Skip to main content Accessibility help
×
Home

Transformation of excess mortality in people with schizophrenia and bipolar disorder in Taiwan

  • Y.-J. Pan (a1) (a2), L.-L. Yeh (a3), H.-Y. Chan (a4) (a5) and C.-K. Chang (a6)

Abstract

Background

Given the concerns regarding the adverse health outcomes associated with weight gain and metabolic syndrome in relation to use of second-generation antipsychotics (SGAs), we aimed in this study to explore whether the increase in the use of SGAs would have any impacts on the trend of excess mortality in people with schizophrenia and bipolar disorder (BPD).

Method

Two nationwide samples of individuals with schizophrenia and BPD were identified in Taiwan's National Health Insurance Research Database in 2003 and in 2008, respectively. Age- and gender-standardized mortality ratios (SMRs) were calculated for each of the 3-year observation periods. The SMRs were compared between the calendar year cohorts, by disease group, and by causes of death.

Results

The mortality gap for people with schizophrenia decreased slightly, revealing an SMR of 3.40 (95% CI 3.30–3.50) for the 2003 cohort and 3.14 (3.06–3.23) for the 2008 cohort. The mortality gap for BPD individuals remained relatively stable with only those aged 15–44 years having an SMR rising significantly from 7.04 (6.38–7.76) to 9.10 (8.44–9.79). Additionally, in this group of BPD patients aged 15–44 years, the natural-cause-SMR increased from 5.65 (4.93–6.44) to 7.16 (6.46–7.91).

Conclusions

Compared with the general population, the gap in the excess mortality for people with schizophrenia reduced slightly. However, the over 200% difference between the cohorts in the excess mortality for BPD individuals aged 15–44 years could be a warning sign. Future research to further examine the related factors underlying those changes is warranted.

Copyright

Corresponding author

*Address for correspondence: Y.-J. Pan, Department of Psychiatry, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan. (Email: panyiju0211@gmail.com)

References

Hide All
American Psychiatric Association (2002). Practice guideline for the treatment of patients with bipolar disorder (revision) - Introduction. American Journal of Psychiatry 159, 250.
Alexander, GC, Gallagher, SA, Mascola, A, Moloney, RM, Stafford, RS (2011). Increasing off-label use of antipsychotic medications in the United States, 1995–2008. Pharmacoepidemiology and Drug Safety 20, 177184.
Bardgett, ME, Franks-Henry, JM, Colemire, KR, Juneau, KR, Stevens, RM, Marczinski, CA, Griffith, MS (2013). Adult rats treated with risperidone during development are hyperactive. Experimental and Clinical Psychopharmacology 21, 259267.
Chang, CK, Hayes, RD, Broadbent, M, Fernandes, AC, Lee, W, Hotopf, M, Stewart, R (2010). All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study. BMC Psychiatry 10, 77.
Chen, EY, Tang, JY, Hui, CL, Chiu, CP, Lam, MM, Law, CW, Yew, CW, Wong, GH, Chung, DW, Tso, S, Chan, KP, Yip, KC, Hung, SF, Honer, WG (2011). Three-year outcome of phase-specific early intervention for first-episode psychosis: a cohort study in Hong Kong. Early Intervention in Psychiatry 5, 315323.
Choi, YK, Moran-Gates, T, Gardner, MP, Tarazi, FI (2010). Effects of repeated risperidone exposure on serotonin receptor subtypes in developing rats. European Neuropsychopharmacology 20, 187194.
Correll, CU, Blader, JC (2015). Antipsychotic use in youth without psychosis: a double-edged sword. JAMA Psychiatry 72, 859860.
Correll, CU, Joffe, BI, Rosen, LM, Sullivan, TB, Joffe, RT (2015). Cardiovascular and cerebrovascular risk factors and events associated with second-generation antipsychotic compared to antidepressant use in a non-elderly adult sample: results from a claims-based inception cohort study. World Psychiatry 14, 5663.
Correll, CU, Manu, P, Olshanskiy, V, Napolitano, B, Kane, JM, Malhotra, AK (2009). Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA 302, 17651773.
Dutta, R, Murray, RM, Allardyce, J, Jones, PB, Boydell, JE (2012). Mortality in first-contact psychosis patients in the U.K.: a cohort study. Psychological Medicine 42, 16491661.
Gardner-Sood, P, Lally, J, Smith, S, Atakan, Z, Ismail, K, Greenwood, KE, Keen, A, O'Brien, C, Onagbesan, O, Fung, C, Papanastasiou, E, Eberhard, J, Patel, A, Ohlsen, R, Stahl, D, David, A, Hopkins, D, Murray, RM, Gaughran, F, IMPaCT team (2015). Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial. Psychological Medicine 45, 26192629.
Harris, MG, Burgess, PM, Chant, DC, Pirkis, JE, McGorry, PD (2008). Impact of a specialized early psychosis treatment programme on suicide. Retrospective cohort study. Early Intervention in Psychiatry 2, 1121.
Hayes, RD, Downs, J, Chang, CK, Jackson, RG, Shetty, H, Broadbent, M, Hotopf, M, Stewart, R (2015). The effect of clozapine on premature mortality: an assessment of clinical monitoring and other potential confounders. Schizophrenia Bulletin 41, 644655.
Hennekens, CH, Hennekens, AR, Hollar, D, Casey, DE (2005). Schizophrenia and increased risks of cardiovascular disease. American Heart Journal 150, 11151121.
Higham, J, Flowers, J, Hall, P (2005). Standardisation. Eastern Region Public Health Observatory: Cambridge. Issue 6 (http://www.scotpho.org.uk/downloads/methodology/INPHORM%206-FINAL.pdf).
Hoang, U, Stewart, R, Goldacre, MJ (2011). Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999–2006. BMJ 343, d5422.
Lahti, M, Tiihonen, J, Wildgust, H, Beary, M, Hodgson, R, Kajantie, E, Osmond, C, Raikkonen, K, Eriksson, J (2012). Cardiovascular morbidity, mortality and pharmacotherapy in patients with schizophrenia. Psychological Medicine 42, 22752285.
Lakka, HM, Laaksonen, DE, Lakka, TA, Niskanen, LK, Kumpusalo, E, Tuomilehto, J, Salonen, JT (2002). The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288, 27092716.
Laursen, TM, Mortensen, PB, MacCabe, JH, Cohen, D, Gasse, C (2014). Cardiovascular drug use and mortality in patients with schizophrenia or bipolar disorder: a Danish population-based study. Psychological Medicine 44, 16251637.
Lee, T, Yang, C, Wang, T (2011). Population ageing and national health insurance expenditures: a time-to-death analysis. (in Chinese). Journal of Population Studies 43, 135.
Maher, AR, Maglione, M, Bagley, S, Suttorp, M, Hu, JH, Ewing, B, Wang, Z, Timmer, M, Sultzer, D, Shekelle, PG (2011). Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA 306, 13591369.
Mandell, DJ, Unis, A, Sackett, GP (2011). Post-drug consequences of chronic atypical antipsychotic drug administration on the ability to adjust behavior based on feedback in young monkeys. Psychopharmacology (Berl) 215, 345352.
Miller, CJ, Li, M, Penfold, RB, Lee, AF, Smith, EG, Osser, DN, Bajor, L, Bauer, MS (2014). Patterns of initiation of second generation antipsychotics for bipolar disorder: a month-by-month analysis of provider behavior. BMC Psychiatry 14, 339.
Ministry of Health and Welfare (2016). Cause of Death Statistics. Ministry of Health and Welfare: Taipei, Taiwan. (http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=474&fod_list_no=3443).
Mitchell, PB (2012). Bipolar disorder: the shift to overdiagnosis. Canadian Journal of Psychiatry 57, 659665.
Morgan, VA, McGrath, JJ, Jablensky, A, Badcock, JC, Waterreus, A, Bush, R, Carr, V, Castle, D, Cohen, M, Galletly, C, Harvey, C, Hocking, B, McGorry, P, Neil, AL, Saw, S, Shah, S, Stain, HJ, Mackinnon, A (2014). Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychological Medicine 44, 21632176.
National Health Insurance Administration (2004). National Health Insurance Annual Statistical Report. Bureau of National Health Insurance: Taipei, Taiwan. (https://www.nhi.gov.tw/Resource/webdata/20512_1_Attach_8661_1_s92.pdf).
National Health Insurance Administration (2011). The Report of Enrollment of National Health Insurance and Medical Health care Utilization of Alliens and Mainlanders. Bureau of National Health Insurance: Taipei, Taiwan. (http://www.nhi.gov.tw/Resource/webdata/19485_4_194%E5%9F%B7%E8%A1%8C%E5%A0%B1%E5%91%8A6%E6%9C%88%20(%E9%99%84%E9%8C%84%E4%BA%8C%E4%B9%8B%E9%99%84%E8%A1%A8).pdf).
National Health Insurance Administration (2017). Enrollment and Underwriting. Bureau of National Health Insurance: Taipei, Taiwan. (https://www.nhi.gov.tw/Resource/webdata/20517_2_201702_National%20Health%20Insurance%201.pdf).
National Institute for Health and Care Excellence (NICE) (2006). Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents in Primary and Secondary Care. National Collaborating Centre for Mental Health: London, UK.
Olfson, M, King, M, Schoenbaum, M (2015). Treatment of young people with antipsychotic medications in the United States. JAMA Psychiatry 72, 867874.
Pan, Y, Yeh, L, Chen, Y, Chan, H (2016 a). Three-year mortality in relation to early hospitalization and number of outpatient clinic visits in people with newly diagnosed bipolar disorder. General Hospital Psychiatry 43, 3237.
Pan, Y, Yeh, L, Chen, Y, Kuo, K, Chang, C (2016 b). Hospital treatment, mortality and healthcare costs in relation to socioeconomic status among people with bipolar affective disorder. British Journal of Psychiatry Open 2, 1017.
Reininghaus, U, Dutta, R, Dazzan, P, Doody, GA, Fearon, P, Lappin, J, Heslin, M, Onyejiaka, A, Donoghue, K, Lomas, B, Kirkbride, JB, Murray, RM, Croudace, T, Morgan, C, Jones, PB (2015). Mortality in schizophrenia and other psychoses: a 10-year follow-up of the ӔSOP first-episode cohort. Schizophrenia Bulletin 41, 664673.
Remington, G (2006). Schizophrenia, antipsychotics, and the metabolic syndrome: is there a silver lining? American Journal of Psychiatry 163, 11321134.
Saha, S, Chant, D, McGrath, J (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry 64, 11231131.
Taiwan's Ministry of the Interior (2017). Resident Population by 5-Year and 10-Year Age Group, 1990–2017. Taiwan's Ministry of the Interior: Taipei, Taiwan. (http://sowf.moi.gov.tw/stat/month/m1-06.xls).
Tarricone, I, Ferrari Gozzi, B, Serretti, A, Grieco, D, Berardi, D (2010). Weight gain in antipsychotic-naive patients: a review and meta-analysis. Psychological Medicine 40, 187200.
Tiihonen, J, Lonnqvist, J, Wahlbeck, K, Klaukka, T, Niskanen, L, Tanskanen, A, Haukka, J (2009). 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 374, 620627.
Wahlbeck, K, Westman, J, Nordentoft, M, Gissler, M, Laursen, TM (2011). Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. British Journal of Psychiatry 199, 453458.
World Economic Outlook (WEO) data, IMF (2017). Implied PPP (Purchasing Power Parity) Conversion Rate. ECONSTATS: New York, USA. (http://www.econstats.com/weo/V013.htm).
Wu, CS, Tsai, YT, Tsai, HJ (2015). Antipsychotic drugs and the risk of ventricular arrhythmia and/or sudden cardiac death: a nation-wide case-crossover study. Journal of the American Heart Association 4, e001568.
Wu, CY, Chang, CK, Hayes, RD, Broadbent, M, Hotopf, M, Stewart, R (2012 a). Clinical risk assessment rating and all-cause mortality in secondary mental healthcare: the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) Case Register. Psychological Medicine 42, 15811590.
Wu, CY, Chen, YJ, Ho, HJ, Hsu, YC, Kuo, KN, Wu, MS, Lin, JT (2012 b). Association between nucleoside analogues and risk of hepatitis B virus-related hepatocellular carcinoma recurrence following liver resection. JAMA 308, 19061914.
Yatham, LN, Kennedy, SH, Parikh, SV, Schaffer, A, Beaulieu, S, Alda, M, O'Donovan, C, Macqueen, G, McIntyre, RS, Sharma, V, Ravindran, A, Young, LT, Milev, R, Bond, DJ, Frey, BN, Goldstein, BI, Lafer, B, Birmaher, B, Ha, K, Nolen, WA, Berk, M (2013). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disorders 15, 144.

Keywords

Type Description Title
WORD
Supplementary materials

Pan supplementary material
Pan supplementary material 1

 Word (14 KB)
14 KB
WORD
Supplementary materials

Pan supplementary material
Pan supplementary material 2

 Word (12 KB)
12 KB
UNKNOWN
Supplementary materials

Pan supplementary material
Pan supplementary material 3

 Unknown (4.9 MB)
4.9 MB
UNKNOWN
Supplementary materials

Pan supplementary material
Pan supplementary material 4

 Unknown (7.5 MB)
7.5 MB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed