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
. 2021 Apr:298:113755.
doi: 10.1016/j.psychres.2021.113755. Epub 2021 Jan 24.

Risk factors for natural cause mortality in a cohort of 1494 persons with serious mental illness

Faith Dickerson  1 , Andrea Origoni  2 , Kelly Rowe  2 , Emily Katsafanas  2 , Theresa Newman  2 , Rita S Ziemann  2 , Amalia Squire  2 , Sunil Khushalani  2 , Cassie Stallings  2 , Gail Daumit  3 , Robert Yolken  4
Affiliations

Risk factors for natural cause mortality in a cohort of 1494 persons with serious mental illness

Faith Dickerson et al. Psychiatry Res. 2021 Apr.

Abstract

Persons with serious mental illness die on average more than 10 years younger than those in the overall population, mostly due to natural causes. Previous studies have identified predictors of natural cause mortality in this population but few have been prospective studies using clinical variables from in-person evaluations. A cohort of 1494 individuals with schizophrenia, bipolar disorder, or major depressive disorder were assessed at baseline and mortality status was determined from the US National Death Index after up to 20 years of follow-up. Analyses included multivariate Cox proportional hazard models to determine independent predictors of natural cause mortality. A total of 125 (8.4%) individuals died of natural causes. In multivariate models, the strongest predictor of mortality after age was tobacco smoking at baseline with a dose-related effect. Having diabetes, a cardiovascular condition, particularly hypertension, and lower cognitive functioning were also significant risks, along with divorced/separated status. The receipt of gabapentin or fluoxetine also significantly increased mortality risk. Premature death can be reduced by smoking cessation and the improved management of conditions such as hypertension and diabetes.

Keywords: Bipolar disorder; Death; Schizophrenia; Tobacco.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest

The authors declare no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flow chart of study.
Fig. 2.
Fig. 2.
Survival by Number of Packs per Day at Baseline (N=1494) HR cigarette ppd (packs per day) <0.5, 1.48 (95% CI .82, 2.69); HR >0.5 and <= 1.0 ppd, 2.45 (95% CI 1.50, 3.99); HR > 1 ppd, 5.13 (95% CI 3.19, 8.24). Data about numbers at risk for each time point shown in Supplemental Table 2.
Fig. 3.
Fig. 3.
Survival by Marital Status at Baseline (N=1494) HR Married 0.46 (95% CI 0.18, 1.14); HR Divorced /Separated 1.73 (95% CI 1.17, 2.56); HR Widowed 1.65 (95% CI 0.72, 3.82). Data about numbers at risk for each time point shown in Supplemental Table 3.
Fig. 4.
Fig. 4.
Survival by Cardiovascular Condition at Baseline (N=1494) HR Hypertension 2.18 (95% CI 1.42, 3.34, p<.001); HR Elevated cholesterol, not hypertension =164 (11%), HR 1.60 (0.90, 2.85, p=1.06); HR Other, not hypertension or elevated cholesterol = 161 (11%), HR 1.58 (0.91, 2.76, p=.103). Data about numbers at risk for each time point shown in Supplemental Table 4.
See this image and copyright information in PMC

References

    1. Ahmed S, Bachu R, Kotapati P, Adnan M, Ahmed R, Farooq U, Saeed H, Khan AM, Zubair A, Qamar I, Begum G, 2019. Use of gabapentin in the treatment of substance use and psychiatric disorders: a systematic review. Front. Psychiatry 10, 228. - PMC - PubMed
    1. Attar R, Jensen SE, Nielsen RE, Polcwiartek C, Andell P, Pedersen CT, Kragholm K, 2020. Time trends in the use of coronary procedures, guideline-based therapy, and all-cause mortality following the acute coronary syndrome in patients with schizophrenia. Cardiology 145 (7), 401–409. - PubMed
    1. Benjamini Y, Hochberg Y, 1995. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J. R. Stat. Soc 57 (1), 289–300.
    1. Cowper DC, Kubal JD, Maynard C, Hynes DM, 2002. A primer and comparative review of major US mortality databases. Ann. Epidemiol 12 (7), 462–468. - PubMed
    1. Curtis MD, Griffith SD, Tucker M, Taylor MD, Capra WB, Carrigan G, Holzman B, Torres AZ, You P, Arnieri B, Abernethy AP, 2018. Development and validation of a high-quality composite real-world mortality endpoint. Health Serv. Res 53 (6), 4460–4476. - PMC - PubMed

Publication types