Life expectancy in schizophrenia

This short article by Dan Polansky intends to investigate the following question: what is the change of life expectancy in people with the diagnosis of schizophrenia compared to the general population? It turns out that the answer depends significantly on the source consulted.

Additional material currently considered not central is on the talk page.

Relevant snippets from sources found, with comments/reservations:

* 28.5 years: U.S. NIMH states: "The estimated average potential life lost for individuals with schizophrenia in the U.S. is 28.5 years."[1]
* Reservation: NIMH traces the claim to Olfson et al. 2015. However, the figure "28.5" does not appear in the abstract of Olfson et al. 2015.[2]. The abstract reports in terms of "standardized mortality ratios (SMRs)", including this: "Adults with schizophrenia were more than 3.5 times (all-cause SMR, 3.7; 95% CI, 3.7-3.7) as likely to die in the follow-up period as were adults in the general population."
* 10-25 years (or 20 years per abstract): Laursen et al. 2014: "This article reviews the literature on excess early mortality in persons with schizophrenia and suggests reasons for the high mortality as well as possible ways to reduce it. Persons with schizophrenia have an exceptionally short life expectancy. High mortality is found in all age groups, resulting in a life expectancy of approximately 20 years below that of the general population."[3] Something like an early publication version of Laursen et al. 2014 is available with full text online (also as pdf) from researchgate.net.[4] There we find: "In conclusion, all studies find a significant and very low life expectancy in persons with schizophrenia. However, some of the studies use only information on the persons with schizophrenia who died, and results should therefore be interpreted with caution. With that caution in mind, studies indicate that the lives of persons with schizophrenia are between 10 and 25 years shorter than those of the general population."
* Reservation: Laursen's abstract does not match the article body: the abstract states the figure of 20, but article body states "between 10 and 25 years"; it is unclear where this figure of 20 comes from. The figure of 25 is given only by the Finnish study referenced by Laursen (Tiihonen et al. 2009), so an extreme-free range would be 10-20 anyway, and then, it is hard to see how 20 would be somehow the mean value, or that it is even a good idea to calculate a mean of different values from different countries. Moreover, the figure 25 was for "life expectancy at age 20" per Minnesota 10X10 report (which reports on Laursen), so was not necessarily directly comparable to figures for life expectancy at birth.
* 14.5 years; 15.9 years (men) and 13.6 years (women): Hjorthøj et al. 2017, mutli-continent: "We identified 11 studies in 13 publications covering all inhabited continents except South America (Africa n=1, Asia n=1, Australia n=1, Europe n=7, and North America n=3) that involved up to 247 603 patients. Schizophrenia was associated with a weighted average of 14·5 years of potential life lost (95% CI 11·2–17·8), and was higher for men than women (15·9, 13·8–18·0 vs 13·6, 11·4–15·8). Loss was least in the Asian study and greatest in Africa. The overall weighted average life expectancy was 64·7 years (95% CI 61·1–68·3), and was lower for men than women (59·9 years, 95% CI 55·5–64·3 vs 67·6 years, 63·1–72·1). Life expectancy was lowest in Asia and Africa. Timing of publication and risk of bias had little effect on results."[5]
* 10-20: Medical News Today states: "Studies suggest that, on average, people with schizophrenia live around 10–20 years less than people without the condition, but this will depend on the individual."[6]
* References Hjorthøj et al. 2017 for the figure of 14.5 years. The figure 10-20 years is referenced from WHO 2018.[7]
* 15.9 years (men) and 13.6 years (women): MentalHealth.com states: "In an analysis of 11 studies published in 13 publications covering the continents of Africa, Asia, Australia, Europe, and North America, which involved 247 603 patients, schizophrenia was associated with premature death. This means that people with schizophrenia tend to live significantly shorter lives than the general population. The studies concluded that men with schizophrenia lose an average of 15.9 years of life, and women with schizophrenia lose around 13.6 years."[8]
* This seems to be based on Hjorthøj et al. 2017, given the numbers match.[5]
* 10-20 years: WHO: "People with schizophrenia have a life expectancy 10-20 years below that of the general population (4)."[9]
* WHO traces the statement to Laursen et al. 2014.[3] However, Laursen mentions 25 years as the highest value reported in the examined studies; on the other hand, the value of 25 is for "life expectancy at age 20", which is different from life expectancy at birth.
* 15-20: Peritogiannis et al. 2022: "Schizophrenia is a life-shortening disease and life expectancy in patients may be 15–20 years shorter than in the general population, with increasing longevity gap over time."[10]
* 10-25 years: Correll et al., Dec 2022: "On average, schizophrenia is associated with 10–25 years of potential life-years lost (Crump et al., 2013; Tanskanen et al., 2018). In Finland, having schizophrenia reportedly lowers the life expectancy by 15.5 years in men and 10.9 years in women (Nordentoft et al., 2013)."[11]
* 10-25 years: Minnesota 10X10 report: "In 2014 Laursen et al’s review on early mortality in schizophrenia summarized a number of studies when he stated that the lives of persons with schizophrenia are between 10-25 years shorter than the general population (Denmark – 11.2 years shorter; Sweden - 12 years shorter for males 15 years shorter for females; Israel – 12 years shorter; UK – 14.6 years shorter; Finland – 10-15 years shorter. Another Finnish follow-up showed that in 1996 life expectancy at age 20 was 25 years shorter and 22.5 years shorter in 2006."[12]
* 14.6 years (men): Chang 2011 found for London, U.K.: "Compared to national figures, all disorders were associated with substantially lower life expectancy: 8.0 to 14.6 life years lost for men and 9.8 to 17.5 life years lost for women. Highest reductions were found for men with schizophrenia (14.6 years lost) and women with schizoaffective disorders (17.5 years lost)."[13]
* 15-20 years: Ringen 2014: "In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years."[14] And: "Life expectancy for people with schizophrenia is estimated to be about 15–20 years shorter than for the general population (2, 11)."
* It traces the 2nd statement to Hennekens 2005 and Laursen et al. 2013 (different from Laursen 2014, see below).
* 20 years: Swedish SBU 2012: "The Swedish Council on Health Technology Assessment in Health Care (SBU) conducted a systematic literature review of research on effects of antipsychotics for treatment of schizophrenia, with a focus on second generation antipsychotics (SGA). [...] It is estimated that a person with schizophrenia will live 20 years less than the general population, in part due to the increased rates for suicide, coronary diseases and lifestyle diseases."[15] Cites no sources and provides no detail on the publications reviewed.
* 10-25 years: Laursen 2012: "Patients with schizophrenia have two-fold to three-fold higher mortality rates compared with the general population, corresponding to a 10–25-year reduction in life expectancy."[16]
* 15 years: Hennekens 2005, for the U.S.: "Whereas the average life expectancy in the general population of the United States is approximately 76 years (72 years in men and 80 years in women), that among patients with schizophrenia is approximately 20% shorter or 61 years (57 years in men and 65 years in women)."[17]
* 15.6 - 20.0 years: Laursen et al. 2013, for Nordic countries: "In the Nordic countries, women and men with severe mental disorders have an approximately 15 and 20 years shorter life expectancy, respectively, than the general population [8].[18]

A part of a table that differentiates men from women, per country, where the column Difference has the sought figure:

Denmark - Finland - Sweden
Men Life expectancy Difference* Life expectancy Difference* Life expectancy Difference*
Schizophrenia 40.7 20.0 43.6 17.1 44.3 18.9
Women Life expectancy Difference * Life expectancy Difference * Life expectancy Difference *
Schizophrenia 48.8 16.5 51.9 15.6 50.7 16.9
* 15 years: Gøtzsche 2023: "The psychiatrists are fully aware - and have often written about it – that the lifespan for patients with schizophrenia is 15 years shorter than for other people (Hjorthøj et al., 2017), but they don’t blame their drugs or themselves, but the patients."[19]
* 25 years in 1996 (Finland) and 22.5 years in 2006 (Finland): Tiihonen et al. 2009: "Although the proportional use of second-generation antipsychotic drugs rose from 13% to 64% during follow-up, the gap in life expectancy between patients with schizophrenia and the general population did not widen between 1996 (25 years), and 2006 (22·5 years)."[20]
* 25 years in the U.S. for serious mental illness (less granular than schizophrenia): Elias 2007: "Adults with serious mental illness treated in public systems die about 25 years earlier than Americans overall, a gap that's widened since the early '90s when major mental disorders cut life spans by 10 to 15 years, according to a report due Monday."[21]
* Reservation: Elias 2007 is part of main stream media, not a scientific report. One would ideally find the report Elias 2007 is referring to.

One has to consider whether the figure is worldwide or country-specific. Furthermore, men can be differentiated from women, leading to different figures in some studies. Moreover, one needs to distinguish life expectancy at birth from e.g. life expectancy at age 20, which was used by one cited study.

Westman et al. 2011 reports life expectancy gaps for the category of "serious mental disorders", more general than schizophrenia. The specific case of schizophrenia is reported in Figure 1 in a graphical manner, but there seems to be no numerical statement associated. The life expectancy reported is "at 15 year" rather than at birth.[22] Westman et al. 2011 is mentioned in Minnesota 10X10 report.

## References

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1. ↑ Schizophrenia, National Institute of Mental Health (NIMH)
2. ↑ Premature Mortality Among Adults With Schizophrenia in the United States by Olfson et al, 2015
3. ↑ 3.0 3.1 Excess Early Mortality in Schizophrenia by Laursen et al., 2014, annualreviews.org
4. ↑ Excess Early Mortality in Schizophrenia, researchgate.net
5. ↑ 5.0 5.1 Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis by Hjorthøj et al., 21 Feb 2017, thelancet.com
6. ↑ What to know about life expectancy for people with schizophrenia, 27 July 2023, medicalnewstoday.com
7. ↑ Management of physical health conditions in adults with severe mental disorders, 1 Jan 2018, who.int
8. ↑ What is the life expectancy for people with schizophrenia?, 21 Sep 2023, mentalhealth.com
9. ↑ Mental disorders, who.int
10. ↑ Mortality in Schizophrenia-Spectrum Disorders: Recent Advances in Understanding and Management - PMC by Peritogiannis et al., 2022
11. ↑ Factors and their weight in reducing life expectancy in schizophrenia - ScienceDirect by Correll et al, Dec 2022
12. ↑ Minnesota 10X10 report, mn.gov
13. ↑ Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London by Chang et al., 2011
14. ↑ Increased Mortality in Schizophrenia Due to Cardiovascular Disease – A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions by Ringen et al., 2014
15. ↑ Schizophrenia – pharmacological treatments, patient involvement and organization of care by Swedish SBU, 21 Nov 2012, sbu.se
16. ↑ Life expectancy and cardiovascular mortality in persons with schizophrenia by Laursen, Munk-Olsen, Vestergaard March 2012
17. ↑ Schizophrenia and increased risks of cardiovascular disease by Hennekens, Hennekens, Hollar, Casey, Dec 2005
18. ↑ Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries by Laursen, Wahlbeck, Hällgren, Westman, Ösby, Alinaghizadeh, Gissler, Nordentoft, 2013
19. ↑ Neuroleptics do much more harm than good and should not be used by Peter C Gøtzsche, 2023, psychrights.org
20. ↑ 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study) by Tiihonen et al., 2009, thelancet.com
21. ↑ Mentally ill die 25 years earlier, on average by Marilyn Elias, 3 May 2007, usatoday.com
22. ↑ Successful deinstitutionalization of mental health care: Increased life expectancy among people with mental disorders in Finland by Westman et al., 2011

## Further reading

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* Schizophrenia#Prognosis, wikipedia.org -- only one sentence about life expectancy: "It decreases life expectancy by between 20 and 28 years."