American adults with schizophrenia face a much higher risk of an early death, particularly from heart and lung diseases associated with smoking, a new study finds.
The rise in risk “is evident in early adulthood and persists into later life. Especially high risks of mortality were observed from diseases for which tobacco use is a key risk factor,” concluded a team led by Dr. Mark Olfson, of Columbia University in New York City.
The issue is a familiar one, said one expert who reviewed the new findings.
“Individuals with mental illnesses like schizophrenia and bipolar disorder die, on average, approximately two decades early, and primarily from cardiovascular disease and other preventable chronic illnesses,” said Dr. Michael Compton, chair of psychiatry at Lenox Hill Hospital in New York City.
In the study, Olfson’s team looked at data from more than 1 million Medicaid patients aged 20 to 64 with schizophrenia.
The researchers found that these patients were 3.5 times more likely to have died over the course of the study period compared to adults in the general population.
Of the more than 65,500 schizophrenia patient deaths with a known cause, almost 56,000 were from diseases and other natural causes, and nearly 10,000 were from unnatural causes such as suicide, murder and accidents (both poisoning and non-poisoning-related accidents).
Heart disease had the highest death rate and accounted for nearly a third of all natural deaths for people with schizophrenia. Cancer accounted for about one in six deaths. Other leading causes of natural death included diabetes, chronic obstructive pulmonary disease (COPD, often linked to smoking), flu and pneumonia, the study found.
Since so many of these causes of death were tied to smoking, “these findings support efforts to train mental health care professionals in tobacco use prevention” for people with schizophrenia, Olfson’s team concluded.
About one in seven deaths was due to unnatural causes. Accidents accounted for about half those deaths and suicide for about a quarter. Another leading cause of death was non-suicidal substance use, mostly from alcohol and other drugs.
Two experts in the care of people with schizophrenia said the findings weren’t surprising, and are another sign that more must be done to protect the physical health of patients.
These individuals need “wide-reaching programs to intervene early in preventing obesity and smoking, and to promote healthy lifestyle choices,” said Katherine Burdick, a professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City.
She believes that people with schizophrenia face “unique challenges” to maintaining a healthy lifestyle and doctors must “do whatever is necessary to help patients optimize cardiovascular health through regular exercise, proper diet and the avoidance of substances including tobacco, alcohol and illicit drugs.”
Dr. William Dubin is chair of psychiatry at Temple University’s School of Medicine in Philadelphia. He said that strengthening links between a patient’s psychiatrist and his or her primary care physician is key to keeping both the body and the mind healthy.
“In the future, psychiatric programs should have medical practitioners embedded [within them],” Dubin said. Also, some psychiatric drugs can promote weight gain and other metabolic issues, and psychiatrists “need better awareness” of that, he said.
The study was published online Oct. 28 in the journal JAMA Psychiatry.
The U.S. National Institute of Mental Health has more about schizophrenia.
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