Excess Mortality in Persons with Severe Mental Disorders: a Multilevel Intervention Framework and Priorities for Clinical Practice, Policy and Research Agendas

Overview

Journal World Psychiatry

Specialty Psychiatry

Date 2017 Jan 28

PMID 28127922

Citations 261

Authors

Nancy H Liu

Gail L Daumit

Tarun Dua

Ralph Aquila

Fiona Charlson

Pim Cuijpers

Benjamin Druss

Kenn Dudek

Melvyn Freeman

Chiyo Fujii

Wolfgang Gaebel

Ulrich Hegerl

Itzhak Levav

Thomas Munk Laursen

Hong Ma

Mario Maj

Maria Elena Medina-Mora

Merete Nordentoft

Dorairaj Prabhakaran

Karen Pratt

Martin Prince

Thara Rangaswamy

David Shiers

Ezra Susser

Graham Thornicroft

Kristian Wahlbeck

Abe Fekadu Wassie

Harvey Whiteford

Shekhar Saxena

Affiliations

Soon will be listed here.

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.

Citing Articles

Technology use and interest in digital apps for mental health promotion and lifestyle intervention among young adults with serious mental illness.

Naslund J, Aschbrenner K J Affect Disord Rep. 2025; 6.

PMID: 40027518 PMC: 11870643. DOI: 10.1016/j.jadr.2021.100227.

Twenty-four-hour movement guidelines and depressive symptoms: association, temporal trends and moderators over a ten-year period among 45,297 US adolescents.

Lopez-Gil J, Solmi M, Garcia-Hermoso A, Vancampfort D, Fabiano N, Schuch F Eur Child Adolesc Psychiatry. 2025; .

PMID: 39994034 DOI: 10.1007/s00787-025-02663-3.

Conceptual competence in medicine: promoting psychosomatic awareness in clinics, research and education.

von Boetticher D Front Psychiatry. 2025; 16:1500638.

PMID: 39980980 PMC: 11840571. DOI: 10.3389/fpsyt.2025.1500638.

Physical Health and Health Behaviours of Australians with Psychosis.

Happell B, Platania-Phung C, Furness T, Scholz B, Niyonsenga T, Watkins A Community Ment Health J. 2025; .

PMID: 39976847 DOI: 10.1007/s10597-024-01417-w.

Effectiveness of referral to a population-level telephone coaching service for improving health risk behaviours in people with a mental health condition: a randomised controlled trial.

Hanly G, Campbell E, Bartlem K, Dray J, Fehily C, Colyvas K BMC Public Health. 2025; 25(1):677.

PMID: 39966799 PMC: 11837387. DOI: 10.1186/s12889-025-21614-w.

References

Torniainen M, Mittendorfer-Rutz E, Tanskanen A, Bjorkenstam C, Suvisaari J, Alexanderson K . Antipsychotic treatment and mortality in schizophrenia. Schizophr Bull. 2014; 41(3):656-63. PMC: 4393693. DOI: 10.1093/schbul/sbu164. View

Lawrence D, Holman C, Jablensky A, Threlfall T, Fuller S . Excess cancer mortality in Western Australian psychiatric patients due to higher case fatality rates. Acta Psychiatr Scand. 2000; 101(5):382-8. DOI: 10.1034/j.1600-0447.2000.101005382.x. View

Jones S, Howard L, Thornicroft G . 'Diagnostic overshadowing': worse physical health care for people with mental illness. Acta Psychiatr Scand. 2008; 118(3):169-71. DOI: 10.1111/j.1600-0447.2008.01211.x. View

Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx B . Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. Am J Psychiatry. 2014; 171(4):453-62. DOI: 10.1176/appi.ajp.2013.13030325. View

De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei D . Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry. 2011; 10(2):138-51. PMC: 3104888. DOI: 10.1002/j.2051-5545.2011.tb00036.x. View

Barnes T, Paton C, Cavanagh M, Hancock E, Taylor D . A UK audit of screening for the metabolic side effects of antipsychotics in community patients. Schizophr Bull. 2007; 33(6):1397-403. PMC: 2779874. DOI: 10.1093/schbul/sbm038. View

Crump C, Sundquist K, Winkleby M, Sundquist J . Mental disorders and risk of accidental death. Br J Psychiatry. 2013; 203(3):297-302. DOI: 10.1192/bjp.bp.112.123992. View

Appel L, Champagne C, Harsha D, Cooper L, Obarzanek E, Elmer P . Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003; 289(16):2083-93. DOI: 10.1001/jama.289.16.2083. View

McGuire A, Kukla M, Green A, Gilbride D, Mueser K, Salyers M . Illness management and recovery: a review of the literature. Psychiatr Serv. 2013; 65(2):171-9. PMC: 4203303. DOI: 10.1176/appi.ps.201200274. View

10.

Druss B, Zhao L, von Esenwein S, Morrato E, Marcus S . Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011; 49(6):599-604. DOI: 10.1097/MLR.0b013e31820bf86e. View

11.

Crump C, Sundquist K, Winkleby M, Sundquist J . Comorbidities and mortality in bipolar disorder: a Swedish national cohort study. JAMA Psychiatry. 2013; 70(9):931-9. DOI: 10.1001/jamapsychiatry.2013.1394. View

12.

Rosenberg S, Goldberg R, Dixon L, Wolford G, Slade E, Himelhoch S . Assessing the STIRR model of best practices for blood-borne infections of clients with severe mental illness. Psychiatr Serv. 2010; 61(9):885-91. PMC: 3632357. DOI: 10.1176/ps.2010.61.9.885. View

13.

Stanley S, Laugharne J . Clinical guidelines for the physical care of mental health consumers: a comprehensive assessment and monitoring package for mental health and primary care clinicians. Aust N Z J Psychiatry. 2011; 45(10):824-9. DOI: 10.3109/00048674.2011.614591. View

14.

Buchanan R, Kreyenbuhl J, Kelly D, Noel J, Boggs D, Fischer B . The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull. 2009; 36(1):71-93. PMC: 2800144. DOI: 10.1093/schbul/sbp116. View

15.

Crump C, Sundquist K, Winkleby M, Sundquist J . Mental disorders and vulnerability to homicidal death: Swedish nationwide cohort study. BMJ. 2013; 346:f557. PMC: 6364268. DOI: 10.1136/bmj.f557. View

16.

Drake R, ONeal E, Wallach M . A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders. J Subst Abuse Treat. 2007; 34(1):123-38. DOI: 10.1016/j.jsat.2007.01.011. View

17.

Burns T, Catty J, Becker T, Drake R, Fioritti A, Knapp M . The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet. 2007; 370(9593):1146-52. DOI: 10.1016/S0140-6736(07)61516-5. View

18.

Haklai Z, Goldberger N, Stein N, Pugachova I, Levav I . The mortality risk among persons with psychiatric hospitalizations. Isr J Psychiatry Relat Sci. 2012; 48(4):230-9. View

19.

Nordentoft M, Wahlbeck K, Hallgren J, Westman J, Osby U, Alinaghizadeh H . Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. PLoS One. 2013; 8(1):e55176. PMC: 3555866. DOI: 10.1371/journal.pone.0055176. View

20.

Druss B, Zhao L, von Esenwein S, Bona J, Fricks L, Jenkins-Tucker S . The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophr Res. 2010; 118(1-3):264-70. PMC: 2856811. DOI: 10.1016/j.schres.2010.01.026. View