Schizophrenia Mortality: Barriers to Progress

Abstract

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.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry. 2011;199:441–2.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  CAS  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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. https://doi.org/10.1017/S1092852918001396.

  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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  Google Scholar 

  12. 12.

    Pignolo RJ. Exceptional human longevity. Mayo Clin Proc. 2019;94:110–24.

    Article  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Morris BJ, Willcox BJ, Donlon TA. Genetic and epigenetic regulation of human aging and longevity. Bbadis. 2018. https://doi.org/10.1016/j.bbadis.2018.08.039.

  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. https://doi.org/10.3389/fpsyt.2019.00009.

  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.

    Article  Google 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.

    Article  Google 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.

    Article  CAS  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  PubMed  Google 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.

  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.

    Article  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Fitch MI. Supportive care framework. Can Oncol Nurs J. 2008;18:6–14.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  Google Scholar 

  36. 36.

    Seeman MV. Solitude and schizophrenia. Psychosis. 2017;9:176–83.

    Article  Google 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.

    Article  PubMed  Google Scholar 

  38. 38.

    Pinto RM. Using social network interventions to improve mentally ill clients’ well-being. Clin Soc Work J. 2006;34:83–100.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Cohen S. Social relationships and health. Am Psychol. 2004;59:676–84.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7:e1000316.

    Article  PubMed  PubMed Central  Google 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.

    Article  CAS  PubMed  PubMed Central  Google 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.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  Google 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.

    Article  CAS  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  Google 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.

    Article  CAS  PubMed  Google Scholar 

  54. 54.

    Kim ES, Strecher VJ, Ryff CD. Purpose in life and use of preventive health care services. PNAS. 2014;111:16331–6.

    Article  CAS  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  Google 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.

  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.

  60. 60.

    Trussell DE, Mair H. Seeking judgment free spaces: poverty, leisure, and social inclusion. JLR. 2010;42:513–33.

  61. 61.

    Twigger-Holroyd A. Perceptions and practices of dress-related leisure: shopping, sorting, making and mending. Ann Leisure Res. 2016;19:275–93.

    Article  Google 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.

    Article  Google 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.

  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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  Google 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. https://doi.org/10.1007/s00127-019-01655-4.

  71. 71.

    Mood C, Jonsson JP. The social consequences of poverty: an empirical test on longitudinal data. Soc Indic Res. 2016;127:633–52.

    Article  PubMed  Google Scholar 

  72. 72.

    Corrigan P. How stigma interferes with mental health care. Am Psychol. 2004;59:614–25.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  CAS  PubMed  PubMed Central  Google 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.

    Article  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  82. 82.

    Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367:528–9.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  PubMed  Google Scholar 

  90. 90.

    Onwordi E, Howes O. Trends in mortality in schizophrenia and their implications. Acta Psychiatr Scand. 2018;138:489–91.

    Article  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mary V. Seeman.

Ethics declarations

Conflict of Interest

The author declares that she has no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Seeman, M.V. Schizophrenia Mortality: Barriers to Progress. Psychiatr Q 90, 553–563 (2019). https://doi.org/10.1007/s11126-019-09645-0

Download citation

Keywords

  • Schizophrenia
  • Mortality
  • Centarians
  • Poverty
  • Symptoms
  • Stress
  • Stigma
  • Antipsychotics