methodological issues of the standardized mortality ratio (SMR) in occupational cohort studies. International Journal of Epidemiology 15, 8–21.Google Scholar
Tsuang, MT, Simpson, JC (1985). Mortality studies in psychiatry. Should they stop or proceed? Archives of General Psychiatry 42, 98–103.Google Scholar
Tsuang, MT, Woolson, RF (1977). Mortality in patients with schizophrenia, mania, depression and surgical conditions. A comparison with general population mortality. British Journal of Psychiatry 130, 162–166.Google Scholar
Tsuang, MT, Woolson, RF, Fleming, JA (1980). Premature deaths in schizophrenia and affective disorders. An analysis of survival curves and variables affecting the shortened survival. Archives of General Psychiatry 37, 979–983.CrossRefGoogle ScholarPubMed
Tuffin, R, Quinn, A, Ali, F, Cramp, P (2009). A review of the accuracy of death certification on the intensive care unit and the proposed reforms to the Coroner's system. Journal of the Intensive Care Society 10, 134–137.Google Scholar
Supplementary material: File

Dutta Supplementary Table

Supplementary Table S1. Subtypes of underlying cause of death in a first episode psychosis cohort

Download Dutta Supplementary Table(File)
File 96.8 KB