January 31, 2018
3 min read

First diagnosis of psychotic disorder increases risk of death eightfold

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Gregory E. Simon

The rate of all-cause mortality observed among adolescents and young adults after first diagnosis of psychotic disorder was about eight times higher than the rate observed among a matched control group of general outpatient service users, according to data published in JAMA Psychiatry.

“Among people with serious mental illnesses, including schizophrenia and affective psychoses, all-cause mortality rates are two to three times those in the general population,” Gregory E. Simon, MD, MPH, from Kaiser Permanente Washington Health Research Institute, and colleagues wrote. “Much of the concern regarding excess mortality among people with psychotic disorders has focused on chronic illness, especially cardiovascular disease. More recent research suggests an even greater increase in mortality soon after the initial diagnosis of a psychotic disorder.”

Using population-based records data from five large integrated health systems in the United States, researchers examined mortality in adolescents and young adult members aged 16 to 30 years following their first diagnosis of a psychotic disorder — schizophrenia, schizoaffective disorder, mood disorder with psychotic symptoms or other psychotic disorder — from 2009 through 2015 in any treatment setting. They compared the mortality rates of individuals with psychotic disorders with two control groups — the general outpatient group (members making an outpatient visit) and the unipolar depression group (those receiving first diagnosis of unipolar depression) — matched for age, sex, health system and year of diagnosis. They included any individual who died within 3 years after the index diagnosis or visit date.

Overall, 11,713 teens and young adults with first diagnosis of a psychotic disorder were matched to 35,576 general outpatients and 23,415 individuals with a first diagnosis of unipolar depression. Analysis showed that the rate of all-cause mortality after the first diagnosis of a psychotic disorder (54.6 per 10,000; 95% CI, 41.3-68 per 10,000) was about 8 times higher than that of the general outpatient group (6.7 per 10,000; 95% CI, 4-9.4 per 10,000), with deaths due to injury or poisoning, including self-harm, unintentional harm, and assaults, accounting for most of that difference. All-cause mortality among teens and young adults with a first diagnosis of psychotic disorder was nearly 3 times that seen in the unipolar depression group (20.5 per 10,000; 95% CI, 14.7-26.3 per 10,000), with deaths due to self-harm, unintentional harm and assaults accounting for most of that difference. Notably, mortality risk did not significantly differ between the psychotic disorder group and the general outpatient group.

“Recent concern about excess mortality in people with psychotic disorders has focused on chronic illnesses like diabetes and heart disease,” Simon told Healio Psychiatry. “Among younger patients with recent onset of psychosis, we should be most concerned about unnatural causes of death, especially suicide.”

After adjusting for covariates, the relative hazard of death in the psychotic disorder group compared with the general outpatient group was 34.93 (95% CI, 8.19-149.1) for self-inflicted injury or poisoning and 4.67 (95% CI, 2.01-10.86) for any other type of injury or poisoning. Although all-cause mortality among those with psychotic disorders fell from 54.6 to 27.1 per 10,000 persons, and injury and poisoning mortality fell from 30.6 to 15.1 per 10,000 persons between the first and third years post diagnosis, both rates stayed 3 times as high as those seen in the general outpatient group (9 per 10,000 for all-cause; 4.8 per 10,000 for injury or poisoning).

“Our findings support the importance of systematic early intervention for young people experiencing the first onset of psychosis. Strong evidence supports the effectiveness of coordinated specialty care programs for improving clinical and functional outcomes,” Simon and colleagues wrote. “Early intervention programs should give special attention to assessing and addressing the risk of self-harm. Clinicians caring for young people with psychotic symptoms should be aware that the 1 or 2 years after first onset of a psychotic disorder may be a period of high risk of mortality.” – by Savannah Demko

Disclosures: Simon and colleagues are employed by Kaiser Permanente. They report no other relevant financial disclosures.