Intended for healthcare professionals


Hospital admission for schizophrenia and bipolar disorder

BMJ 2011; 343 doi: (Published 13 September 2011) Cite this as: BMJ 2011;343:d5652
  1. Brian J Miller, assistant professor
  1. 1Department of Psychiatry, Georgia Health Sciences University, Augusta, GA 30912, USA
  1. brmiller{at}

A critical window to recognise and modify the risk of mortality

The well documented association between serious mental illness, including schizophrenia and bipolar disorder, and increased premature death from unnatural and natural causes is an important public health problem. In 2004-5 in England, the indirect costs of schizophrenia, including those associated with premature death, were estimated at £4.7bn (€5.7bn; $7.6bn).1 In 2002 in the United States, the indirect costs of death from suicide in patients with schizophrenia were estimated at $1.1bn.2 However, an important unresolved question is whether this “mortality gap” between people with and without serious mental illness is increasing over time? In the linked record linkage study (doi:10.1136/bmj.d5422), Hoang and colleagues use hospital episode statistics and death registration data in England to investigate this important question.3

It is inherently complex to study changes in mortality over time because of the potential for confounding, heterogeneity between studies (for example, differences in the length of follow-up and clinical status of the patients), and the potential lack of generalisability to other cohorts. For example, one meta-analysis found evidence for increasing all cause mortality over time in patients with schizophrenia,4 but another did not.5 Although standardised mortality ratios—the ratio of observed to expected deaths, where expected deaths are based …

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