Leo Sher, M.D.

A review paper, “Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors” was recently published in World Psychiatry (1). The authors conducted a systematic review and random-effects meta-analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical comorbidities or groups with different psychiatric disorders, also assessing moderators.

Across 135 studies spanning from 1957 to 2021 (schizophrenia: N=4,536,447; general population controls: N=1,115,600,059; other psychiatric illness controls: N=3,827,955), all-cause mortality was increased in people with schizophrenia versus any non-schizophrenia control group, with the largest risk in first-episode and incident (i.e., earlier-phase) schizophrenia versus the general population. Specific-cause mortality was highest for suicide or injury-poisoning or undetermined non-natural cause, followed by pneumonia among natural causes. Comorbid substance use disorder increased all-cause mortality.

Antipsychotics were protective against all-cause mortality versus no antipsychotic use, with largest effects for second-generation long-acting injectable anti-psychotics (SGA-LAIs), clozapine, and any SGA. Antipsychotics were also protective against natural cause-related mortality, yet first-generation antipsychotics (FGAs) were associated with increased mortality due to suicide and natural cause in incident schizophrenia.

The authors suggest that targeting comorbid substance abuse, long-term maintenance antipsychotic treatment and appropriate/earlier use of SGA-LAIs and clozapine could reduce mortality in patients with schizophrenia.

References

1. Correll CU, Solmi M, Croatto G, Schneider LK, Rohani-Montez SC, Fairley L, Smith N, Bitter I, Gorwood P, Taipale H, Tiihonen J. Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors. World Psychiatry. 2022 Jun;21(2):248-271. doi: 10.1002/wps.20994.