Mortality Rate Trends in Patients Diagnosed with Schizophrenia or Bipolar Disorder: a Nationwide Study with 20 years of Follow-up

Overview

Journal Int J Bipolar Disord

Date 2019 Mar 2

PMID 30820700

Citations 35

Authors

Line Hosbond Lomholt

Diana Vincens Andersen

Christina Sejrsgaard-Jacobsen

Cagla Margit Ozdemir

Claus Graff

Ole Schjerning

Svend Eggert Jensen

Sune Puggard Vogt Straszek

Rasmus W Licht

Simon Grontved

Rene Ernst Nielsen

Affiliations

Soon will be listed here.

Abstract

Background: Patients with severe mental illness (SMI) have a reduced life expectancy of one to two decades as compared to the general population, with most years of life lost due to somatic diseases. Most previous studies on disorders constituting SMI, e.g. schizophrenia and bipolar disorder, have investigated the disorders separately and hence not compared the disorders in terms of mortality rates relative to the background population.

Methods: A register-based cohort study including the entire Danish population comparing mortality rates relative to the background population, controlling for age and sex, i.e. standardized mortality ratios (SMRs) in patients diagnosed with schizophrenia with those in patients diagnosed with bipolar disorder, during the study period from 1995 to 2014.

Results: The SMR of patients with SMI was significantly higher than one for each calendar year in the study period with an overall SMR of 4.58, 95% CI (4.48-4.69) in patients diagnosed with schizophrenia (n = 38,500) and of 2.57 (95% CI 2.49-2.65) in patients diagnosed with bipolar disorder (n = 23,092). When investigating time trends in SMR for schizophrenia and for bipolar disorder, respectively, an increase in SMR over time was shown with a mean increase of 0.03 per year for schizophrenia and 0.02 for bipolar disorder (p < 0.01 for both disorders). The ratio between SMR for schizophrenia and SMR for bipolar disorder for each calendar year over the study period was constant (p = 0.756).

Conclusions: Increasing SMRs over the last 20 years were found for both patients diagnosed with bipolar disorder and patients diagnosed with schizophrenia. Despite clear differences between the two disorders regarding SMRs, the increases in SMR over time were similar, which could suggest similar underlying factors influencing mortality rates in both disorders.

Citing Articles

Cost-effectiveness of the SMILE intervention compared with usual care for people with severe mental illness: A randomized clinical trial.

El Alili M, van Meijel B, Van Tulder M, Adriaanse M PLoS One. 2025; 20(1):e0313100.

PMID: 39761242 PMC: 11703068. DOI: 10.1371/journal.pone.0313100.

Circulating Cell-Free Mitochondrial DNA in Plasma of Individuals with Schizophrenia and Cognitive Deficit in Mexican Population.

Garcia-de la Cruz D, Juarez-Rojop I, Tovilla-Zarate C, Nicolini H, Genis-Mendoza A Neuropsychiatr Dis Treat. 2024; 20:1757-1765.

PMID: 39323935 PMC: 11423824. DOI: 10.2147/NDT.S460554.

General practitioners' experiences of providing somatic care for patients with severe mental illness: a qualitative study.

Jonsson A, Brandt Brodersen J, Reventlow S, Svanholm C, Moller A, Brostrom Kousgaard M BMC Prim Care. 2024; 25(1):96.

PMID: 38519880 PMC: 10958876. DOI: 10.1186/s12875-024-02338-z.

Cardiovascular autonomic reflex tests using a handheld device in the diagnosis of cardiovascular autonomic neuropathy in patients with schizophrenia.

Blok-Husum L, Brcelic M, Bassi H, Jensen S, Nielsen R, Kragholm K Am Heart J Plus. 2024; 26:100252.

PMID: 38510185 PMC: 10945952. DOI: 10.1016/j.ahjo.2023.100252.

Disparities in cardiovascular disease and treatment in the Nordic countries.

Hojstrup S, Thomsen J, Prescott E Lancet Reg Health Eur. 2023; 33:100699.

PMID: 37953994 PMC: 10636266. DOI: 10.1016/j.lanepe.2023.100699.

References

Julious S, Nicholl J, George S . Why do we continue to use standardized mortality ratios for small area comparisons?. J Public Health Med. 2001; 23(1):40-6. DOI: 10.1093/pubmed/23.1.40. View

Fleischhacker W, Cetkovich-Bakmas M, De Hert M, Hennekens C, Lambert M, Leucht S . Comorbid somatic illnesses in patients with severe mental disorders: clinical, policy, and research challenges. J Clin Psychiatry. 2008; 69(4):514-9. DOI: 10.4088/jcp.v69n0401. View

Bjorkman T, Angelman T, Jonsson M . Attitudes towards people with mental illness: a cross-sectional study among nursing staff in psychiatric and somatic care. Scand J Caring Sci. 2008; 22(2):170-7. DOI: 10.1111/j.1471-6712.2007.00509.x. View

Laursen T, Munk-Olsen T, Agerbo E, Gasse C, Mortensen P . Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Arch Gen Psychiatry. 2009; 66(7):713-20. DOI: 10.1001/archgenpsychiatry.2009.61. View

Laursen T, Nordentoft M . Heart disease treatment and mortality in schizophrenia and bipolar disorder - changes in the Danish population between 1994 and 2006. J Psychiatr Res. 2010; 45(1):29-35. DOI: 10.1016/j.jpsychires.2010.04.027. View

Howard L, Barley E, Davies E, Rigg A, Lempp H, Rose D . Cancer diagnosis in people with severe mental illness: practical and ethical issues. Lancet Oncol. 2010; 11(8):797-804. DOI: 10.1016/S1470-2045(10)70085-1. View

Wahlbeck K, Westman J, Nordentoft M, Gissler M, Laursen T . Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry. 2011; 199(6):453-8. DOI: 10.1192/bjp.bp.110.085100. View

Laursen T . Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophr Res. 2011; 131(1-3):101-4. DOI: 10.1016/j.schres.2011.06.008. View

Pedersen C . The Danish Civil Registration System. Scand J Public Health. 2011; 39(7 Suppl):22-5. DOI: 10.1177/1403494810387965. View

10.

Lynge E, Sandegaard J, Rebolj M . The Danish National Patient Register. Scand J Public Health. 2011; 39(7 Suppl):30-3. DOI: 10.1177/1403494811401482. View

11.

Mors O, Perto G, Mortensen P . The Danish Psychiatric Central Research Register. Scand J Public Health. 2011; 39(7 Suppl):54-7. DOI: 10.1177/1403494810395825. View

12.

Moore D, Posada C, Parikh M, Arce M, Vaida F, Riggs P . HIV-infected individuals with co-occurring bipolar disorder evidence poor antiretroviral and psychiatric medication adherence. AIDS Behav. 2011; 16(8):2257-66. PMC: 3351543. DOI: 10.1007/s10461-011-0072-2. View

13.

Naing N . Easy way to learn standardization : direct and indirect methods. Malays J Med Sci. 2012; 7(1):10-5. PMC: 3406211. View

14.

Kessing L, Hansen H, Hvenegaard A, Christensen E, Dam H, Gluud C . Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. Br J Psychiatry. 2013; 202(3):212-9. DOI: 10.1192/bjp.bp.112.113548. View

15.

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

16.

Uggerby P, Ostergaard S, Roge R, Correll C, Nielsen J . The validity of the schizophrenia diagnosis in the Danish Psychiatric Central Research Register is good. Dan Med J. 2013; 60(2):A4578. View

17.

Nielsen R, Uggerby A, Jensen S, McGrath J . Increasing mortality gap for patients diagnosed with schizophrenia over the last three decades--a Danish nationwide study from 1980 to 2010. Schizophr Res. 2013; 146(1-3):22-7. DOI: 10.1016/j.schres.2013.02.025. View

18.

Laursen T, Wahlbeck K, Hallgren J, Westman J, Osby U, Alinaghizadeh H . Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries. PLoS One. 2013; 8(6):e67133. PMC: 3691116. DOI: 10.1371/journal.pone.0067133. View

19.

Mitchell A, Pereira I, Yadegarfar M, Pepereke S, Mugadza V, Stubbs B . Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake. Br J Psychiatry. 2014; 205(6):428-35. DOI: 10.1192/bjp.bp.114.147629. View

20.

Mitchell A, Vancampfort D, De Hert M, Stubbs B . Do people with mental illness receive adequate smoking cessation advice? A systematic review and meta-analysis. Gen Hosp Psychiatry. 2014; 37(1):14-23. DOI: 10.1016/j.genhosppsych.2014.11.006. View