Jaakko Keinänen1, Outi Mantere2, Niina Markkula3, Krista Partti4, Jonna Perälä5, Samuli I Saarni6, Tommi Härkänen7, Jaana Suvisaari8. 1. National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland. Electronic address: jaakko.keinanen@thl.fi. 2. Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Bipolar Disorders Clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montréal, QC H4H 1R3, Canada. Electronic address: outi.mantere@douglas.mcgill.ca. 3. National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Universidad del Desarrollo, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago, Chile. Electronic address: niina.markkula@helsinki.fi. 4. National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; University of Helsinki, Doctoral Program in Clinical Research, P.O. Box 700, FIN-00029 HUS, Finland. Electronic address: krista.partti@thl.fi. 5. National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland. Electronic address: jonna.perala@hus.fi. 6. National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Turku University Hospital and the University of Turku, P.O. Box 52, FIN-20521, Turku, Finland. Electronic address: samuli.saarni@tyks.fi. 7. National Institute for Health and Welfare, Department of Public Health Solutions, Health Monitoring Unit, P.O. Box 30, FIN-00271, Helsinki, Finland. Electronic address: tommi.harkanen@thl.fi. 8. National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland. Electronic address: jaana.suvisaari@thl.fi.
Abstract
OBJECTIVES: We conducted a population based study aiming at finding predictors of mortality in psychotic disorders and evaluating the extent to which sociodemographic, lifestyle and health-related factors explain the excess mortality. METHODS: In a nationally representative sample of Finns aged 30-70years (n=5642), psychotic disorders were diagnosed using structured interviews and medical records in 2000-2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk. RESULTS: No people with affective psychoses (n=36) died during the follow-up, thus the analysis was restricted to non-affective psychotic disorders (NAP) (n=106). Adjusting for age and sex, NAP was statistically significantly associated with all-cause mortality (hazard ratio (HR) 2.99, 95% CI 2.03-4.41) and natural-cause mortality (HR 2.81, 95% CI 1.85-4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95% CI 1.10-4.05) for all-cause and to 1.98 (95% CI 0.94-4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07-0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07-11.69). CONCLUSIONS: The elevated mortality risk in people with NAP is only partly explained by socioeconomic factors, lifestyle, cardio-metabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic diseases in people with psychotic disorders.
OBJECTIVES: We conducted a population based study aiming at finding predictors of mortality in psychotic disorders and evaluating the extent to which sociodemographic, lifestyle and health-related factors explain the excess mortality. METHODS: In a nationally representative sample of Finns aged 30-70years (n=5642), psychotic disorders were diagnosed using structured interviews and medical records in 2000-2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk. RESULTS: No people with affective psychoses (n=36) died during the follow-up, thus the analysis was restricted to non-affective psychotic disorders (NAP) (n=106). Adjusting for age and sex, NAP was statistically significantly associated with all-cause mortality (hazard ratio (HR) 2.99, 95% CI 2.03-4.41) and natural-cause mortality (HR 2.81, 95% CI 1.85-4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95% CI 1.10-4.05) for all-cause and to 1.98 (95% CI 0.94-4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07-0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07-11.69). CONCLUSIONS: The elevated mortality risk in people with NAP is only partly explained by socioeconomic factors, lifestyle, cardio-metabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic diseases in people with psychotic disorders.
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