Major psychiatric disorders increase risk of mortality.

ED FROM Laursen TM, Munk-Olsen T, Nordentoft M, et al. Increased mortality among patients admitted with major psychiatric disorders: a register-based study comparing mortality in unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia. J Clin Psychiatry 2007;68:899–907. Notes: Overlaps in the diagnostic groups (for example, where an individual had more than one diagnosis) were not censored out of analyses. In analyses, people admitted with more than one diagnosis were included in all diagnostic groups into which they were categorised. Correspondence to: Thomas Munk Laursen, MSc, PhD, National Centre for RegisterBased Research, University of Aarhus, Taasingegade 1, DK-8000 Aarhus C, Denmark; [email protected] Source of funding: The Stanley Medical Research Institute, Chevy Chase, MD and the Center for Basic Psychiatric Research, Aarhus, Denmark. C O M M EN TA R Y E pidemiological studies have consistently found excess mortality rates among individuals with diagnoses of serious mental illness (schizophrenia, schizoaffective disorder and bipolar and unipolar affective disorders) compared with general population rates. Laursen and colleagues replicate these findings in a register-based study that permitted a unique comparison of the magnitude of excess mortality across diagnostic, age and gender groups by cause of death. All four diagnostic groups experienced remarkably similar degrees of excess mortality, a finding relatively new to the literature. Another unique finding is the increase in excess mortality contributed by the presence of one or more first degree relative with a psychiatric admission, possibly suggesting shared genetic or environmental influences on mortality. The reported similarity of overall mortality, in addition to the results of a recent extensive systematic review of mortality in schizophrenia, supports the likelihood that these findings are reasonably generalisable to other settings. The results of this study have important implications for clinical practice. The greatest excess mortality risk was found for unnatural causes of death, chiefly suicide, a not unexpected finding which emphasises the need for aggressive suicide prevention strategies. However, in terms of absolute mortality, cardiovascular and other natural causes of death make by far the greatest contribution to premature death among the seriously mentally ill. A recent commentary focused on cardiovascular disease underscored both the excess prevalence of risk factors for these disorders among individuals with severe mental illness (for example, comparatively high prevalence of smoking, diabetes, dyslipidaemia, hypertension or obesity) and the relative lack of effective treatment for these conditions in US academic and public sector mental health treatment settings. These findings plus recent evidence that the mortality gap for schizophrenia may be worsening over time, together with the increased liability of some antipsychotic agents to adversely affect adiposity and glucose and lipid metabolism, clearly point to the need for changes in practice to ensure the recognition, prevention and treatment of these modifiable risk factors. In particular, there is a need for closer collaboration between mental health and general medicine practitioners plus access to specific treatment programmes (for example, smoking cessation) if the observed mortality gap is to be reduced. Thomas J Craig, MD, MPH Springfield, Virginia, USA Competing interests: None. 1. Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry 1998;173:11–53. 2. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry 2007; 64:1123–31. 3. Colton CW, Mandersheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 2006;3:A42. 4. Newcomer JW, Hennekens CH. Severe mental illness and risk of cardiovascular disease. JAMA 2007;298: 1794–6. Prognosis EBMH February 2008 Vol 11 No 1 9 group.bmj.com on June 18, 2017 Published by http://ebmh.bmj.com/ Downloaded from