J Korean Med Sci.  2017 May;32(5):835-842. 10.3346/jkms.2017.32.5.835.

Mortality in Schizophrenia and Other Psychoses: Data from the South Korea National Health Insurance Cohort, 2002–2013

• Kim W
• Jang SY
• Chun SY
• Lee TH
• Han KT
• Park EC

• KMID: 2375086
• DOI: http://doi.org/10.3346/jkms.2017.32.5.835

Abstract

Individuals with psychoses show excess mortality, which is a major public health concern. This study examined all-cause and suicide mortality rates in Korean patients diagnosed with schizophrenia, mood disorder, or mental and behavioral disorder due to psychoactive substance use and to compare this with that of the general population. Data were from the National Health Insurance cohort, 2002 to 2013. A total of 107,190 cases aged 15 years or over were included. Mortality rates per 100,000 person years (PY) were obtained. Poisson regression modelling was conducted to quantify the effect of baseline characteristics on all-cause and suicide mortality risks. Standardized mortality ratios (SMRs) were also calculated. All-cause mortality was the highest among mental and behavioral disorder patients (1,051.0 per 100,000 PY), followed by schizophrenia (949.1 per 100,000 PY) and mood disorder patients (559.5 per 100,000 PY). Highest suicide mortality was found in schizophrenia (177.2 per 100,000 PY), mental and behavioral disorder (143.7 per 100,000 PY), and mood disorder patients (59.7 per 100,000 PY). The rate ratios (RRs) for all-cause and suicide mortality were reduced for younger populations and women. Psychoses patients had higher all-cause (schizophrenia, SMR 2.4; 95% confidence interval [CI] 2.2-2.5; mood disorder, SMR 1.4; 95% CI 1.3-1.5; mental and behavioral disorder, SMR 2.6; 95% CI 2.5-2.8) and suicide (schizophrenia, SMR 8.4; 95% CI 7.2-9.6; mood disorder, SMR 2.8; 95% CI 2.1-3.5; mental and behavioral disorder, SMR 6.8; 95% CI 5.7-7.9) mortality rates than the general population. These findings infer that efforts should be made to reduce excess mortality in psychoses.

Keyword

Schizophrenia; Mood Disorder; Mental and Behavioral Disorder; Mortality; Suicide; Korea

MeSH Terms

Cohort Studies*
Female
Humans
Korea*
Mood Disorders
Mortality*
National Health Programs*
Psychotic Disorders*
Public Health
Schizophrenia*
Suicide

Reference

1. Healy D, Le Noury J, Harris M, Butt M, Linden S, Whitaker C, Zou L, Roberts AP. Mortality in schizophrenia and related psychoses: data from two cohorts, 1875-1924 and 1994-2010. BMJ Open. 2012; 2:e001810.

2. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015; 72:334–341. PMID: 25671328.

3. Dickerson F, Stallings C, Origoni A, Schroeder J, Khushalani S, Yolken R. Mortality in schizophrenia: clinical and serological predictors. Schizophr Bull. 2014; 40:796–803. PMID: 23943410.

4. Dickerson F, Origoni A, Schroeder J, Schweinfurth LA, Stallings C, Savage CL, Katsafanas E, Banis M, Khushalani S, Yolken R. Mortality in schizophrenia and bipolar disorder: clinical and serological predictors. Schizophr Res. 2016; 170:177–183. PMID: 26607103.

5. Eaton WW, Roth KB, Bruce M, Cottler L, Wu L, Nestadt G, Ford D, Bienvenu OJ, Crum RM, Rebok G, et al. The relationship of mental and behavioral disorders to all-cause mortality in a 27-year follow-up of 4 epidemiologic catchment area samples. Am J Epidemiol. 2013; 178:1366–1377. PMID: 24091891.

6. Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014; 13:153–160. PMID: 24890068.

7. Kim SW, Yoon JS. Suicide, an urgent health issue in Korea. J Korean Med Sci. 2013; 28:345–347. PMID: 23487589.

8. Cho MJ, Seong SJ, Park JE, Chung IW, Lee YM, Bae A, Ahn JH, Lee DW, Bae JN, Cho SJ, et al. Prevalence and correlates of DSM-IV mental disorders in South Korean adults: the Korean Epidemiologic Catchment Area Study 2011. Psychiatry Investig. 2015; 12:164–170.

9. Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry. 2015; 72:1172–1181. PMID: 26509694.

10. Nordentoft M, Wahlbeck K, Hällgren J, Westman J, Osby U, Alinaghizadeh H, Gissler M, Laursen TM. Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. PLoS One. 2013; 8:e55176. PMID: 23372832.

11. Saku M, Tokudome S, Ikeda M, Kono S, Makimoto K, Uchimura H, Mukai A, Yoshimura T. Mortality in psychiatric patients, with a specific focus on cancer mortality associated with schizophrenia. Int J Epidemiol. 1995; 24:366–372. PMID: 7635598.

12. Park S, Kim SY, Hong JP. Cause-specific mortality of psychiatric inpatients and outpatients in a general hospital in Korea. Asia Pac J Public Health. 2015; 27:164–175. PMID: 22815305.

13. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40:373–383. PMID: 3558716.

14. Lemogne C, Nabi H, Melchior M, Goldberg M, Limosin F, Consoli SM, Zins M. Mortality associated with depression as compared with other severe mental disorders: a 20-year follow-up study of the GAZEL cohort. J Psychiatr Res. 2013; 47:851–857. PMID: 23590806.

15. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007; 64:1123–1131. PMID: 17909124.

16. Talaslahti T, Alanen HM, Hakko H, Isohanni M, Häkkinen U, Leinonen E. Patients with very-late-onset schizoprhenia-like psychosis have higher mortality rates than elderly patients with earlier onset schizophrenia. Int J Geriatr Psychiatry. 2015; 30:453–459. PMID: 24990229.

17. Crump C, Sundquist K, Winkleby MA, Sundquist J. Comorbidities and mortality in bipolar disorder: a Swedish national cohort study. JAMA Psychiatry. 2013; 70:931–939. PMID: 23863861.

18. Reininghaus U, Dutta R, Dazzan P, Doody GA, Fearon P, Lappin J, Heslin M, Onyejiaka A, Donoghue K, Lomas B, et al. Mortality in schizophrenia and other psychoses: a 10-year follow-up of the ӔSOP first-episode cohort. Schizophr Bull. 2015; 41:664–673.

19. Lee H, Lee K, Koo JW, Park SC. Suicide in patients with schizophrenia: a review on the findings of recent studies. Korean J Schizophr Res. 2015; 18:5–9.

20. Nielsen RE, Uggerby AS, Jensen SO, McGrath JJ. Increasing mortality gap for patients diagnosed with schizophrenia over the last three decades--a Danish nationwide study from 1980 to 2010. Schizophr Res. 2013; 146:22–27. PMID: 23523021.

21. Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol. 2010; 24:81–90. PMID: 20923923.

22. Roshanaei-Moghaddam B, Katon W. Premature mortality from general medical illnesses among persons with bipolar disorder: a review. Psychiatr Serv. 2009; 60:147–156. PMID: 19176408.

23. Bowie CR, Harvey PD. Cognition in schizophrenia: impairments, determinants, and functional importance. Psychiatr Clin North Am. 2005; 28:613–633. PMID: 16122570.

24. Jackson JL, Kroenke K. Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Arch Intern Med. 1999; 159:1069–1075. PMID: 10335683.

25. Lester H, Tritter JQ, Sorohan H. Patients’ and health professionals’ views on primary care for people with serious mental illness: focus group study. BMJ. 2005; 330:1122–1126. PMID: 15843427.

26. Park JH, Kim KW. A review of the epidemiology of depression in Korea. J Korean Med Assoc. 2011; 54:362–369.