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Abstract
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AIMS: We aimed to analyze whether people with substance-induced psychosis (SIP), both those who convert and do not convert to schizophrenia, have higher all-cause and cause-specific mortality when compared to the general population.
DESIGN: Prospective cohort study. SETTING: Nationwide Danish registers. PARTICIPANTS/CASES: We included all people born in Denmark, living in Denmark on their 15(th) birthday, and aged 15 or more during the study period from January 1(st) , 1994, and August 10(th) , 2017. MEASUREMENTS: Exposure was categorized as: 1) Neither SIP nor schizophrenia; 2) SIP without preceding schizophrenia; 3) SIP converted to schizophrenia; 4) Schizophrenia without preceding SIP. Any SIP and substance-specific SIPS were examined regarding all-cause and cause-specific mortality.
FINDINGS: The study included a total of 5,619,691 individuals. Compared to people with neither schizophrenia nor SIP, people with SIP without preceding schizophrenia had an increased risk of dying (hazard ratio (HR)=6.23, 95% confidence interval (CI) 5.96-6.50), as had those with SIP converting to schizophrenia (HR=9.77, 95% CI 8.84-10.79) and those with only schizophrenia (HR=3.07, 95% CI 3.03-3.13). A similar pattern, albeit with higher HRs, was observed for suicides and accidental deaths. Other cause-specific-mortality groups also generally showed the same pattern, as did types of individual substances.
CONCLUSIONS: SIP was strongly associated with an increased risk of both all-cause and cause-specific mortality, even among cases who did not convert to schizophrenia. This provides a strong rationale for monitoring people with previous diagnosis of SIP and developing and implementing interventions to reduce this excess mortality.
Language: en |