Simon GE, et al. - Researchers used population-based data to assess the overall and cause-specific mortality after first diagnosis of a psychotic disorder. They observed increased early mortality among young persons experiencing the first onset of psychosis. This highlighted the significance of systematic intervention for these patients. They recommended clinicians to attend to the elevated suicide risk after the first diagnosis of a psychotic disorder.

Methods

• Records from 5 integrated health systems that serve more than 8 million members in 5 states were used for this cohort study.
• From all members making an outpatient visit (general outpatient group) and from all receiving a first diagnosis of unipolar depression (unipolar depression group), researchers selected members aged 16 through 30 years who received a first lifetime diagnosis of a psychotic disorder from September 30, 2009, through September 30, 2015, and 2 comparison groups matched for age, sex, health system, and year of diagnosis.
• Exposures included first recorded diagnosis of schizophrenia, schizoaffective disorder, mood disorder with psychotic symptoms, or other psychotic disorder in any outpatient, Emergency Department, or inpatient setting.
• Outcomes assessed included death within 3 years after the index diagnosis or visit date, ascertained from health system electronic health records, insurance claims, and state mortality records.

Results

• Researchers matched a total of 11,713 members with first diagnosis of a psychotic disorder (6,976 [59.6%] men and 4,737 [40.4%] women; 2,368 [20.2%] aged 16-17 and 9,345 [79.8%] aged 18-30 years) to 35,576 outpatient service users and 23,415 members with a first diagnosis of unipolar depression.
• They observed that all-cause mortality was 54.6 (95% CI, 41.3-68.0) per 10,000 in the psychotic disorder group compared with 20.5 (95% CI, 14.7-26.3) per 10,000 in the unipolar depression group and 6.7 (95% CI, 4.0-9.4) per 10,000 in the general outpatient group during the year after the first diagnosis.
• The psychotic disorder group compared with the general outpatient group showed the relative hazard of death of 34.93 (95% CI, 8.19-149.10) for self-inflicted injury or poisoning and 4.67 (95% CI, 2.01-10.86) for other type of injury or poisoning after adjustment for race, ethnicity, and preexisting chronic medical conditions.
• The psychotic disorder and the general outpatient groups did not differ significantly regarding risk of death due to heart disease or diabetes (hazard ratio, 0.78; 95% CI, 0.15-3.96).
• In the psychotic disorder group, between the first and third years after diagnosis, all-cause mortality decreased from 54.6 to 27.1 per 10,000 persons and injury and poisoning mortality decreased from 30.6 to 15.1 per 10,000 persons.
• However, both rates remained 3 times as high as in the general outpatient group (9.0 per 10,000 for all causes; 4.8 per 10,000 for injury or poisoning).