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Randomized Controlled Trial
. 2023 Sep 7;49(5):1256-1268.
doi: 10.1093/schbul/sbad111.

Predictors of Mortality Following a Schizophrenia Spectrum Diagnosis: Evidence From the 20-Year Follow-up of the OPUS Randomized Controlled Trial

Marie Stefanie Kejser Starzer  1   2 , Helene Gjervig Hansen  1   2 , Carsten Hjorthøj  1   3 , Helene Speyer  1 , Nikolai Albert  1   4 , Merete Nordentoft  1   2
Affiliations
Randomized Controlled Trial

Predictors of Mortality Following a Schizophrenia Spectrum Diagnosis: Evidence From the 20-Year Follow-up of the OPUS Randomized Controlled Trial

Marie Stefanie Kejser Starzer et al. Schizophr Bull. .

Erratum in

Abstract

Background and hypothesis: The life expectancy of patients diagnosed with schizophrenia is 10-12 years lower than in the general population and the mortality gap seems to be worsening. Many of these deaths might be avoidable. We aimed to determine mortality rates and causes of death after a first-episode psychosis, and to examine if clinical characteristics at baseline or during illness could predict mortality.

Study design: The OPUS study was a randomized controlled trial of 578 patients first diagnosed with schizophrenia spectrum disorders. Patients were clinically assessed after 2, 5, 10, and 20 years. Information about time and cause of death was obtained from the Danish Cause of Death Register. Hazard ratios were used to assess predictors of death.

Study results: In total, 82 (14.4%) participants died during 20 years of follow-up. The most common cause of death was suicide (27%). At baseline employment (HR 0.47 P = .049), psychotic disorder other than schizophrenia (HR 0.36, P = .017), and longer duration of untreated psychosis (HR 0.57 P = .042) predicted lower mortality while substance use predicted higher mortality (HR 2.56, P < .001). During follow-up, symptom remission without antipsychotic medication and recovery predicted lower mortality (HR 0.08 P = .013 and HR 0.21, P = .028) while substance use (HR 3.64 P < .001), and all chronic illnesses predicted increased risk.

Conclusions: There is an increased risk of early mortality in schizophrenia compared to the background population, and there is an urgent need for new efforts to improve the disparities in health that lead to this increased mortality.

Trial registration: ClinicalTrials.gov NCT00157313.

Keywords: Schizophrenia spectrum; cause of death; longitudinal study; mortality; predictors; risk factors.

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Conflict of interest statement

We declare no competing interests.

Figures

Fig. 1.
Fig. 1.
Flowchart of participation and death**. ** The did not participate number for each period refers only to that specific follow-up reassessment, as all individuals were contacted and asked to participate again in each follow-up, allowing for some to reenter the study. *There were four reasons why participants could not be found: Homelessness, emigration, protected identity, or conservatorship.
Fig. 2.
Fig. 2.
Mortality rates in the OPUS cohort vs. background population.
Fig. 3.
Fig. 3.
Cumulative incidence curves of all-cause mortality, death due to external causes, and death from medical conditions and diseases:
Fig. 4.
Fig. 4.
Cumulative incidence curves for significant predictors of overall mortality.
See this image and copyright information in PMC

References

    1. Plana-Ripoll O, Pedersen CB, Agerbo E, et al. . A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. Lancet. 2019;394(10211):1827–1835. doi: 10.1016/S0140-6736(19)32316-5 - DOI - PubMed
    1. Lee EE, Liu J, Tu X, Palmer BW, Eyler LT, Jeste DV.. A widening longevity gap between people with schizophrenia and general population: a literature review and call for action. Schizophr Res. 2018;196:9–13. doi: 10.1016/J.SCHRES.2017.09.005 - DOI - PMC - PubMed
    1. Wildgust HJ, Beary M.. Are there modifiable risk factors which will reduce the excess mortality in schizophrenia? J Psychopharmacol. 2010;24(4 suppl):37–50. doi: 10.1177/1359786810384639 - DOI - PMC - PubMed
    1. Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS.. Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry. 2015;72(12):1172–1181. doi: 10.1001/JAMAPSYCHIATRY.2015.1737 - DOI - PubMed
    1. Liu NH, Daumit GL, Dua T, et al. . Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry. 2017;16(1):30–40. doi: 10.1002/WPS.20384 - DOI - PMC - PubMed

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