Adolescents and young adults have a significantly increased mortality risk, including from suicide, after their first diagnosis of a psychotic disorder, according to findings published online in JAMA Psychiatry.
The cohort study analyzed records from 5 integrated health systems covering over 8 million people in 5 states. The researchers included patients 16 through 30 who received a first lifetime diagnosis of a psychotic disorder between September 20, 2009 and September 30, 2015 (n=11,713) and 2 comparison groups (a general outpatient group [n=35,576] and a unipolar depression group [n=23,415]) matched for age, sex, health system, and year of diagnosis.
The primary outcome examined was death within 3 years after the index diagnosis or visit date.
Participants with psychotic disorders had an all-cause mortality rate of 54.6 per 10,000 (95% CI, 41.3-68.0) in the first year after diagnosis compared with 20.5 per 10,000 (95% CI, 14.7-26.3) in participants with unipolar depression and 6.7 per 10,000 (95% CI, 4.0-9.4) in the general outpatient group.
Compared with the general outpatient group, the relative hazard of death in participants with psychotic disorder was 34.92 (95% CI, 8.19-149.10) for self-inflicted injury or poisoning and 4.67 (95% CI, 2.01-10.86) for other type of injury or poisoning, after adjusting for race, ethnicity, and preexisting chronic medical conditions.
All-cause mortality in participants with psychotic disorder decreased from 54.6 to 27.1 per 10,000 between the first and third year after diagnosis and injury and poisoning mortality decreased from 30.6 to 15.1 per 10,000.
These rates were significantly higher than the rates in the general outpatient group, which were 9.0 per 10,000 for all-cause mortality and 4.8 per 10,000 for injury and poisoning mortality.
“Early intervention programs should give special attention to assessing and addressing the risk of self-harm,” the researchers wrote. “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.”
These findings emphasize the importance of systemic intervention in adolescents and young adults experiencing the first onset of psychosis.
Simon GE, Stewart C, Yarborough BJ, et al. Mortality rates after the first diagnosis of psychotic disorder in adolescents and young adults [published online January 31, 2018] JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.4437