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A retrospective study found that people with schizophrenia or bipolar disorder were more likely to die of other serious medical conditions .
Prof Peter Kinderman, Professor of Clinical Psychology, University of Liverpool, said:
“This is a valuable paper addressing an important public health problem. We know that serious mental health problems pose a risk to physical health and this paper is clear evidence of the striking risk of premature death faced by people with serious mental health problems.
“The Government’s mental health strategy is clear that they want ‘fewer people with mental health problems [to] die prematurely’. It’s clear that this is a huge problem. People with mental health problems are at risk of a wide range of physical illnesses, and it’s vital that mental health services improve, and work better with physical health services to address this.
“We know some of the risks – people with serious mental health problems are at risk from lifestyle factors (smoking, drinking, lack of exercise, poor diet) but also potentially from the medication that is prescribed, often for very long periods, occasionally without proper review, often in combination and sometimes above recommended doses. And, when physical problems are identified, people with mental health problems often receive inadequate care.
“So it’s vital that mental health services improve – to give people the care they need and to avoid inappropriate forms of care – and work better with physical health services and primary care. It would be unacceptable, especially given the Government’s mental health strategy, not to address the problems Dr Hoang and colleagues have identified.”
Prof Richard Morriss, Professor of Psychiatry, University of Nottingham, said:
“The reasons for the premature death of patients from cardiovascular and respiratory causes is only partially understood. Many factors such as poverty, lack of motivation and organisational skills due to their underlying condition, poor diet, tendency for medication to increase obesity and worsen blood glucose and lipid profiles, higher rates of smoking, alcohol and drug use than the general population are likely to be involved.
“However, there are also other issues which have been previously studied such as restricted access to secondary care treatment for these conditions, various mechanisms that increase the likelihood of poorer autonomic nervous system control of the cardiovascular system, and possible propensity to both increased clotting and bleeding that would lead to heart attacks, strokes and pulmonary embolus, and cardiac arrhythmia.
“The UK government’s recent undertaking to delay mortality so that it is the same as the general population is going to be difficult to achieve given such an incomplete understanding of the reasons for this premature mortality and the failure to make much in roads into this mortality from large scale intervention studies for depression.
“Measures to improve physical health care screening, improved health education around lifestyle and steps to ensure access to correct treatment for people with bipolar disorder and schizophrenia may have some impact and seem fair and equitable to implement. The most recent NICE Guidelines for bipolar disorder and schizophrenia give guidance on this and hopefully over time these will be implemented.
“Although this is an important observation it is hardly new (see NICE guidelines 2006 for bipolar disorder). The paper adds to data that has already emerged on this from other parts of the world. The same would also be true for depression as well. The observations on what they died from are also not surprising and entirely in keeping with studies published over the last 10-15 years e.g. Osby et al 2001 in Archives of General Psychiatry.”
‘Mortality after hospital discharge for people withschizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006’, by Uy Hoang et al., published in the BMJ on Tuesday 13 September.