Psychotic disorders confer ‘staggering’ increase in unnatural death risk

By Eleanor McDermid, Senior medwireNews Reporter

Mortality among patients during the first 10 years after first-episode psychosis is marked by a huge increase in the rate of unnatural death relative to the general population, a UK study shows.

The rate of unnatural death was 386.3 per 100,000 person–years, equating to what the researchers describe as a “staggering” 13-fold increase over that in the general population.

The most common cause of unnatural death was suicide, which at 239.1 per 100,000 person–years was 20-fold more common than in the general population.

“Even though we could not directly compare results between decades, in line with evidence from earlier studies, we noted period effects suggestive of a widening mortality gap, insofar as a greater relative all-cause mortality risk was observed for the decade of follow-up for this cohort than that reported for earlier decades”, say lead researcher Ulrich Reininghaus (Institute of Psychiatry, London) and colleagues.

This increase was likely due to death from unnatural causes; the team also observed a twofold increase in the risk of mortality from natural causes, but this was in line with older studies. Mortality from any cause was fourfold higher than in the general population.

The findings emerge from the ӔSOP-10 study, which involves 557 patients with first-episode psychosis identified in two UK centres and followed up for an average of 10 years, until December 2012.

Younger people, aged 16–29 years, were significantly less likely than those aged 30–65 years to die of natural causes and women were significantly less likely than men to die of unnatural causes. After accounting for baseline age and gender, the researchers identified just one factor that predicted death from natural causes, with a time to first psychosis remission exceeding 2 years increasing the risk 6.61-fold relative to a shorter time.

Two factors predicted unnatural death, with illicit drug use in the year before baseline increasing the risk 3.78-fold and full family involvement at first contact reducing it by 91%.

“Our finding that family involvement at first contact reduces risk of unnatural-cause mortality, although requiring replication, is, to our knowledge, the first to base family and carer involvement in such prevention strategies on firmer empirical ground”, the researchers write in Schizophrenia Bulletin.

Given that death from unnatural causes remained elevated throughout follow-up, they suggest there is an argument for promoting family involvement through all stages of illness.

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