SMI Research Digest: The Mortality Gap
SMI Digest is a monthly publication from Treatment Advocacy Center (TAC) that summarizes recently published research on topics related to severe mental illness (SMI). This month’s Digest focuses on the mortality gap between people with schizophrenia and the general population.
People with schizophrenia are estimated to have a life expectancy 15-20 years shorter than the general population. Despite the development of novel treatments and approaches for physical and mental health conditions, evidence suggests that the mortality gap for people with schizophrenia has gotten worse over the past two decades. Other severe mental illnesses like depression and bipolar disorder have not seen this same worsening over time, making this a critical area for research and practice.
What drives the mortality gap for schizophrenia spectrum disorders? While people with schizophrenia are more likely to die from non-natural causes like injury and suicide, the largest driver of the mortality gap is thought to be untreated or undertreated physical health conditions like cardiovascular disease, respiratory disease, and cancer. The elevated likelihood of dying from treatable physical health conditions is especially alarming. Compared to the general population, people with schizophrenia have been estimated to be at a 600% risk of dying from pneumonia and a 200-300% risk of dying from infections, respiratory conditions, or diabetes, among others. While people with SMI often have more contact with the healthcare system than the general population, research suggests they are less likely to receive physical check-ups and health screenings. In order to reduce the mortality gap, people with SMI should be offered the same physical health treatment, basic health screenings, and access to lifestyle interventions (e.g., smoking cessation programs) as the general population.
Early detection and treatment are important for reducing the mortality gap. There were several pieces of important research underlining the efficacy of early psychosis programs at reducing mortality published in the past year. A 2025 meta-analysis of research on the relationship between early intervention services and suicidal behavior found that early intervention for psychotic disorders was associated with a statistically significant decrease in both suicide attempts and death by suicide. This meta-analysis found that most successful early intervention programs included case management along with medication and psychotherapy. Another 2025 study published in “The British Journal of Psychiatry” explored data from over 14,000 people to determine best practices for early intervention services and found that people who received interventions for their physical health in early psychosis programs had lower mortality rates than those who did not. Despite their effectiveness, early intervention programs are underutilized in the United States, especially in rural areas. Funding has been cited as the most common barrier to implementing early intervention services for psychosis.
Ongoing support to prevent relapse may also be needed to prevent early mortality. While early services are critically important, ongoing support to prevent relapse may be especially important for reducing risk of mortality, according to a 2025 study published in “International Journal of Neuropsychopharmacology”. This study explored the relationship between relapse and mortality among 32,071 people living with stable schizophrenia (i.e., no relapse in the past 12 months). The study found that even a single episode of relapse was associated with an increased risk of mortality. Like any chronic condition, schizophrenia spectrum disorders may require continuous treatment to manage symptoms and prevent relapse. Care providers and those impacted by schizophrenia may also want to note the important role of antipsychotic medication in reducing risk of relapse and mortality.
