The excess mortality in people with psychotic disorders is a major public health concern, but little is known about the clinical and social risk factors which may predict this health inequality and help inform preventative strategies. We aimed to investigate mortality in a large epidemiologically characterized cohort of individuals with first-episode psychosis compared with the general population and to determine clinical and social risk factors for premature death. All 557 individuals with first-episode psychosis initially identified in 2 areas (Southeast London and Nottinghamshire, United Kingdom) were traced over a 10-year period in the ӔSOP-10 study. Compared with the general population, all-cause (standardized mortality ratio [SMR] 3.6, 95% confidence interval [CI] 2.6-4.9), natural-cause (SMR 1.7, 95% CI 1.0-2.7) and unnatural-cause (SMR 13.3, 95% CI 8.7-20.4) mortality was very high. Illicit drug use was associated with an increased risk of all-cause mortality (adj. rate ratio [RR] 2.31, 95% CI 1.06-5.03). Risk of natural-cause mortality increased with a longer time to first remission (adj. RR 6.61, 95% CI 1.33-32.77). Family involvement at first contact strongly reduced risk of unnatural-cause mortality (adj. RR 0.09, 95% CI 0.01-0.69). Our findings suggest that the mortality gap in people with psychotic disorders remains huge and may be wider for unnatural-cause mortality than previously reported. Efforts should now focus on further understanding and targeting these tractable clinical and social risk factors of excess mortality. Early intervention and dual diagnosis services may play a key role in achieving more rapid remission and carer involvement and addressing substance use problems to reduce excess mortality in psychosis.

中文翻译：

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精神分裂症和其他精神病的死亡率：ӔSOP 首发队列的 10 年随访。

精神病患者的高死亡率是一个主要的公共卫生问题，但人们对可能预测这种健康不平等并有助于制定预防策略的临床和社会风险因素知之甚少。我们的目的是调查一个具有流行病学特征的大型首发精神病患者队列与普通人群相比的死亡率，并确定过早死亡的临床和社会风险因素。在 ӔSOP-10 研究中，对最初在 2 个地区（伦敦东南部和英国诺丁汉郡）发现的所有 557 名首发精神病患者进行了为期 10 年的追踪。与一般人群相比，全因（标准化死亡率 [SMR] 3.6，95% 置信区间 [CI] 2.6-4.9）、自然原因（SMR 1.7，95% CI 1.0-2.7）和非自然原因（SMR 13. 3、95% CI 8.7-20.4) 死亡率非常高。非法药物使用与全因死亡风险增加相关（调整比率 [RR] 2.31, 95% CI 1.06-5.03）。自然原因死亡的风险随着首次缓解时间的延长而增加（调整 RR 6.61，95% CI 1.33-32.77）。首次接触时的家庭参与大大降低了非自然原因死亡的风险（adj. RR 0.09, 95% CI 0.01-0.69）。我们的研究结果表明，精神病患者的死亡率差距仍然很大，并且非自然原因死亡率的差距可能比以前报道的要大。现在的努力应该集中在进一步了解和针对这些导致死亡率过高的易处理的临床和社会风险因素。