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. 2013 May 21:346:f2539.
doi: 10.1136/bmj.f2539.

The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers

David Lawrence  1 , Kirsten J Hancock, Stephen Kisely
Affiliations

The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers

David Lawrence et al. BMJ. .

Abstract

Objective: To examine the mortality experience of psychiatric patients in Western Australia compared with the general population.

Design: Population based study.

Setting: Western Australia, 1985-2005.

Participants: Psychiatric patients (292,585) registered with mental health services in Western Australia.

Main outcome measures: Trends in life expectancy for psychiatric patients compared with the Western Australian population and causes of excess mortality, including physical health conditions and unnatural causes of death.

Results: When using active prevalence of disorder (contact with services in previous five years), the life expectancy gap increased from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females between 1985 and 2005. Additionally, 77.7% of excess deaths were attributed to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%). Suicide was the cause of 13.9% of excess deaths.

Conclusions: Despite knowledge about excess mortality in people with mental illness, the gap in their life expectancy compared with the general population has widened since 1985. With most excess deaths being due to physical health conditions, public efforts should be directed towards improving physical health to reduce mortality in people with mental illness, in addition to ongoing efforts to prevent suicide.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: SK had financial support from the Griffith Institute for Health and Medical Research for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Active (five year) prevalence of mental disorders in people aged 15 and over, as assessed by contact with mental health services in past five years in Western Australia, by year and sex
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Fig 2 Life expectancy of people with alcohol or drug disorders, schizophrenia, and affective or other psychoses compared with the Western Australia population, by year and sex
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Fig 3 Life expectancy of people with selected non-psychotic mental disorders compared with the Western Australia population, by year and sex
See this image and copyright information in PMC

Comment in

References

    1. Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry 1998;173:11-53. - PubMed
    1. Lawrence D, Kisely S, Pais J. The epidemiology of excess mortality in people with mental illness. Can J Psychiatry 2010;55:752-60. - PubMed
    1. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 1997;170:205-28. - PubMed
    1. De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. prevalence, impact of medications and disparities in health care. World Psychiatry 2011;10:52-77. - PMC - PubMed
    1. Lawrence D, Holman CDJ, Jablensky AV. Duty to care: preventable physical illness in people with mental illness. University of Western Australia, 2001.

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