Psychiatric Quarterly

, Volume 90, Issue 3, pp 553–563 | Cite as

Schizophrenia Mortality: Barriers to Progress

  • Mary V. SeemanEmail author
Review Article


Individuals with schizophrenia die, on average, 20 years before their peers, with ‘natural causes’ accounting for 80% of premature deaths. The aim of this narrative review is to address this phenomenon from the perspective of known factors that contribute to long life. The relevant literature from the last decade was searched in PubMed and Google Scholar databases. Four factors have been shown to be common to centarians, people who live to be a hundred: genes, life style behaviors that favor a healthy heart, social support, and a subjective purpose in life. The latter three factors are potentially modifiable but, in the context of schizophrenia, there are barriers to change, namely poverty, illness symptoms, stress, stigma, and side effects of antipsychotic medication. Barriers to change need to be addressed before substantial progress can be made in increasing the health and mortality risk of people with schizophrenia.


Schizophrenia Mortality Centarians Poverty Symptoms Stress Stigma Antipsychotics 


Compliance with Ethical Standards

Conflict of Interest

The author declares that she has no conflict of interest.


  1. 1.
    Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry. 2011;199:441–2.CrossRefGoogle Scholar
  2. 2.
    Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature mortality among adults with schizophrenia. JAMA Psychiat. 2015;72:1172–81.CrossRefGoogle Scholar
  3. 3.
    Bak M, Fransen A, Janssen J, van Os J, Drukker M. Almost all antipsychotics result in weight gain: a meta-analysis. PLoS One. 2014;9:e94112.CrossRefGoogle Scholar
  4. 4.
    Bressington D, Mui J, Tse ML, Gray R, Cheung EFC, Chien WT. Cardiometabolic health, prescribed antipsychotics and health-related quality of life in people with schizophrenia-spectrum disorders: a cross-sectional study. BMC Psychiatry. 2016;16:411.CrossRefGoogle Scholar
  5. 5.
    Carpiniello B, Manchia M, Orrù MG, Pinna F. Mortality in mental disorders: are we approaching to close the gap respect to other medical specialties? The case of schizophrenia. J Psychopathol. 2019;25:39–44.Google Scholar
  6. 6.
    Eyler LT, Jeste DV. Aging of the body and the brain in schizophrenia. Schizophr Res. 2018;196:1–6.CrossRefGoogle Scholar
  7. 7.
    Cullen AE, Holmes S, Pollak TA, Blackman G, Joyce DW, Kempton MJ, et al. Associations between non-neurological autoimmune disorders and psychosis: a meta-analysis. Biol Psychiatry. 2019;85:35–48.CrossRefGoogle Scholar
  8. 8.
    Huang MH, Chen MH, Huang KL, Hsu J, Bai Y, Cheng C, et al. Increased risk of type 2 diabetes among the siblings of patients with schizophrenia. CNS Spectr. 2019:1–7.
  9. 9.
    Karim RS, Kwan MMS, Finlay AJF, Kondalsamy-Chennakesavan S, Toombs MR, Nicholson GC, et al. Mortality in hospital patients with and without mental disorders: a data-linkage cohort study. J Psychiatr Res. 2019;111:104–9.CrossRefGoogle Scholar
  10. 10.
    Giuliani C, Pirazzini C, Delledonne M, Xumerl L, Descombes P, Marquis J, et al. Centenarians as extreme phenotypes: an ecological perspective to get insight into the relationship between the genetics of longevity and age-associated diseases. Mech Ageing Dev. 2017;165:195–201.CrossRefGoogle Scholar
  11. 11.
    Heinz M, Cone N, Da Rosa G, Bishop AJ, Finchum T. Examining supportive evidence for psychosocial theories of aging within the oral history narratives of centenarians. Societies. 2017;7:8.CrossRefGoogle Scholar
  12. 12.
    Pignolo RJ. Exceptional human longevity. Mayo Clin Proc. 2019;94:110–24.CrossRefGoogle Scholar
  13. 13.
    Giefing-Kröll C, Grubeck-Loebenstein B. Improving health in later life: how a life course approach could improve health and well-being in old age. In: Walker A, editor. The future of ageing in Europe. Switzerland: Springer Nature; 2018. p. 177–215.Google Scholar
  14. 14.
    Murabito JM, Yuan R, Lunetta KL. The search for longevity and healthy aging genes: insights from epidemiological studies and samples of long-lived individuals. J Gerontol A Biol Sci Med Sci. 2012;67:470–9.CrossRefGoogle Scholar
  15. 15.
    Giuliani C, Garagnani P, Franceschi C. Genetics of human longevity within an eco-evolutionary nature-nurture framework. Circ Res. 2018;123:745–77.CrossRefGoogle Scholar
  16. 16.
    Morris BJ, Willcox BJ, Donlon TA. Genetic and epigenetic regulation of human aging and longevity. Bbadis. 2018.
  17. 17.
    Gianfrancesco O, Bubb VJ, Quinn JP. Treating the “E” in “G × E”: trauma-informed approaches and psychological therapy interventions in psychosis. Front Psych. 2019;10.
  18. 18.
    Pakpahan E, Hoffmann R, Kröger H. The long arm of childhood circumstances on health in old age: evidence from SHARELIFE. Adv Life Course Res. 2017;31:1–10.CrossRefGoogle Scholar
  19. 19.
    Lennartsson C, sif Eyjólfsdóttir H, Keller CR, Fritzell J, Pearlin LI, Schieman S, et al. Stress, health, and the life course: some conceptual perspectives. J Health Soc Behav. 2005;46:205–19.CrossRefGoogle Scholar
  20. 20.
    Hanson M, Gluckman P. Developmental origins of noncommunicable disease: population and public health implications. Am J Clin Nutr. 2011;94(suppl_6, 1):1754–8.CrossRefGoogle Scholar
  21. 21.
    Xia Q, Cai H, Xiang YB, Zhou P, Li H, Yang G, et al. Prospective cohort studies of birth weight and risk of obesity, diabetes, and hypertension in adulthood in the Chinese population. J Diabetes. 2019;11:55–64.CrossRefGoogle Scholar
  22. 22.
    Seckl JR, Holmes MC. Mechanisms of disease: glucocorticoids, their placental metabolism and fetal 'programming' of adult pathophysiology. Nat Clin Pract Endocrinol Metab. 2007;3:479–88.CrossRefGoogle Scholar
  23. 23.
    Zelko IN, Zhua J, Roman J. Maternal undernutrition during pregnancy alters the epigenetic landscape and the expression of endothelial function genes in male progeny. Nutr Res. 2019;61:53–63.CrossRefGoogle Scholar
  24. 24.
    Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care. 2007;30:2287–92.CrossRefGoogle Scholar
  25. 25.
    Robinson WP, Peñaherrera MS, Konwar C, Yuan V, Wilson SL. Epigenetic modifications in the human placenta. In: Human reproductive and prenatal genetics. Leung PCK, Qiao J, eds. Academic Press, Cambridge, Mass. 2019, Ch. 13, 293–311.Google Scholar
  26. 26.
    Chase KA, Melbourne JK, Rosen C, McCarthy-Jones S, Jones N, Feiner BM, et al. Traumagenics: at the intersect of childhood trauma, immunity and psychosis. Psychiatry Res. 2018;273:369–77.CrossRefGoogle Scholar
  27. 27.
    Speakman JR, Mitchell SE, Mazidi M. Calories or protein? The effect of dietary restriction on lifespan in rodents is explained by calories alone. Exp Gerontol. 2016;86:28–38.CrossRefGoogle Scholar
  28. 28.
    Colman RJ, Beasley TM, Kemnitz JW, Johnson SC, Weindruch R, Anderson RM. Caloric restriction reduces age-related and all-cause mortality in rhesus monkeys. Nat Commun. 2014;5:3557.CrossRefGoogle Scholar
  29. 29.
    Dipasquale S, Pariante CM, Dazzan P, Aguglia E, McGuire P, Mondelli V. The dietary pattern of patients with schizophrenia: a systematic review. J Psychiatr Res. 2012;47:197–207.CrossRefGoogle Scholar
  30. 30.
    Darmon N, Drewnowski A. Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutr Rev. 2015;73:643–60.CrossRefGoogle Scholar
  31. 31.
    Livingstone KM, Olstad DL, Leech RM, Ball K, Meertens B, Potter J, et al. Socioeconomic inequities in diet quality and nutrient intakes among Australian adults: findings from a nationally representative cross-sectional study. Nutrients. 2017;9:E1092.CrossRefGoogle Scholar
  32. 32.
    Si Hassen W, Castetbon K, Cardon P, Enaux C, Nicolaou M, Lien N, et al. Socioeconomic indicators are independently associated with nutrient intake in French adults: a DEDIPAC study. Nutrients. 2016;8:158.CrossRefGoogle Scholar
  33. 33.
    Fitch MI. Supportive care framework. Can Oncol Nurs J. 2008;18:6–14.CrossRefGoogle Scholar
  34. 34.
    Degnan A, Berry K, Sweet D, Abel K, Crossley N, Edge D. Social networks and symptomatic and functional outcomes in schizophrenia: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2018;53:873–88.CrossRefGoogle Scholar
  35. 35.
    Walsh J, Hochbrueckner R, Corcoran J, Spence R. The lived experience of schizophrenia: a systematic review and meta-synthesis. Soc Work Ment Health. 2016;14:607–24.CrossRefGoogle Scholar
  36. 36.
    Seeman MV. Solitude and schizophrenia. Psychosis. 2017;9:176–83.CrossRefGoogle Scholar
  37. 37.
    Green MF, Horan WP, Lee J, McCleery A, Reddy LF, Wynn JK. Social disconnection in schizophrenia and the general community. Schizophr Bull. 2018;44:242–9.CrossRefGoogle Scholar
  38. 38.
    Pinto RM. Using social network interventions to improve mentally ill clients’ well-being. Clin Soc Work J. 2006;34:83–100.CrossRefGoogle Scholar
  39. 39.
    Cohen S. Social relationships and health. Am Psychol. 2004;59:676–84.CrossRefGoogle Scholar
  40. 40.
    Schrempft S, Jackowska M, Hamer M, Steptoe A. Associations between social isolation, loneliness, and objective physical activity in older men and women. BMC Public Health. 2019;19:74.CrossRefGoogle Scholar
  41. 41.
    Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7:e1000316.CrossRefGoogle Scholar
  42. 42.
    Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102:1009–16.CrossRefGoogle Scholar
  43. 43.
    Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10:227–37.CrossRefGoogle Scholar
  44. 44.
    Holt-Lunstad J. Why social relationships are important for physical health: a systems approach to understanding and modifying risk and protection. Annu Rev Psychol. 2018;69:437–58.CrossRefGoogle Scholar
  45. 45.
    Keinanen J, Mantere O, Markkula N, Partti K, Perälä J, Saarni SI, et al. Mortality in people with psychotic disorders in Finland: a population-based 13-year follow-up study. Schizophr Res. 2018;192:113–8.CrossRefGoogle Scholar
  46. 46.
    Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosom Med. 2009;71:574–9.CrossRefGoogle Scholar
  47. 47.
    Musich S, Wan SHS, Kraemer S, Hawkins K, Wicker E. Purpose in life and positive health outcomes among older adults. Popul Health Management. 2018;2:139–47.CrossRefGoogle Scholar
  48. 48.
    Schaefer SM, Morozink Boylan J, van Reekum CM, Lapate RC, Norris CJ, Ryff CD, et al. Purpose in life predicts better emotional recovery from negative stimuli. PLoS One. 2013;8:e80329.CrossRefGoogle Scholar
  49. 49.
    Zilioli S, Slatcher RB, Ong AD, Gruenewald TL. Purpose in life predicts allostatic load ten years later. J Psychosom Res. 2015;79:451–7.CrossRefGoogle Scholar
  50. 50.
    Zhao Y, Fu H, Guo A, Qiu L, Cheung KSL, Wu B, et al. A comparison of perceived uselessness between centenarians and non-centenarians in China. BMC Geriatr. 2018;8:251.CrossRefGoogle Scholar
  51. 51.
    Stillman TF, Baumeister RF, Lambert NM, Crescioni AW, DeWall CN, Fincham FD. Alone and without purpose: life loses meaning following social exclusion. J Exp Soc Psychol. 2009;45:686–94.CrossRefGoogle Scholar
  52. 52.
    Lambert NM, Stillman TF, Hicks JA, Kamble S, Baumeister RF, Fincham FD. To belong is to matter: sense of belonging enhances meaning in life. Personal Soc Psychol Bull. 2013;39:1418–27.CrossRefGoogle Scholar
  53. 53.
    Pulopulos MM, Kozusznik MW. The moderating role of meaning in life in the relationship between perceived stress and diurnal cortisol. Stress. 2018;21:203–10.CrossRefGoogle Scholar
  54. 54.
    Kim ES, Strecher VJ, Ryff CD. Purpose in life and use of preventive health care services. PNAS. 2014;111:16331–6.CrossRefGoogle Scholar
  55. 55.
    Wagner LC, Torres-González F, Runte Geidel A, King MB. Existential questions in schizophrenia: perceptions of patients and caregivers. Rev Saúde Pública. 2011;45:401–8.CrossRefGoogle Scholar
  56. 56.
    Iwasaki Y, Messina ES, Hopper T. The role of leisure in meaning-making and engagement with life. J Posit Psychol. 2018;13:29–35.CrossRefGoogle Scholar
  57. 57.
    Hutchinson SL, Nimrod G. Leisure as a resource for successful aging by older adults with chronic health conditions. Int J Aging Hum Develop. 2012;74:41–65.CrossRefGoogle Scholar
  58. 58.
    Iwasaki Y, Coyle C, Shank J, Messina E, Porter H. Leisure-generated meanings and active living for persons with mental illness. Rehab Couns Bull. 2013;57:46–56.Google Scholar
  59. 59.
    Iwasaki Y, Messina E, Coyle C, Shank J. Role of leisure in meaning-Making for community-dwelling adults with mental illness: Inspiration for engaged life. JLR. 2015;47:538–55.Google Scholar
  60. 60.
    Trussell DE, Mair H. Seeking judgment free spaces: poverty, leisure, and social inclusion. JLR. 2010;42:513–33.Google Scholar
  61. 61.
    Twigger-Holroyd A. Perceptions and practices of dress-related leisure: shopping, sorting, making and mending. Ann Leisure Res. 2016;19:275–93.CrossRefGoogle Scholar
  62. 62.
    Wensley R, Slade A. Walking as a meaningful leisure occupation: the implications for occupational therapy. Br J Occup Ther. 2012;75:85–92.CrossRefGoogle Scholar
  63. 63.
    Hegarty CB, Plucker JA. Creative leisure and self-expression. Int J Creativity Problem Solving. 2012;22:63–78.Google Scholar
  64. 64.
    Petrou P, Bakker AB, den Heuvel M. Weekly job crafting and leisure crafting: implications for meaning-making and work engagement. JOOP. 2017;90:129–52.Google Scholar
  65. 65.
    Porter H, Iwasaki Y, Shank J. Conceptualizing meaning-making through leisure experiences. Soc Leisure/Loisir Soc. 2013;33:167–94.Google Scholar
  66. 66.
    Roth DL, Brown SL, Rhodes JD, Haley WE. Reduced mortality rates among caregivers: does family caregiving provide a stress-buffering effect? Psychol Aging. 2018;33:619–29.CrossRefGoogle Scholar
  67. 67.
    Miyawaki A, Tanaka H, Kobayashi Y, Kawachi I. Informal caregiving and mortality ― who is protected and who is not? A prospective cohort study from Japan. Soc Sci Med. 2019;223:24–30.CrossRefGoogle Scholar
  68. 68.
    Eneman M, Vanhee L, Liessens D, Luyten P, Sabbe B, Corveleyn J. Humanistic psychiatry and psychotherapy: listening to patients as persons in search of meaning. The case of schizophrenia. J Humanist Psychol. 2019;59:148–69.CrossRefGoogle Scholar
  69. 69.
    Rosen A. Return from the vanishing point: a clinician's perspective on art and mental illness, and particularly schizophrenia. Epidemiol Psychiatr Sci. 2007;16:126–32.CrossRefGoogle Scholar
  70. 70.
    Topor A, Stefansson CG, Denhov A, Bülow P, Andersson G. Recovery and economy; salary and allowances: a 10-year follow-up of income for persons diagnosed with first-time psychosis. Soc Psychiatry Psychiatr Epidemiol. 2019;54.
  71. 71.
    Mood C, Jonsson JP. The social consequences of poverty: an empirical test on longitudinal data. Soc Indic Res. 2016;127:633–52.CrossRefGoogle Scholar
  72. 72.
    Corrigan P. How stigma interferes with mental health care. Am Psychol. 2004;59:614–25.CrossRefGoogle Scholar
  73. 73.
    Davey Smith G, Carroll D, Rankin S, Rowan D. Socioeconomic differentials in mortality: evidence from Glasgow graveyards. Br Med J. 1992;305:1554–7.CrossRefGoogle Scholar
  74. 74.
    Gould EM, Chappel DB. Graveyard gleanings: socio-economic, geographical and gender inequalities in health at Tynemouth, UK, 1833-1853. J Public Health Med. 2000;22:280–6.CrossRefGoogle Scholar
  75. 75.
    Pruessner JC, Dedovic K, Pruessner M, Lord C, Buss C, Collins L, et al. Stress regulation in the central nervous system: evidence from structural and functional neuroimaging studies in human populations. Psychoneuroendocrinol. 2010;35:179–91.CrossRefGoogle Scholar
  76. 76.
    Chiang JJ, Turiano NA, Mroczek DK, Miller GE. Affective reactivity to daily stress and 20-year mortality risk in adults with chronic illness: findings from the National Study of daily experiences. Health Psychol. 2018;37:170–8.CrossRefGoogle Scholar
  77. 77.
    Seeman TE, Crimmins E, Huang MH, Singer B, Bucur A, Gruenewald T, et al. Cumulative biological risk and socio-economic differences in mortality: MacArthur studies of successful aging. Soc Sci Med. 2004;58:1985–97.CrossRefGoogle Scholar
  78. 78.
    Nugent KL, Chiappelli J, Rowland LM, Hong LE. Cumulative stress pathophysiology in schizophrenia as indexed by allostatic load. Psychoneuroendocrinol. 2015;60:120–9.CrossRefGoogle Scholar
  79. 79.
    Savransky A, Chiappelli J, Fisseha F, Wisner KM, Xiaoming D, Mirmomen SM, et al. Elevated allostatic load early in the course of schizophrenia. Transl Psychiatry. 2018;8:246.CrossRefGoogle Scholar
  80. 80.
    Berger M, Juster RP, Westphal S, Amminger GP, Bogerts B, Schiltz K, et al. Allostatic load is associated with psychotic symptoms and decreases with antipsychotic treatment in patients with schizophrenia and first-episode psychosis. Psychoneuroendocrinol. 2018;90:35–42.CrossRefGoogle Scholar
  81. 81.
    Hooker CI, Tully LM, Verosky SC, Fisher M, Holland C, Vinogradov S. Can I trust you? Negative affective priming influences social judgments in schizophrenia. J Abnorm Psychol. 2011;120:98–107.CrossRefGoogle Scholar
  82. 82.
    Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367:528–9.CrossRefGoogle Scholar
  83. 83.
    Geiss M, Chamberlain J, Weaver T, McCormick C, Raufer A, Scoggins L, et al. Diagnostic overshadowing of the psychiatric population in the emergency department: physiological factors identified for an early warning system. J Am Psychiatr Nurses Assoc. 2018;24:327–31.CrossRefGoogle Scholar
  84. 84.
    Jones S, Howard L, Thornicroft G. ‘Diagnostic overshadowing’: worse physical health care for people with mental illness. Acta Psychiatr Scand. 2008;118:169–71.CrossRefGoogle Scholar
  85. 85.
    Brown S, Kim M, Mitchell C, Inskip H. Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry. 2010;196:116–21.CrossRefGoogle Scholar
  86. 86.
    Druss BG, Chwastiak L, Kern J, Parks JJ, Ward MC, Raney LE. Psychiatry’s role in improving the physical health of patients with serious mental illness: a report from the American Psychiatric Association. Psychiatr Serv. 2018;69:254–6.CrossRefGoogle Scholar
  87. 87.
    Lee EE, Liu J, Tu X, Palmer BW, Eyler LT, Jeste DV. A widening longevity gap between people with schizophrenia and general population: a literature review and call for action. Schizophr Res. 2018;196:9–13.CrossRefGoogle Scholar
  88. 88.
    Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiat. 2015;72:334–41.CrossRefGoogle Scholar
  89. 89.
    Nemani KL, Greene MC, Ulloa M, Vincenzi B, Copeland PM, Al-Khadari S, et al. Clozapine, diabetes mellitus, cardiovascular risk and mortality: results of a 21-year naturalistic study in patients with schizophrenia and schizoaffective disorder. Clin Schizophr Relat Psychoses. 2019;12:168–76.CrossRefGoogle Scholar
  90. 90.
    Onwordi E, Howes O. Trends in mortality in schizophrenia and their implications. Acta Psychiatr Scand. 2018;138:489–91.CrossRefGoogle Scholar
  91. 91.
    Rødevand L, Steen NE, Elvsåshagen T, Quintana DS, Reponen EJ, Mørch RH, et al. Cardiovascular risk remains high in schizophrenia with modest improvements in bipolar disorder during past decade. Acta Psychiatr Scand. 2019;139:348–60.CrossRefGoogle Scholar
  92. 92.
    Tanskanen A, Tiihonen J, Taipale H. Mortality in schizophrenia: 30-year nationwide follow-up study. Acta Psychiatr Scand. 2018;138:492–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of TorontoTorontoCanada

Personalised recommendations