The Epidemiology of Excess Mortality in People with Mental Illness

Abstract

T he excess mortality of people with mental illness has been known for many years. In 1841, William Farr 1 reported to the Royal Statistical Society on mortality within the major asylums and licensed houses of the period in England. He estimated, using life-table methods, the mortality rate in the best facility to be about 3 times that of the general population, and mortality in other facilities to be several times higher again. The report inspired the British parliament to require regular compilation of statistics within all asylums, and established mortality rate as a measure of the quality of care provided. The high mortality was attributed to infectious diseases and the poor conditions within the asylums, such as lack of exercise and warmth, poor diet, and lack of medical care. During subsequent years, mortality in people with mental illness has been the subject of hundreds of studies. In the most comprehensive meta-analyses to date, Harris and Barraclough 2,3 identified 152 reports on all-cause mortality and 249 on suicide. They found that all mental disorders were associated with an increased risk of premature death. Overall

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“…CVD accounts for much of the excess mortality in psychiatric patients. 442 CVD develops more than a decade earlier in patients with bipolar disorders than in controls. 443 Therefore it could be recommended to start primary prevention earlier rather than later in these patients.…”

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“…Of particular concern is the fact that the gap in premature mortality is widening and people with schizophrenia are widely regarded as being among the most deprived [4]. The underlying causes for the increased risk of premature mortality are complex and multi-factorial, however, it is known that natural causes contribute more to the increased risk of premature mortality than accidents or suicide [5]. For example, the most prevalent physical comorbidities contributing to the increased risk of premature mortality are cardio-metabolic [6,7] and respiratory diseases [8].…”

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“…Bien que de nombreux facteurs puissent contribuer à la mauvaise santé de cette population, les explications pointent généralement vers des facteurs liés au mode de vie (ex. : manque d'exercice, alcool et usage du tabac), à la condition sociale et aux effets secondaires néfastes de la médication (Lawrence et al, 2010). La mortalité reste toutefois élevée pour cette population, même après l'ajustement des facteurs de risques comportementaux comme l'usage du tabac, l'activité physique et l'indice de masse corporelle.…”