Many deaths among schizophrenia, bipolar patients ‘avoidable’

More than half of all deaths in patients aged less than 75 years with schizophrenia or bipolar disorder are avoidable, results from a UK study show.

However, even after accounting for avoidable causes of death, including suicide, patients with schizophrenia or bipolar disorder still have significantly higher mortality rates than the general population, say the researchers.

"This may reflect a wider increase in risk of disease associated with SMI [severe mental illness], not just for those diseases for which death is deemed avoidable," suggest Uy Hoang (University of Oxford) and team.

"It is also possible that current definitions of avoidable causes of death have lower specificity in these populations at high risk of mortality," they add.

The findings come from a study of 51,624 patients with schizophrenia (n=37,607) or bipolar disorder (n=14,017) who were aged less than 75 years and discharged from inpatient care between 2006 and 2007.

In total, 480 patients with schizophrenia and 169 with bipolar disorder died within 365 days of discharge.

Avoidable deaths, such as suicide and those caused by accidents and suboptimal healthcare, accounted for 60.2% of all deaths in patients with schizophrenia and 59.2% of deaths in patients with bipolar disorder.

Compared with the general population, all-cause mortality rates were significantly higher in schizophrenia and bipolar disorder patients, at standardized mortality ratios (SMRs) of 4.23 and 2.60, respectively.

Although SMRs among patients with schizophrenia and bipolar disorder fell significantly after excluding avoidable deaths, they remained significantly elevated, at 2.38 and 1.66, respectively.

"Our study indicates that avoidable mortality is an important component of death in people with schizophrenia and bipolar disorder who have recently been discharged from inpatient care, especially deaths potentially amenable to high-quality medical care," write the researchers in Acta Psychiatrica Scandinavica.

They conclude: "Bringing mortality from avoidable causes and suicide down to general population levels would reduce the overall mortality excess in severe mental illness substantially, by about 50%, but would not eliminate it.

"Other underlying factors beyond those conventionally considered as 'avoidable' need further research."

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