Excess mortality from chronic physical disease in psychiatric patients-the forgotten problem.

Physical and psychiatric symptoms often occur together. In both hospital and primary care the presence of one leads to a worse outcome in the other.' For instance, physical illness has a large, immediate effect on depressive symptoms, while further depressive symptoms are associated with increased subsequent physical morbidity. Among all outcomes, it is the increase in mortality that is of most concern. The death rate for people with mental illness is around 70% higher than for the rest of the population, even after adjusting for demographics, including socioeconomic status.^ In the case of schizophrenia, the risk is considerably greater.^ Patients with major mental illnesses, such as schizophrenia, and major depressive, bipolar, and delusional disorders, can die up to 25 years earlier than the general population.'* Contrary to common perception, it is not suicide that accounts for most of these deaths among people with mental illness, but common diseases such as heart disease, cancer, and chronic lung disease.^ Excess mortality from these diseases is 10 times that of deliberate self-harm yet receives little attention when compared with suicide prevention. Nova Scotian data suggest that while 100 people a year will die of suicide, an additional 1000 people with psychiatric illness will die of preventable physical disease than would be expected if their mortality risk was the same as the general population.^ This represents about 33 000 potentially preventable deaths for Canada annually.