New Research Documents Widening Mortality Gap for Bipolar and Schizophrenia

Many efforts have been made to decrease mortality rates in the UK. However, these programs have not been effective in persons who are diagnosed with bipolar or schizophrenia disorders. Researchers from University College London compared the mortality rates from natural and unnatural causes in persons with a bipolar disorder diagnosis and those with a schizophrenia diagnosis to the general population. They found that “the improvement in health in the general population is increasing more rapidly than in those with SMI, and health inequalities are growing.”

Longitudinal Studies have demonstrated that people designated as living with “severe mental illness (SMI)” have a significantly reduced life expectancy. This can be exacerbated when individuals are on placed on psychiatric medications. We have seen evidence of this from studies that have demonstrated increased mortality risk in persons with Alzheimer’s on antipsychotics, those with Parkinson’s on antipsychotics, and in persons on antidepressants. Efforts in numerous countries have been aimed at reducing mortality rates and the mortality gap between persons experiencing SMI and the general population.

The authors of the present study examined longitudinal data (2000-2014) from the Health Improvement Network. Persons over the age of 16 were included. Individuals in the sample with a Bipolar or Schizophrenia diagnosis were matched on age, gender, and primary care practice with individuals without these diagnoses. Cardiovascular mortality and suicide were used as natural an unnatural causes of death.

Overall the rate of mortality from baseline to follow-up was lowered for persons with a bipolar disorder diagnosis and those with a schizophrenia diagnosis. Mortality was elevated in those with bipolar disorder and schizophrenia relative to the general population after adjusting for age, gender, calendar year, area-level deprivation and ethnicity. Among those diagnosed with schizophrenia, men had a higher mortality rate than women. Those diagnosed with schizophrenia had elevated risk for cardiovascular deaths. Moreover, cardiovascular disease diagnosis rates were raised in persons with bipolar disorder and in those with schizophrenia.

Suicide and self-harm rates in the group with a bipolar disorder diagnosis and those with a schizophrenia diagnosis were higher than the comparison group.

Overall, even though the study found decreasing rates of all-cause mortality in both those with bipolar and those with schizophrenia since 2000, hazard-ratios for mortality relative to the comparison group increased from the mid-2000’s- 2014.

All-cause mortality in those with a bipolar diagnosis was 1.77 times that of the general population and 2.08 times greater in persons with a schizophrenia diagnosis. In those with a schizophrenia diagnosis, the risk of dying before 50 of cardiovascular disease was significantly elevated.

The authors interpreted these results to suggest that the general population’s health is improving more rapidly than those with a bipolar or schizophrenia diagnosis. The authors suggest that this could be because negative health behaviors are more difficult to address in persons with a “serious mental illness.” The authors also acknowledge that polypharmacy may be increasing mortality rates, especially as persons with bipolar and schizophrenia are often prescribed numerous medications.

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Hayes, J. F., Marston, L., Walters, K., King, M. B., & Osborn, D. P. (2017). Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014. The British Journal of Psychiatry, 211(3), 175-181. (Link)