Because deaths from cardiovascular disease and other lifestyle-related diseases were the most common causes of death among patients with schizophrenia, “addressing the disparity in cardiovascular death will likely require increased focus on primary prevention and on the identification and management of conditions contributing to cardiovascular mortality risk,” wrote Dr. Olfson.

High mortality rates due to COPD, lung cancer, and influenza and pneumonia, along with cardiovascular death risk, also show that smoking is a major risk factor. Approximately two-thirds of adults with schizophrenia smoke, and they tend to smoke more heavily than the general population. The recent decline in smoking in the United States did not extend to adults with schizophrenia.


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“Many factors, including economic disadvantage, negative health behaviors, and difficulties accessing and adhering to medical treatments, are thought to contribute to premature mortality in schizophrenia,” wrote Dr. Olfson. “Adults with schizophrenia are also less likely than age-matched peers to receive adequate treatment for major medical conditions, which may compound risk of premature mortality.”

In an accompanying editorial, Shuichi Suetani, MBChB, from the Queensland Centre for Mental Health Research and The Park Centre for Mental Health in Wacol, Australia and colleagues address the question: How more can be done to prevent and treat these risk factors and diseases found in schizophrenia?

“What is needed now is a thorough realignment of policy and funding to support action at the clinical level,” wrote Suetani. Government reform “needs to ensure priority is given to physical and mental health care of those with severe mental disorders … If we do not make the strategic investments to align the funding, professional responsibilities, and consumer outcomes to prioritize physical health, it is unlikely that the current patchwork of underfunded programs will affect the differential mortality gap in disorders such as schizophrenia.”

Dr. Suretani added that mental and physical health go hand in hand. “The widely used mantra of ‘no health without mental health’ needs to be complemented with a commitment to ‘no mental health without physical health.’”

References

Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature Mortality Among Adults With Schizophrenia in the United States. JAMA Psychiatry. 2015; doi:10.1001/jamapsychiatry.2015.1737.

Suetani S, Whiteford HA, MdGrath JJ. An Urgent Call to Address the Deadly Consequences of Serious Mental Disorders. JAMA Psychiatry. 2015; doi:10.1001/jamapsychiatry.2015.1981.