Mortality of People with Severe Mental Illness: Causes and Ways of its Reduction

Compared to the general population, people with severe mental illness (SMI) have a poorer health status and a higher mortality rate, with a 10-20 year reduction in life expectancy. Only a minority of premature deaths are attributable to unnatural causes, such as suicide, homicides or accidents, while the vast majority of premature deaths are due to physical health problems, such as cardiovascular, respiratory or infectious diseases, diabetes mellitus and cancer. It is likely that during the COVID-19 pandemic the mortality rates in patients with SMIs will be even higher, due to physical complications of COVID-19 infection. People with SMI have a significantly increased risk of being infected by COVID-19, and being hospitalized in intensive care units due to COVID-19 complications. This increased risk is likely due to several factors, such as 1) the presence of cognitive dysfunctions in people with SMIs, which turns into difficulties complying with preventive behaviors; 2) the presence of stigma, which represents an obstacle to health care access for SMI patients; 3) the higher prevalence of comorbid medical conditions that are associated with increased risk for COVID-19 severe illness, such as cardiovascular diseases, cancer and chronic obstructive pulmonary disease; 4) socioeconomic disadvantages, which result in unsafe working and living environments.

Excess mortality and morbidity in SMI has been explained by intertwined components, which include individual patients’ factors (e.g., severity of symptoms, impulsivity, emotional dysregulation, deficits in cognitive and social skills), lifestyle behaviors (e.g., smoking, poor diet, sedentary behavior, alcohol and drug abuse), social disadvantages (i.e., stigma, discriminating policies, unemployment, homelessness, limited family, social and community resources) and healthcare disparities (e.g., poor quality of service provision, limited access to health information, reduced prescriptions for physical check-ups, professionals’ negative attitudes towards people with an SMI). The management of physical illnesses in people with SMI is becoming a public health priority, and it will likely be even more important in the years to come, due to several factors, including 1) increased life expectancy; 2) the fragmentation of medicine into smaller specialties; 3) the difficulties of health professionals managing patients with mental health problems and comorbid physical conditions. Interventions aimed at reducing risk factors and improving the physical health of people with severe mental disorders may be taken at different levels, including 1) policy-making levels, through the development of national policies for the promotion of healthy lifestyle behaviors and the development of comprehensive health-care packages; 2) public health action e.g., through the improvement of screening programs for physical conditions and the promotion of care coordination strategies; 3) the individual clinical level, through the promotion of early management and treatment of physical conditions in patients with SMIs, and the development and the implementation of cognitive-behavioral interventions addressing unhealthy lifestyle behaviors.

The overall aim of the present Research Topic is to improve the understanding of the complex relationship between mortality and being mentally ill. Papers on the prevalence of comorbid medical conditions, on mortality rates, risk factors and treatment strategies for patients with SMIs, and co-occurring physical diseases are welcome. Moreover, we highly welcome manuscripts on the effects of the COVID-19 pandemic on the well-being, physical health and mortality of patients with SMIs.

All forms of submissions are allowed: Original Research articles, Review, Method articles, Clinical Trials, Case Reports, Mini-Reviews, Perspectives, and Hypotheses & Theories.