What they found was “a more comprehensive picture than was previously available of the gap in mortality, highlighting the need for more effective strategies to improve the medical care of this patient population.”

Increased risk of mortality “was particularly elevated for COPD, influenza and pneumonia, diabetes mellitus, cardiovascular disease, and suicide,” they write. “Among all causes of death, suicide was associated with the highest mean years of potential life lost per death,” Olfson et al note.

The mortality rate was higher for men than women, increased with age, and was higher for those of white race/ethnicity than for other racial/ethnic groups.


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“In absolute terms, the leading identified causes of death were cardiovascular disease, cancer, and accidents,” they wrote. By age group, unnatural (vs. natural) deaths were highest among those 20 to 34 years of age, which was attributed to accidents and suicide, while natural deaths from cardiovascular disease were highest in those 35 to 54 and 55 to 64 years of age.

These patterns can guide clinicians managing patients with schizophrenia. Olfson et al suggest the following:

  • Provide early clinical focus on cardiovascular health, including primary prevention and identifying and managing conditions that contribute to risk, such as diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease. They also called for long-term studies “to determine whether and to what extent antipsychotic treatment contributes to cardiovascular mortality in schizophrenia.”

  • Increase rates of screening and counseling for tobacco use and nicotine therapy, which remain low among adults with schizophrenia. Approximately two-thirds of this population smokes, “and they tend to smoke more heavily than smokers in the general population,” the authors point out.

  • Aggressively reduce modifiable risk factors for cancer—especially lung cancer—and pursue early cancer detection.

  • Introduce harm reduction interventions for patients with co-morbid substance abuse to reduce the “large excess of deaths due to drugs of abuse.”

  • “Improve mental health training of law enforcement professionals,” due to the 3-fold increased risk for death related to legal interventions with firearms.