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Predictors of Mortality Following a Schizophrenia Spectrum Diagnosis: Evidence from the 20-Year Follow-Up of the OPUS Randomized Controlled Trial
28 Pages Posted: 21 Dec 2022
More...Abstract
Background: The life expectancy of patients diagnosed with schizophrenia is about 10-12 years lower than in the general population and the mortality gap seems to be worsening. Many of these deaths might be avoidable.We aimed to determine mortality rates and causes of death in a schizophrenia spectrum population and examine if any baseline characteristics or clinical characteristics during the course of illness could predict mortality.
Methods:The OPUS I study was a randomized controlled trial with 578 patients diagnosed with schizophrenia spectrum disorders. Patients were reassessed after 2, 5, 10 and 20 years. Information about time and cause of death was obtained from the Danish Cause of Death Register. Hazard ratios were used to assess predictors of death.
Outcome: In total 82 (14∙4%) participants died during 20 years of follow-up. The most common cause of death was suicide (27%). At baseline employment (HR 0∙47 p=0∙049), psychotic disorder other than schizophrenia (HR 0∙36, p = 0∙017), and shorter duration of untreated psychosis (HR 0∙57 p = 0∙042) predicted lower mortality while substance-use predicted higher mortality (HR 2∙56, p <0∙001). During follow-up, symptom remission without antipsychotic medication and recovery predicted lower mortality (HR 0∙08 P =0∙013 and HR 0∙21, p=0∙028) while substance use (HR 3∙64 P<0∙001), and all chronic illnesses increased it.
Interpretation: There is an increased risk of early mortality in schizophrenia compared to the background population, and there is an urgent need for new efforts to improve the disparities in health that lead to this increased mortality.
Trial Registration Details: Registered at ClinicalTrials.gov NCT00157313.
Funding Information: The project was funded by unrestricted grants from the Tryg Foundation, Lundbeck Foundation and Helsefonden.
Declaration of Interests: We declare no competing interests.
Ethics Approval Statement: The OPUS trial has been approved by the Regional Ethical Scientific Committee (Protocol nr.: 17023873), and by the Danish data protection agency (RHP-2017-047, I-Suite nr: 05855).
Keywords: Schizophrenia, schizophrenia spectrum disorder, early mortality, risk factors
Suggested Citation: Suggested Citation