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Evidence on mortality in severe mental illness (SMI) comes primarily from
clinical samples in high-income countries.
To describe mortality in people with SMI among a population cohort from a
We followed-up 919 adults (from 68 378 screened) with SMI over 10 years.
Standardised mortality ratios (SMR) and years of life lost (YLL) as a
result of premature mortality were calculated.
In total 121 patients (13.2%) died. The overall SMR was twice that of the
general population; higher for men and people with schizophrenia.
Patients died about three decades prematurely, mainly from infectious
causes (49.6%). Suicide, accidents and homicide were also common causes
Mortality is an important adverse outcome of SMI irrespective of setting.
Addressing common natural and unnatural causes of mortality are urgent
priorities. Premature death and mortality related to self-harm should be
considered in the estimation of the global burden of disease for SMI.
The outcome and impact of major depression in developing countries are
To describe the outcome of major depression and compare the disability
and patterns of service use among different outcome groups.
In a case cohort study, nested within a population-based survey of 68 000
participants using the Composite International Diagnostic Interview
(CIDI), 300 participants were randomly selected from those with current
major depression and 300 from those with no lifetime history.
Participants were re-interviewed after 18–62 months to ascertain current
diagnosis, psychological symptoms, disability and use of health
Of participants with major depression at baseline 26% also met criteria
for major depression at follow up. Mortality ratio standardised for age
and gender was 3.55 (95% CI 1.97 to 6.39). All indices of measure of
disability were significantly higher in the persistently depressed group
compared with the completely recovered group. Participants who had
recovered partially resembled participants with persistent depression.
Two-thirds of those with persistent depression had not sought any
Major depression was associated with mortality and disability Those with
residual symptoms remained disabled. Help-seeking was unusual.