Excess Mortality, Causes of Death and Life Expectancy in 270,770 Patients with Recent Onset of Mental Disorders in Denmark, Finland and Sweden

Psychiatric Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
PLoS ONE (Impact Factor: 3.23). 01/2013; 8(1):e55176. DOI: 10.1371/journal.pone.0055176
Source: PubMed


BACKGROUND: Excess mortality among patients with severe mental disorders has not previously been investigated in detail in large complete national populations. OBJECTIVE: To investigate the excess mortality in different diagnostic categories due to suicide and other external causes of death, and due to specific causes in connection with diseases and medical conditions. METHODS: In longitudinal national psychiatric case registers from Denmark, Finland, and Sweden, a cohort of 270,770 recent-onset patients, who at least once during the period 2000 to 2006 were admitted due to a psychiatric disorder, were followed until death or the end of 2006. They were followed for 912,279 person years, and 28,088 deaths were analyzed. Life expectancy and standardized cause-specific mortality rates were estimated in each diagnostic group in all three countries. RESULTS: The life expectancy was generally approximately 15 years shorter for women and 20 years shorter for men, compared to the general population. Mortality due to diseases and medical conditions was increased two- to three-fold, while excess mortality from external causes ranged from three- to 77-fold. Mortality due to diseases and medical conditions was generally lowest in patients with affective disorders and highest in patients with substance abuse and personality disorders, while mortality due to suicide was highest in patients with affective disorders and personality disorders, and mortality due to other external causes was highest in patients with substance abuse. CONCLUSIONS: These alarming figures call for action in order to prevent the high mortality.

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Available from: Merete Nordentoft,
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    • "Later studies of the Danish population have shown that the risk of suicide during psychiatric inpatient admission and after discharge has decreased in the period from 1998 to 2005 (Madsen and Nordentoft, 2013 "
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    ABSTRACT: Suicide is a serious public health problem, with more than 800,000 deaths taking place worldwide each year. Mental disorders are associated with increased risk of suicide. In schizophrenia and other psychotic disorders, the lifetime risk of suicide death is estimated to be 5.6%. The risk is particularly high during the first year of the initial contact with mental health services, being almost twice as high as in the later course of the illness. The most consistently reported risk factor for suicide among people with psychotic disorders is a history of attempted suicide and depression. Suicide risk in psychosis in Denmark decreased over time, most likely because of improved quality of inpatient and outpatient services. There is a high proportion of young people with first-episode psychosis who attempted suicide before their first contact with mental health services. This finding suggests that the mortality rates associated with psychotic disorders may be underreported because of suicide deaths taking place before first treatment contact. However, currently, no data exist to confirm or refute this hypothesis. Attempted suicide can be an early warning sign of later psychotic disorder. Data from different studies indicate that the risk of suicide attempt during the first year of treatment is as high as 10%. The most important risk factors for attempted suicide after the first contact are young age, female sex, suicidal plans, and a history of suicide attempt. Early intervention services are helpful in first-episode psychosis, and staff members should, in collaboration with the patients, monitor the risk of suicide and develop and revise crisis plans.
    The Journal of nervous and mental disease 05/2015; 203(5):387-392. DOI:10.1097/NMD.0000000000000296 · 1.69 Impact Factor
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    • "Obesity is a growing concern because being overweight is widely regarded as a major risk factor for metabolic syndrome [1], cardiovascular disease [2], and premature death [3,4]. The prevalence of obesity among patients with schizophrenia is higher [5,6], and the life expectancy of patients with schizophrenia is approximately 15 years shorter for women and 20 years shorter for men, compared to the general population [7]. Although the mechanisms for this weight gain have not been entirely elucidated, dietary factors may be important in the development of obesity. "
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    ABSTRACT: Background Obesity among patients with schizophrenia is a growing concern because being overweight is widely regarded as a major risk factor for cardiovascular disease and premature death. Dietary patterns have been suggested as one modifiable factor that may play a role in development of obesity. The objective of this study was to examine the association between dietary patterns and obesity among patients with schizophrenia in Japan. Methods We recruited patients (n = 338) aged 44.0 ± 13.2 (mean ± SD) years with a DSM-IV diagnosis of schizophrenia who were admitted to four psychiatric hospitals using a cross-sectional design. Diet was assessed with a validated brief-type self-administered diet history questionnaire (BDHQ). Dietary patterns from 52 predefined food groups were extracted by principal component analysis. Results A total of 61 subjects (18.0%) were classified as obese. Three dietary patterns were identified: the healthy dietary pattern, the processed food dietary pattern, and the alcohol and accompanying dietary patterns. After adjusting for age and gender, patients within the high tertile of each healthy dietary pattern (OR = 0.29, 95% CI = 0.13 to 0.62) and processed food dietary pattern (OR = 0.44, 95% CI = 0.22 to 0.89) had a significantly lower risk for obesity compared with low tertile of dietary pattern. Conclusions Our findings suggest that dietary patterns, including higher intake of protein, fat, n-3 polyunsaturated fatty acids, n-6 polyunsaturated fatty acids, and vitamins, may be related to a decreased prevalence of obesity within patients with schizophrenia. Future longitudinal research exploring dietary patterns and obesity among patients with schizophrenia is warranted.
    BMC Psychiatry 06/2014; 14(1):184. DOI:10.1186/1471-244X-14-184 · 2.21 Impact Factor
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    • "The reduced life expectancy is not only comprised of excess death from suicide and accidents, but increased prevalence of medical co-morbidities. In this patient group, death due to cardiovascular disease, cancer and diabetes is increased by a OR of 1.5e2.6 compared to the general population (Nordentoft et al., 2013). A common denominator for these conditions is an unhealthy lifestyle in terms of diet, smoking and physical activity. "
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    ABSTRACT: Background Physical activity is inversely associated with the risk of cardiovascular disease, diabetes and all-cause mortality. Patients with depression are less likely to be physically active, and thus more prone to developing these diseases. The aim of this study was to identify patient and study characteristics associated with adherence to exercise interventions. Method We pooled data from patients allocated to active exercise interventions from two previously conducted exercise trials (n = 166) offering two or three weekly sessions. We divided the patients into a high attendance or a low attendance group. We then compared patient characteristics, distance to training facilities, depression, anxiety, and satisfaction with the offered intervention between the two groups. Results High attendance was positively associated with age (p = 0.05) and satisfaction with the intervention (p < 0.001). We found no association between attendance and any other patient characteristics, severity of depression, severity of anxiety, or distance to training facilities. Patient satisfaction was positively associated with the patient’s age (p = 0.008) and improvement in depression (p = 0.04). Median attendance did not differ between the two trials offering two or three sessions per week (p = 0.44). Conclusion Severity of depression or anxiety in mild to moderate depression did not predict attendance, but high attendance was associated with higher age and satisfaction with the intervention. These findings suggest that motivational focus on younger participants should be encouraged and ways to improve satisfaction with the intervention should be considered.
    Mental Health and Physical Activity 02/2014; 7(1). DOI:10.1016/j.mhpa.2014.01.003
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