Interventions for Improving Longevity in Those With Schizophrenia

People with schizophrenia have a life expectancy that is a couple of decades short of their peers, on average, and 80% of deaths are attributed to natural causes, which is mainly from heart disease.¹ Of 4 factors found to contribute to longevity in people who live past 100 years — genes, a healthy diet, a solid support network, and a purpose in life — 3 are found to be lacking in schizophrenia.¹ Factors contributing to longevity can potentially be modified, but there are strong barriers to change before longevity can be increased in schizophrenia.

Between 15% to 40% of life expectancy is thought to be predetermined by the presence of certain gene variants, mainly apolipoprotein E, forkhead box O3, interleukin 6, insulin like growth factor 1.¹ However, researchers believe that early death in schizophrenia is more likely caused by gene-environment interactions. Exposure to toxins during early childhood and short duration of schooling may affect genes in ways that lower life expectancy in schizophrenia.

Eating in moderation, consuming relatively few calories, and maintaining a low body mass index are all shown to contribute to longevity. A plant-based diet with goat’s milk, red wine, herbal tea, and adequate hydration are associated with a longer lifespan.¹ However, people with schizophrenia tend to eat high-calorie diets that are high in saturated fat and use substances like alcohol and marijuana that contribute to poor nutrition. High-calorie diets may be more prevalent in schizophrenia due to factors such as substance abuse, medication-induced cravings, and living in close proximity to fast-food restaurants in neighborhoods populated by the economically disadvantaged.¹

A review of 148 studies found that people with solid support networks have a 50% increased likelihood of survival over those who are socially disconnected.¹ A solid support network offers emotional, physical, psychological, spiritual, and social supports, as well as informational support that helps with decision making in regard to health. People with schizophrenia tend to have small social networks that consist mainly of relatives and caregivers. Mental illness stigma and social withdrawal, a symptom of schizophrenia, are other factors that may contribute to lack of supports in schizophrenia.

Having a sense of purpose in life is found to counter stress, prevent illness, and lead to the practicing of healthy lifestyle behaviors that promote longevity. Taking care of family members is also correlated with longevity. However, people with schizophrenia often do not take part in leisurely activities that create a sense of purpose and are often unable to care for others on behalf of their illness.¹

Very little can be done to change one’s genetic inheritance or the early exposures that may have affected gene health. However, eating healthier foods, consuming fewer calories, establishing a social support network, and finding a purpose in life are all behaviors that may help increase longevity in schizophrenia. Self-management interventions in schizophrenia may also be effective at helping these individuals modify their lifestyles as needed to increase longevity.

The British Journal of Psychiatry reports that self-management interventions for people with severe mental illness can greatly improve quality of life outcomes as well as symptoms, functioning, self-efficacy, hope, and empowerment.² 

Evidence from 9 studies (n=863) shows that self-management interventions have a significant effect on self-rated quality of life (standardized mean difference [SMD] -0.23; 95% confidence interval [CI] -0.37 to -0.10) that is maintained at follow-up (k=7; n=980; SMD -0.25; 95% CI -0.37 to -0.12) in those with severe mental illness.² An effective self-management intervention for schizophrenia should include education about schizophrenia and its treatment, coping skills for managing persistent symptoms, recognition of signs of relapse, development of a relapse prevention plan, and a recovery-focused element such as setting personal goals related to recovery.²

Poverty, stress, stigma, and side effects of medications are some major barriers to longevity in this population. Researchers say that short lifespans in schizophrenia are mostly linked to the economic disadvantage faced by these individuals.¹

People with severe mental illnesses such as schizophrenia usually live in poverty, which determines where they live, the types of food they eat, the people they spend time with, and what they do for leisure. Poverty is found to shape attitudes about health and prevent easy access to medical care.¹

People with schizophrenia also tend to have a high amount of physiological and psychological stress due to their symptoms and lifestyles. Stigma surrounding mental illness contributes to stress and can make it difficult for those with schizophrenia to receive quality medical care. Some doctors attribute physical symptoms experienced in schizophrenia to the delusions produced by mental illness.¹

Antipsychotics are shown to improve cumulative physical stress in schizophrenia, which may help with longevity.¹ However, long-term use of antipsychotics may cause weight gain, lipid and glucose dysregulation, memory impairment, poor hygiene, inadequate self-care, and a higher risk for accidents that lead to early death. Despite existing evidence that shows antipsychotics may cause these side effects, individuals with schizophrenia who use these medications have a lower overall mortality rate than those who do not.¹

In addition to using self-management interventions in schizophrenia to increase longevity, physicians can work with patients to modify current unhealthy lifestyle behaviors. People with schizophrenia can benefit from increased physical activity, healthy diet, substance abuse treatment, and adequate social supports.

References

1. Seeman MV. Schizophrenia mortality: barriers to progress [published online May 30, 2019]. Psychiatr Q. doi: 10.1007/s11126-019-09645-0

2. Lean M, Fornells-Ambrojo M, Milton A, et al. Self-management interventions for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry. 2019; 214(5):260-268.