New Research Documents Widening Mortality Gap for Bipolar and Schizophrenia

Analysis of longitudinal data from 2000-2014 demonstrate mortality gap is widening between persons with a diagnosis of bipolar or schizophrenia compared to the general population

Bernalyn Ruiz
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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.”

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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 Psychiatry211(3), 175-181. (Link)

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7 COMMENTS

  1. Bipolar is the worst diagnosis now. Although statistically the prognosis is better then schizophrenia, if you have bipolar especially psychotic bipolar you’d going to get:
    1. antipsychotic.
    2. mood stabilizer (sometimes lithium + lamotrigine)
    3. anti-anxiety pill (some kind of klonopin)
    4. anti-depressant
    5. anti-seizure meds (carbamazepine or valproic acid).
    While with schizophrenia you may get away with only an antipsychotic (although rarely nowadays).
    This drug cocktails are especially dangerous and in no way ‘evidence based’. No wonder that mortality gap is widening.

  2. The reason for the mortality disparity is not health care disparity, it is psychiatric drugs. In fact, you might pen the cause of this heightened mortality on the attention given to their “health”. Not only does the industry have a hard time addressing the fact that the drugs are killing people, but the industry has a hard time addressing the fact that the drugs are impeding, in a very many cases, recovery. Polypharmacy only raises the mortality rate you get from using a psychiatric drug in the first place. You don’t need to be “anti-medication” to realize that you shouldn’t be using these substances in excess, and that’s what we’ve got right now, excessive use of pharmaceuticals. Lessen the usage, and the mortality rate will decline correspondingly. You want to do something about this mortality rate? If so, do something about the number one treatment for the “disorders” we are commenting on, drugs.

    • I suspect this is true but I’d like a bit more epidemiology to prove it. There other people apart from those who are diagnosed with bipolar and schizophrenia who don’t get much exercise, smoke lots and eat a lot of cake. I’d like comparison with them in terms of mortality.

        • Great point! I never took up smoking, but I hear it can help minimize suffering caused by psych drugs. Since I am off the drugs I’m no longer wolfing down sweets or drinking quarts of coffee a day. I am losing 2 or 3 pounds a month effortlessly.

          My mood swings and depression have vanished. Still get anxious in public from years as a “consumer.” Keep worrying my mom will blow my cover.

          Exercise remains a challenge due to iatrogenic illness from long term drug use. And it’s hard to eat right on $733 a month..