(Apr. 5, 2016) The research is “a done deal”: People with schizophrenia and bipolar disorder die younger than the rest of the population. What’s not “done” is finding the answer to “why” and then implementing practices that would change the answer.
“There are more editorials than basic research in this area,” John McGrath, MD, of the University of Queensland, Australia, told an audience at the 5th Schizophrenia International Research Society Conference meeting in Florence, Italy, from April 2 to 6, 2016. “We really have to do better.”
In a session entitled “Schizophrenia and mortality: Different aspects, different solutions,” researchers from Denmark, Netherlands, Australia, and the United States described three modifiable conditions that influence early mortality.
Substance Abuse
“Substance misuse is a risk factor for mortality, and people with schizophrenia have an increased risk for mortality, so are the two related?” was the question examined by Danish researchers using the national patient registry maintained since the 1960s in Denmark.
The answer: yes, and strongly.
One-third of all death in schizophrenia occurred in people with a co-occurring substance abuse disorder, according to Carsten Hjorthøj, MD, of Copenhagen University Hospital. The survey examined deaths for individuals born in 1955 or later.
Compared with the general population:
- Men with schizophrenia (SZ) and co-occurring substance abuse were 8 times more likely to die than men in the general population – twice the death rate for men with SZ alone. The risk factor for men with bipolar disorder (BP) and substance abuse was 6 times, again twice the risk for men with BP alone.
- Women with SZ and co-occurring substance abuse were 9 times more likely to die than women without co-occurring substance abuse – about twice the death rate of women with SZ alone. Women with BP and co-occurring substance abuse were 7 times more likely to die, again twice the risk for women with BP alone.
“Every substance identified – alcohol, cannabis and hard drugs – was associated with significantly higher mortality in SZ and BP,” Hjorthøj said. The highest association was with the combined use of alcohol and hard drugs. Tobacco use was not analyzed because it is not recorded by the registry.
Tobacco
Tobacco use was among the variables researchers at Sheppard Pratt Health System of Baltimore examined in studying the natural death causes for 1,136 patients with SZ or BP treated at the hospital from 1999 through 2012. In the study, tobacco use emerged as the strongest modifiable risk factor for early death from schizophrenia and a factor in early death in bipolar disorder.
During the study period, 6.1% of the population with schizophrenia died (average age: 54.4). After adjusting for all other variables except age, smoking increased death risk 6 times more than other factors. Smoking also was implicated in early mortality in bipolar disorder, but those results are still under study.
Faith Dickerson, PhD, of Sheppard Pratt, called the reduction in smoking since the US Surgeon General’s 1964 report linking cigarette use to specific diseases “a tremendous public health story that has not included patients with schizophrenia and bipolar.” Today, there are more ex-smokers than current smokers in the US, and less than 25% of the general population smokes, Dickerson said. But 60% of those with schizophrenia and 40% with bipolar disorder use tobacco.
Homelessness
Homeless people with a schizophrenia spectrum diagnosis have “very high mortality rates,” according to a Dutch study using Denmark’s comprehensive registries for homelessness, patients and cause of death. The impact was greater on women than on men.
Marieke Pijnenborg, PhD, from the University of Groningen, reported that for the population born 1982 to 1993, schizophrenia reduced life expectancy 22 years in homeless men and 17 years in homeless women compared to the Danish general population.
Schizophrenic women who were homeless were 11 times more likely than other schizophrenic women to die from suicide, homicide or accident during the study period. That’s nearly three times the increased risk of death in homeless schizophrenic men, who were 4 times more likely to die from those conditions than housed men with SZ.
Risk of death from diseases and other medical conditions also was higher among homeless individuals with psychotic conditions but not as significantly.
All homelessness is associated with early mortality, Pijnenborg said, but psychiatric diagnosis was found to be associated with half the deaths in the homeless population.
Data as a Weapon for Change
In summary of all the presentations, McGrath said the data on early death and mental illness should be “leveraged against governments” to advocate for building research capacity to learn more and to advocate for more intervention.
“This is an urgent issue,” McGrath said. “We have to use our data as a weapon against politicians. There are good data coming through. We have an obligation to translate it into better outcomes.”
The Office of Research and Public Affairs is reporting daily from theSchizophrenia International Research Society Conference. For news and reports from the conference, follow us on Twitter.
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