Importance Despite the potential importance of understanding excess mortality among people with mental disorders, no comprehensive meta-analyses have been conducted quantifying mortality across mental disorders. Objective To conduct a systematic review and meta-analysis of mortality among people with mental disorders and examine differences in mortality risks by type of death, diagnosis, and study characteristics. Data sources We searched EMBASE, MEDLINE, PsychINFO, and Web of Science from inception through May 7, 2014, including references of eligible articles. Our search strategy included terms for mental disorders (eg, mental disorders, serious mental illness, and severe mental illness), specific diagnoses (eg, schizophrenia, depression, anxiety, and bipolar disorder), and mortality. We also used Google Scholar to identify articles that cited eligible articles. Study selection English-language cohort studies that reported a mortality estimate of mental disorders compared with a general population or controls from the same study setting without mental illness were included. Two reviewers independently reviewed the titles, abstracts, and articles. Of 2481 studies identified, 203 articles met the eligibility criteria and represented 29 countries in 6 continents. Data extraction and synthesis One reviewer conducted a full abstraction of all data, and 2 reviewers verified accuracy. Main outcomes and measures Mortality estimates (eg, standardized mortality ratios, relative risks, hazard ratios, odds ratios, and years of potential life lost) comparing people with mental disorders and the general population or people without mental disorders. We used random-effects meta-analysis models to pool mortality ratios for all, natural, and unnatural causes of death. We also examined years of potential life lost and estimated the population attributable risk of mortality due to mental disorders. Results For all-cause mortality, the pooled relative risk of mortality among those with mental disorders (from 148 studies) was 2.22 (95% CI, 2.12-2.33). Of these, 135 studies revealed that mortality was significantly higher among people with mental disorders than among the comparison population. A total of 67.3% of deaths among people with mental disorders were due to natural causes, 17.5% to unnatural causes, and the remainder to other or unknown causes. The median years of potential life lost was 10 years (n = 24 studies). We estimate that 14.3% of deaths worldwide, or approximately 8 million deaths each year, are attributable to mental disorders. Conclusions and relevance These estimates suggest that mental disorders rank among the most substantial causes of death worldwide. Efforts to quantify and address the global burden of illness need to better consider the role of mental disorders in preventable mortality.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/2110027/yoi140107.pdf

Mortality in Mental Disorders and Global Disease Burden Implications: A Systematic Review and Meta-analysis

Recent systematic reviews have encouraged the psychiatric research community to reevaluate the contours of schizophrenia epidemiology. This paper provides a concise overview of three related systematic reviews on the incidence, prevalence, and mortality associated with schizophrenia. The reviews shared key methodological features regarding search strategies, analysis of the distribution of the frequency estimates, and exploration of the influence of key variables (sex, migrant status, urbanicity, secular trend, economic status, and latitude). Contrary to previous interpretations, the incidence of schizophrenia shows prominent variation between sites. The median incidence of schizophrenia was 15.2/100,000 persons, and the central 80% of estimates varied over a fivefold range (7.7-43.0/100,000). The rate ratio for males:females was 1.4:1. Prevalence estimates also show prominent variation. The median lifetime morbid risk for schizophrenia was 7.2/1,000 persons. On the basis of the standardized mortality ratio, people with schizophrenia have a two- to threefold increased risk of dying (median standardized mortality ratio = 2.6 for all-cause mortality), and this differential gap in mortality has increased over recent decades. Compared with native-born individuals, migrants have an increased incidence and prevalence of schizophrenia. Exposures related to urbanicity, economic status, and latitude are also associated with various frequency measures. In conclusion, the epidemiology of schizophrenia is characterized by prominent variability and gradients that can help guide future research.

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Schizophrenia: A Concise Overview of Incidence, Prevalence, and Mortality

problems in addition to the signs of the Wernicke-Korsakoff syndrome. Many of the patients were closely examined over long periods and the authors make the point that repeated examinations for as long as ten years in some instances allowed them to describe the natural history of the syndrome. and this they do in their third chapter. Again the description of the pathological findings is precise and comprehensive and the authors stress the periventricular distribution of the lesions and their bilateral symmetry. The authors consider specifically the neuropathological substrate on which are based the defective memory, ocular motor signs, the ataxia, the global confusional state and the occasional disturbance of olfactory and gustatory function. They argue a unity between Wernicke's disease and Korsakoff's psychosis and discuss the relationship between these two and alcoholic cerebellar degeneration, central pontine myelinolysis and other myelinolytic syndromes and interestingly discuss the problem of \"alcoholic dementia\" concluding that the nosological status ofalcoholic dementia is by

https://jnnp.bmj.com/content/jnnp/52/10/1218.2.full.pdf

Neuropsychology Mental Structure

Psychotic syndromes can be understood as disorders of adaptation to social context. Although heritability is often emphasized, onset is associated with environmental factors such as early life adversity, growing up in an urban environment, minority group position and cannabis use, suggesting that exposure may have an impact on the developing 'social' brain during sensitive periods. Therefore heritability, as an index of genetic influence, may be of limited explanatory power unless viewed in the context of interaction with social effects. Longitudinal research is needed to uncover gene-environment interplay that determines how expression of vulnerability in the general population may give rise to more severe psychopathology.

https://sites.oxy.edu/clint/physio/article/theenvironmentandschizophrenia.pdf

The environment and schizophrenia

OBJECTIVE: The authors synthesize findings of previous studies implicating migration as a risk factor for the development of schizophrenia and provide a quantitative index of the associated effect size. METHOD: MEDLINE was searched for population-based incidence studies concerning migrants in English-language publications appearing between the years 1977 and 2003. Article bibliographies and an Australian database were cross-referenced. Studies were included if incidence reports provided numerators and denominators and if age correction was performed or could be performed by the authors. Relative risks for migrant groups were extracted or calculated for each study. Significant heterogeneity across studies indicated the need for a mixed-effects meta-analytic model. RESULTS: The mean weighted relative risk for developing schizophrenia among first-generation migrants (40 effect sizes) was 2.7 (95% confidence interval [CI]=2.3–3.2). A separate analysis performed for second-generation migrants (seven effect siz...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.162.1.12

Schizophrenia and migration: a meta-analysis and review.

Objective: To determine whether the incidence of schizophrenia among people from non-white ethnic minorities is greater in neighbourhoods where they constitute a smaller proportion of the total population. Design: Ecological design including retrospective study of case records to calculate the incidence of schizophrenia in the ethnic minority population across electoral wards and multi-level analysis to examine interaction between individuals and environment. Setting: 15 electoral wards in Camberwell, South London. Participants: All people aged 16 years and over who had contact with psychiatric services during 1988-97. Main outcome measure: Incidence rates of schizophrenia according to Research Diagnostic Criteria. Results: The incidence of schizophrenia in non-white ethnic minorities increased significantly as the proportion of such minorities in the local population fell. The incidence rate ratio varied in a dose-response fashion from 2.38 (95% confidence interval 1.49 to 3.79) in the third of wards where non-white ethnic minorities formed the largest proportion (28-57%) of the local population to 4.4 (2.49 to 7.75) in the third of wards where they formed the smallest proportion (8-22%). Conclusion: The incidence of schizophrenia in non-white ethnic minorities in London is greater when they comprise a smaller proportion of the local population. What is already known on this topic An increased incidence of schizophrenia has been reported in several ethnic minorities in the United Kingdom Biological risk factors do not seem to explain this Reports from the United States have shown an association between the proportion of an ethnic minority living in an area and their admission rates for mental illness in general What this study adds The lower the proportion of non-white ethnic minorities in a local area the higher the incidence of schizophrenia in those minorities

https://www.bmj.com/content/bmj/323/7325/1336.full.pdf

Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment

Context: The long-term risk of suicide after a first episode of psychosis is unknown because previous studies often have been based on prevalence cohorts, been biased to more severely ill hospitalized patients, extrapolated from a short follow-up time, and have made a distinction between schizophrenia and other psychoses. Objective: To determine the epidemiology of suicide in a clinically representative cohort of patients experiencing their first episode of psychosis.

/pdf/reassessing-the-long-term-risk-of-suicide-after-a-first-3e2tjxhhb9.pdf

Reassessing the long-term risk of suicide after a first episode of psychosis.

In this paper, we discuss the conceptual background for including a dimensional component to the DSM V diagnoses for psychoses. We review the evidence for a continuous distribution of psychosis like symptoms in the general population and summarise the research validating the clinical usefulness of psychopathological dimensions. We conclude that diagnostic models using both categorical and dimensional representations of psychosis have better predictive validity than either model independently. Dimensions do not appear to be diagnosis specific so a flexible scoring of dimensions across all psychotic and major affective disorders may be potentially more informative than a system where categorical diagnoses are kept artificially dimension-specific.

Dimensions and the psychosis phenotype

Rates of schizophrenia differ significantly between groups defined at the social level, eg, urban/rural comparisons, neighborhoods, and ethnic minority status. While earlier studies were not able to determine if the social environment influenced the development of schizophrenia (causation) or whether individuals at risk aggregated in adverse social environments (selection), the recent development of multilevel modeling should inform this debate. To date, there are few examples of multilevel analyses in schizophrenia research; however, the small number of studies suggest that there may be a neighborhood social contextual effect that influences rates of schizophrenia and other psychotic disorders. Further research is urgently required to progress our knowledge of how individuals, their genes, and the neighborhoods they live in, interact with each other. Studies need to use well-specified multilevel models, and until then, we should remain cautious in our interpretation of such findings.

Review: The Wider Social Environment and Schizophrenia

OBJECTIVES: To examine the temporal association between depressive symptoms and cognitive functioning and estimate the effect measure modification of the apolipoprotein E (APOE) e4 allele on this relationship. DESIGN: Prospective cohort study. SETTING: General community. PARTICIPANTS: Population-based sample of 598 cognitively intact older adults aged 60 and older, with re-assessments after 3 (N=479) and 6 years (N=412). MEASUREMENTS: Depressive symptoms (Symptom Checklist) and neurocognitive functioning (memory, Visual Verbal Learning Test; attention, Stroop Color-Word Test; processing speed, Letter Digit Substitution Test; general cognition, Mini-Mental State Examination). Longitudinal associations were assessed using linear mixed models. The risk for cognitive impairment, no dementia (CIND) was examined using logistic regression. RESULTS: Adjusting for age, sex, education, and baseline cognition, the rate of change in memory z-scores was 0.00, -0.11, -0.20, and -0.37 for those in the lowest (reference group), second, third, and highest depressive symptom quartiles at baseline, respectively (P<.001 for highest vs lowest quartile). The odds ratios for developing CIND with amnestic features were 1.00, 0.87, 0.69, and 2.98 for the four severity groups (P=.05 for highest vs lowest quartile). Associations were strongest for those with persistent depressive symptoms, defined as high depressive symptoms at baseline and at least one follow-up visit. Results were similar for processing speed and global cognitive function but were not as strong for attention. No APOE interaction was observed. CONCLUSION: Depression and APOE act independently to increase the risk for cognitive decline and may provide targets for prevention and early treatment. © 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.

Judith Allardyce

Papers

Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment

Reassessing the long-term risk of suicide after a first episode of psychosis.

Dimensions and the psychosis phenotype

Review: The Wider Social Environment and Schizophrenia

Depressive symptoms and cognitive decline in community-dwelling older adults.