14 - Mortality and physical illness in schizophrenia

Summary

Mortality among psychiatric patients has been studied for almost as long as mental hospitals have existed (Farr, 1841), and studies of mortality and physical illness among schizophrenic patients have also been conducted for almost as long as the concept of schizophrenia has been in clinical use (Hahnemann, 1931; Alström, 1942). However, mortality studies on the one hand and studies of physical illness in schizophrenia on the other have traditionally been conducted with very different perspectives. Mortality studies have generally been conducted as part of longterm outcome studies of schizophrenia and the finding has generally been excess risk from some cause of death. Studies of physical illness have focused on the identification of illnesses occurring particularly uncommonly among schizophrenic patients, thus implying some biological antagonism that might give clues to aetiology. However, these fields of research are closely related and share many of the same methodological problems.

Studies of mortality

Mortality studies in schizophrenia have been reviewed by Simpson (1988) and Allebeck (1989). Harris and Barraclough (1998) have reviewed papers on schizophrenia mortality published in English during the period 1966-1995 together with weighted SMR (standardized mortality ratio) estimates for individual causes of death. The very large literature on suicide in schizophrenia has been reviewed by Drake et al. (1985) and Caldwell and Gottesman (1990) and is discussed in detail in Chapter 15.