Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Feb;16(1):30-40.
doi: 10.1002/wps.20384.

Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas

Nancy H Liu  1   2 , Gail L Daumit  3 , Tarun Dua  1 , Ralph Aquila  4 , Fiona Charlson  5 , Pim Cuijpers  6 , Benjamin Druss  7 , Kenn Dudek  4 , Melvyn Freeman  8 , Chiyo Fujii  9 , Wolfgang Gaebel  10 , Ulrich Hegerl  11 , Itzhak Levav  12 , Thomas Munk Laursen  13 , Hong Ma  14 , Mario Maj  15 , Maria Elena Medina-Mora  16 , Merete Nordentoft  17 , Dorairaj Prabhakaran  18 , Karen Pratt  4 , Martin Prince  19 , Thara Rangaswamy  20 , David Shiers  21 , Ezra Susser  22 , Graham Thornicroft  19 , Kristian Wahlbeck  23 , Abe Fekadu Wassie  24 , Harvey Whiteford  5 , Shekhar Saxena  1
Affiliations

Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas

Nancy H Liu et al. World Psychiatry. 2017 Feb.

Abstract

Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio-environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.

Keywords: Excess mortality; bipolar disorder; community level and policy-focused interventions; depression; health system-focused interventions; individual-focused interventions; physical health; risk factors; schizophrenia; severe mental disorders.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Multilevel model of interventions to reduce excess mortality in persons with severe mental disorders (SMD)
See this image and copyright information in PMC

References

    1. Wahlbeck K, Westman J, Nordentoft M et al. Outcome of Nordic mental health systems: life expectancy of patients with mental disorders in Denmark, Finland and Sweden 1987‐2006. Br J Psychiatry 2011;199:453‐8. - PubMed
    1. Chesney E, Goodwin GM, Fazel S. Risks of all‐cause and suicide mortality in mental disorders: a meta‐review. World Psychiatry 2014;13:153‐60. - PMC - PubMed
    1. Laursen TM, Musliner KL, Benros ME et al. Mortality and life expectancy in persons with severe unipolar depression. J Affect Disord 2016;193:203‐7. - PubMed
    1. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia. Arch Gen Psychiatry 2007;64:1123‐31. - PubMed
    1. Cuijpers P, Vogelzangs N, Twisk J et al. Comprehensive meta‐analysis of excess mortality in depression in the general community versus patients with specific illnesses. Am J Psychiatry 2014;171:453‐62. - PubMed