Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2014

Open Access 01-12-2014 | Research article

Impact of socioeconomic deprivation on rate and cause of death in severe mental illness

Authors: Julie Langan Martin, Gary McLean, John Park, Daniel J Martin, Moira Connolly, Stewart W Mercer, Daniel J Smith

Published in: BMC Psychiatry | Issue 1/2014

Login to get access

Abstract

Background

Socioeconomic status has important associations with disease-specific mortality in the general population. Although individuals with Severe Mental Illnesses (SMI) experience significant premature mortality, the relationship between socioeconomic status and mortality in this group remains under investigated. We aimed to assess the impact of socioeconomic status on rate and cause of death in individuals with SMI (schizophrenia and bipolar disorder) relative to the local (Glasgow) and wider (Scottish) populations.

Methods

Cause and age of death during 2006-2010 inclusive for individuals with schizophrenia or bipolar disorder registered on the Glasgow Psychosis Clinical Information System (PsyCIS) were obtained by linkage to the Scottish General Register Office (GRO). Rate and cause of death by socioeconomic status, measured by Scottish Index of Multiple Deprivation (SIMD), were compared to the Glasgow and Scottish populations.

Results

Death rates were higher in people with SMI across all socioeconomic quintiles compared to the Glasgow and Scottish populations, and persisted when suicide was excluded. Differences were largest in the most deprived quintile (794.6 per 10,000 population vs. 274.7 and 252.4 for Glasgow and Scotland respectively). Cause of death varied by socioeconomic status. For those living in the most deprived quintile, higher drug-related deaths occurred in those with SMI compared to local Glasgow and wider Scottish population rates (12.3% vs. 5.9%, p = <0.001 and 5.1% p = 0.002 respectively). A lower proportion of deaths due to cancer in those with SMI living in the most deprived quintile were also observed, relative to the local Glasgow and wider Scottish populations (12.3% vs. 25.1% p = 0.013 and 26.3% p = <0.001). The proportion of suicides was significantly higher in those with SMI living in the more affluent quintiles relative to Glasgow and Scotland (54.6% vs. 5.8%, p = <0.001 and 5.5%, p = <0.001).

Conclusions

Excess mortality in those with SMI occurred across all socioeconomic quintiles compared to the Glasgow and Scottish populations but was most marked in the most deprived quintiles when suicide was excluded as a cause of death. Further work assessing the impact of socioeconomic status on specific causes of premature mortality in SMI is needed.
Appendix
Available only for authorised users
Literature
1.
Strickland S, Shetty P, MacIntyre S: Social inequalities and health in the contemporary world: comparative overview. Human biology and social inequality (39th symposium volume of the Society for the Study of Human Biology). 1998, Cambridge University Press, Cambridge, 20-35.
2.
Stirbu I, Kunst A, Mielck A, Mackenbach J: Inequalities in utilisation of general practitioner and specialist services in 9 European countries. BMC Health Serv Res. 2011, 11: 288-10.1186/1472-6963-11-288.CrossRefPubMedPubMedCentral
3.
Van Doorslaer E, Masseria C, Koolman X: Inequalities in access to medical care by income in developed countries. CMAJ. 2006, 174: 177-183. 10.1503/cmaj.050584.CrossRefPubMedPubMedCentral
4.
5.
Health in Scotland 2004. 2005, Scottish Executive, Edinburgh
6.
Choosing health; making healthy choices easier. 2004, The Stationery Office, London
7.
8.
Crump C, Sundquist K, Winkleby MA, Sundquist J: Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study. Am J Psychiatry. 2013, 170: 324-333. 10.1176/appi.ajp.2012.12050599.CrossRefPubMed
9.
Hoang U, Stewart R, Goldacre MJ: Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study. BMJ. 2011, 343: d5422-10.1136/bmj.d5422.CrossRefPubMedPubMedCentral
10.
Laursen TM, Munk-Olsen T, Gasses C: Chronic somatic comorbidity and excess mortality due to natural causes in persons with schizophrenia or bipolar affective disorder. PLoS ONE. 2011, 6: e24597-10.1371/journal.pone.0024597.CrossRefPubMedPubMedCentral
11.
Wahlbeck K, Westman J, Nordentoft M, Gissler M, Munk LT: Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry. 2011, 199 (6): 453-458. 10.1192/bjp.bp.110.085100.CrossRefPubMed
12.
Chang C-K, Hayes RD, Perera G, Broadbent MTM, Fernandes AC, Lee WE, Hotopf M, Stewart R: Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London. PLoS ONE. 2011, 6 (5): e19590-10.1371/journal.pone.0019590. doi:10.1371/journal.pone.0019590CrossRefPubMedPubMedCentral
13.
Morden NE, Lai Z, Goodrich DE, Mackenzie T, McCarthy JF, Austin K, Welsh DE, Bartels S, Kilbourne AM: Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia. Gen Hosp Psychiatry. 2012, 34: 368-379. 10.1016/j.genhosppsych.2012.02.009.CrossRefPubMedPubMedCentral
14.
Lawrence D, Hancock K, Kisley S: The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ. 2013, 346: f2539-10.1136/bmj.f2539. doi:10.1136/bmj.f2539CrossRefPubMedPubMedCentral
15.
Smith DJ, Langan J, McLean G, Guthrie B, Mercer SW: Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study. BMJ Open. 2013, 3: e002808-doi:10.1136/ bmjopen-2013-002808CrossRefPubMedPubMedCentral
16.
Smith DJ, Martin DJ, McLean G, Langan Martin J, Guthrie B, Mercer SW: Multimorbidity in bipolar disorder and under treatment of cardiovascular disease: cross sectional study. BMC Medicine. 2013, 11: 263-274. 10.1186/1741-7015-11-263.CrossRefPubMedPubMedCentral
17.
Lambert TJ, Newcomer JW: Are the cardiometabolic complications of schizophrenia still neglected? Barriers to care. Med J Aust. 2009, 190: S39-S42.PubMed
18.
DE Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S: Physical illness in patients with severe mental disorders. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011, 10 (1): 52-77.CrossRefPubMedPubMedCentral
19.
Frayne SM, Halanych JH, Miller DR, Wang F, Lin H, Pogach L, Sharkansky EJ, Keane TM, Skinner KM, Rosen CS, Berlowitz DR: Disparities in diabetes care: impact of mental illness. Arch Intern Med. 2005, 165 (22): 2631-2638. 10.1001/archinte.165.22.2631.CrossRefPubMed
20.
Weiss AP, Henderson DC, Weilburg JB, Goff DC, Meigs JB, Cagliero E, Grant RW: Treatment of cardiac risk factors among patients with schizophrenia and diabetes. Psychiatr Serv. 2006, 57 (8): 1145-1152. 10.1176/appi.ps.57.8.1145.CrossRefPubMed
21.
Laursen TM, Munk-Olsen T, Agerbo E, Gasse C, Mortensen PB: Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Arch Gen Psychiatry. 2009, 66 (7): 713-720. 10.1001/archgenpsychiatry.2009.61.CrossRefPubMed
22.
Aro S, Aro H, Keskimäki I: Socio-economic mobility among patients with schizophrenia or major affective disorder. A 17-year retrospective follow-up. Br J Psychiatry. 1995, 166 (6): 759-767. 10.1192/bjp.166.6.759.CrossRefPubMed
23.
Park J, McAlaney C, Connolly M: Improving patient care and clinical governance through utilisation of a clinical information system. Clin Govern. 2008, 13 (4): 254-259. 10.1108/14777270810912941.CrossRef
24.
25.
26.
27.
28.
Baxter DN: The mortality experience of individuals on the Salford Psychiatric Case Register. All-cause mortality. Br J Psychiatry. 1996, 168: 772-779. 10.1192/bjp.168.6.772.CrossRefPubMed
29.
Colton CW, Manderscheid RW: Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis. 2006, 3: A42-PubMedPubMedCentral
30.
Osborn DP, Levy G, Nazareth I, Petersen I, Islam A, King MB: Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom’s General Practice Research Database. Arch Gen Psychiatry. 2007, 64: 242-249. 10.1001/archpsyc.64.2.242.CrossRefPubMed
31.
Tran E, Rouillon F, Loze JY, Casadebaig F, Philippe A, Vitry F, Limosin F: Cancer mortality in patients with schizophrenia: an 11-year prospective cohort study. Cancer. 2009, 1 (15): 3555-3562. 10.1002/cncr.24383.CrossRef
32.
Oksbjerg Dalton S, Munk Laursen T, Mellemkjaer L, Johansen C, Mortensen PB: Schizophrenia and the risk for breast cancer. Schizophr Res. 2003, 62: 89-92. 10.1016/S0920-9964(02)00430-9.CrossRefPubMed
33.
Catts VS, Catts SV, O'Toole BI, Frost ADJ: Cancer incidence in patients with schizophrenia and their first-degree relatives—a meta-analysis. Acta Psychiatr Scand. 2008, 117: 323-336. 10.1111/j.1600-0447.2008.01163.x.CrossRefPubMed
34.
Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK: Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990, 264 (19): 2511-2518. 10.1001/jama.1990.03450190043026.CrossRefPubMed
35.
Rosenberg SD, Drake RE, Wolford GI, Mueser KT, Oxman TE, Vidaver RM, Carrieri KL, Luckoor R: Dartmouth assessment of lifestyle instrument (DALI): a substance use disorder screen for people with severe mental illness. Am J Psychiatry. 1998, 155 (2): 232-238.PubMed
36.
37.
Taylor R, Morrell S, Slaytor E, Ford P: Suicide in Urban New South Wales, Australia 1985-1994. Socio-economic and Migrant Interactions. Soc Sci Med. 1998, 47: 1677-1686. 10.1016/S0277-9536(98)00243-3.CrossRefPubMed
38.
Kposowa AJ: Unemployment and suicide: a cohort analysis of social factor predicting suicide in the US: National Longitudinal Mortality Study. Psychol Med. 1999, 31: 127-138. 10.1017/S0033291799002925.CrossRef
39.
Hawton K, Harris L, Simkin S, Bale E, Bond A: Social class and suicidal behaviour: the associations between social class and the characteristics of deliberate self-harm patients and the treatment they are offered. Soc Psychiatry Psychiatr Epidemiol. 2001, 36: 437-443. 10.1007/s001270170021.CrossRefPubMed
40.
Osborn D, Levy G, Nazareth I, King M: Suicide and severe mental illnesses. Cohort study within the UK general practice research database. Schizophr Res. 2008, 99 (1-3): 134-138. 10.1016/j.schres.2007.11.025. Epub 2007 Dec 26CrossRefPubMed
41.
Payne RA, Abel GA, Guthrie B, Mercer SW: The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study. CMAJ. 2013, 185 (5): E221-E228. 10.1503/cmaj.121349. doi:10.1503 /cmaj.121349CrossRefPubMedPubMedCentral
42.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012, 380: 37-43. 10.1016/S0140-6736(12)60240-2.CrossRefPubMed
43.
Gunnell DJ, Peters TJ, Kammerling RM, Brooks J: Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation. BMJ. 1995, 311 (6999): 226-230. 10.1136/bmj.311.6999.226.CrossRefPubMedPubMedCentral
44.
Congdon P: Assessing the Impact of Socioeconomic variables on small area variations in suicide outcomes in England. Int J Environ Res Public Health. 2013, 10 (1): 158-177. 10.3390/ijerph10010158.CrossRef
45.
Surtees PG, Wainwright NW, Luben RN, Wareham NJ, Bingham SA, Khaw KT: Depression and ischemic heart disease mortality: evidence from the EPIC-Norfolk United Kingdom prospective cohort study. Am J Psychiatry. 2008, 165 (4): 515-523. 10.1176/appi.ajp.2007.07061018. doi:10.1176/appi.ajp.2007.07061018. Epub 2008 Feb 1CrossRefPubMed
46.
Scafato E, Galluzzo L, Ghirini S, Gandin C, Rossi A, Solfrizzi V, Panza F, Di Carlo A, Maggi S, Farchi G: Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging. Psychol Med. 2012, 42 (12): 2619-2629. 10.1017/S0033291712000645. doi:10.1017/S0033291712000645. Epub 2012 Apr 11CrossRefPubMed
47.
Phillips AC, Batty GD, Gale CR, Deary IJ, Osborn D, MacIntyre K, Carroll D: Generalized anxiety disorder, major depressive disorder, and their comorbidity as predictors of all-cause and cardiovascular mortality: the Vietnam experience study. Psychosom Med. 2009, 71 (4): 395-403. 10.1097/PSY.0b013e31819e6706. doi:10.1097/PSY.0b013e31819e6706. Epub 2009 Mar 25CrossRefPubMed
48.
Singh GK, Hoyert DL: Social epidemiology of chronic liver disease and cirrhosis mortality in the United States, 1935-1997: trends and differentials by ethnicity, socioeconomic status, and alcohol consumption. Hum Biol. 2000, 72 (5): 801-820.PubMed
49.
Schneider B, Möller MJ, Philipp M: Mortality in affective disorders. J Affect Disord. 2001, 65 (3): 263-274. 10.1016/S0165-0327(00)00290-1.CrossRefPubMed
50.
51.
52.
McCartney G, Shipley M, Hart C, Davey Smith G, Kivimaki M, Walsh D, Watt G, Batty GD: Why do males in Scotland die younger than those in England? Evidence from three prospective cohort studies. PLoS ONE. 2012, 7: 7-18. 10.1371/journal.pone.0038860. ISSN 1932-6203CrossRef
53.
Metadata
Title
Impact of socioeconomic deprivation on rate and cause of death in severe mental illness
Authors
Julie Langan Martin
Gary McLean
John Park
Daniel J Martin
Moira Connolly
Stewart W Mercer
Daniel J Smith
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2014
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-014-0261-4

Other articles of this Issue 1/2014

BMC Psychiatry 1/2014 Go to the issue

Research article

Decreased plasma neuroactive amino acids and increased nitric oxide levels in melancholic major depressive disorder

Debate

On aims and methods of psychiatry – a reminiscence of 50 years of Tinbergen’s famous questions about the biology of behavior

Study protocol

Effectiveness and efficiency of integrated mental health care programmes in Germany: study protocol of an observational controlled trial

Database

Psychosocial interventions for suicidal ideation, plans, and attempts: A database of randomised controlled trials

Research article

Challenges to providing quality substance abuse treatment services for American Indian and Alaska native communities: perspectives of staff from 18 treatment centers

Research article

Lifestyle factors, demographics and medications associated with depression risk in an international sample of people with multiple sclerosis