Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas
Nancy H. Liu, 1 , 2 Gail L. Daumit, 3 Tarun Dua, 1 Ralph Aquila, 4 Fiona Charlson, 5 Pim Cuijpers, 6 Benjamin Druss, 7 Kenn Dudek, 4 Melvyn Freeman, 8 Chiyo Fujii, 9 Wolfgang Gaebel, 10 Ulrich Hegerl, 11 Itzhak Levav, 12 Thomas Munk Laursen, 13 Hong Ma, 14 Mario Maj, 15 Maria Elena Medina‐Mora, 16 Merete Nordentoft, 17 Dorairaj Prabhakaran, 18 Karen Pratt, 4 Martin Prince, 19 Thara Rangaswamy, 20 David Shiers, 21 Ezra Susser, 22 Graham Thornicroft, 19 Kristian Wahlbeck, 23 Abe Fekadu Wassie, 24 Harvey Whiteford, 5 and Shekhar Saxena 1
Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio‐environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual‐focused, health system‐focused, and community level and policy‐focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.
Keywords: Excess mortality, physical health, severe mental disorders, schizophrenia, bipolar disorder, depression, risk factors, individual‐focused interventions, health system‐focused interventions, community level and policy‐focused interventions