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Mortality in first-contact psychosis patients in the UK: a cohort study

Published online by Cambridge University Press:  13 December 2011

R. Dutta ,
R. M. Murray ,
J. Allardyce ,
P. B. Jones  and
J. E. Boydell
R. Dutta*
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
R. M. Murray
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
J. Allardyce
Affiliation:
Department of Psychiatry, Maastricht University, Maastricht, The Netherlands
P. B. Jones
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, UK
J. E. Boydell
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
*
*Address for correspondence: R. Dutta, MRCPsych, Ph.D., Department of Psychosis Studies, Box No. 63, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email: [email protected])
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Abstract

Background

The excess mortality following first-contact psychosis is well recognized. However, the causes of death in a complete incidence cohort and mortality patterns over time compared with the general population are unknown.

Method

All 2723 patients who presented for the first time with psychosis in three defined catchment areas of the UK in London (1965–2004, n=2056), Nottingham (1997–1999, n=203) and Dumfries and Galloway (1979–1998, n=464) were traced after a mean of 11.5 years follow-up and death certificates were obtained. Data analysis was by indirect standardization.

Results

The overall standardized mortality ratio (SMR) for first-contact psychosis was 184 [95% confidence interval (CI) 167–202]. Most deaths (84.2%, 374/444) were from natural causes, although suicide had the highest SMR (1165, 95% CI 873–1524). Diseases of the respiratory system and infectious diseases had the highest SMR of the natural causes of death (232, 95% CI 183–291). The risk of death from diseases of the circulatory system was also elevated compared with the general population (SMR 139, 95% CI 117–164) whereas there was no such difference for neoplasms (SMR 111, 95% CI 86–141). There was strong evidence that the mortality gap compared with the general population for all causes of death (p<0.001) and all natural causes (p=0.01) increased over the four decades of the study. There was weak evidence that cardiovascular deaths may be increasing relative to the general population (p=0.07).

Conclusions

People with first-contact psychosis have an overall mortality risk that is nearly double that of the general population. Most excess deaths are from natural causes. The widening of the mortality gap over the last four decades should be of concern to all clinicians involved in delivering healthcare.

Keywords

Bipolar disordercohort studymortalitypsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 8 , August 2012 , pp. 1649 - 1661
Copyright
Copyright © Cambridge University Press 2011

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Supplementary material: File

Dutta Supplementary Table

Supplementary Table S1. Subtypes of underlying cause of death in a first episode psychosis cohort

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