Fleetwood Kelly J, Alotaibi Raied, Scheuer Stine H, Smith Daniel J, Wild Sarah H, Jackson Caroline A
Usher Institute, University of Edinburgh, Edinburgh, UK.
Clinical and Translational Research, Steno Diabetes Centre Copenhagen, Herlev, Denmark.
BJPsych Open. 2025 May 13;11(3):e103. doi: 10.1192/bjo.2025.49.
People with severe mental illness (SMI) have a higher risk of premature mortality than the general population.
To investigate whether the life expectancy gap for people with SMI is widening, by determining time trends in excess life-years lost.
This population-based study included people with SMI (schizophrenia, bipolar disorder and major depression) alive on 1 January 2000. We ascertained SMI from psychiatric hospital admission records (1981-2019), and deaths via linkage to the national death register (2000-2019). We used the Life Years Lost (LYL) method to estimate LYL by SMI and sex, compared LYL to the Scottish population and assessed trends over 18 3-year rolling periods.
We included 28 797 people with schizophrenia, 16 657 with bipolar disorder and 72 504 with major depression. Between 2000 and 2019, life expectancy increased in the Scottish population but the gap widened for people with schizophrenia. For 2000-2002, men and women with schizophrenia lost an excess 9.4 (95% CI 8.5-10.3) and 8.2 (95% CI 7.4-9.0) life-years, respectively, compared with the general population. In 2017-2019, this increased to 11.8 (95% CI 10.9-12.7) and 11.1 (95% CI 10.0-12.1). The life expectancy gap was lower for bipolar disorder and depression and unchanged over time.
The life expectancy gap in people with SMI persisted or widened from 2000 to 2019. Addressing this entrenched disparity requires equitable social, economic and health policies, healthcare re-structure and improved resourcing, and investment in interventions for primary and secondary prevention of SMI and associated comorbidities.
严重精神疾病（SMI）患者的过早死亡率高于普通人群。
通过确定超额生命年损失的时间趋势，调查SMI患者的预期寿命差距是否正在扩大。
这项基于人群的研究纳入了2000年1月1日尚在世的SMI患者（精神分裂症、双相情感障碍和重度抑郁症患者）。我们从精神病医院入院记录（1981 - 2019年）中确定SMI患者，并通过与国家死亡登记册（2000 - 2019年）的关联来确定死亡情况。我们使用生命年损失（LYL）方法按SMI类型和性别估算LYL，将LYL与苏格兰人群进行比较，并评估了18个3年滚动期内的趋势。
我们纳入了28797名精神分裂症患者、16657名双相情感障碍患者和72504名重度抑郁症患者。2000年至2019年期间，苏格兰人群的预期寿命有所增加，但精神分裂症患者的差距却在扩大。2000 - 2002年，与普通人群相比，精神分裂症男性和女性分别损失了9.4（95%CI 8.5 - 10.3）和8.2（95%CI 7.4 - 9.0）个生命年。在2017 - 2019年，这一数字增加到了11.8（95%CI 10.9 - 12.7）和11.1（95%CI 10.0 - 12.1）。双相情感障碍和抑郁症患者的预期寿命差距较小且随时间保持不变。
2000年至2019年期间，SMI患者的预期寿命差距持续存在或有所扩大。解决这一长期存在的差距需要公平的社会、经济和卫生政策、医疗保健结构调整、资源改善以及对SMI及其相关合并症的一级和二级预防干预措施的投资。
