• Frank Schneider, Michael Erhart, Walter Hewer, Leonie Ak Loeffler, and Frank Jacobi.
• University Hospital Düsseldorf; Central Institute for Ambulatory Care in Germany, Berlin, Germany; Alice Salomon University Berlin, Germany; Department of Geriatric Psychiatry, Christophsbad Hospital, Göppingen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany; Psychologische Hochschule Berlin, Berlin, Germany.
• Dtsch Arztebl Int. 2019 Jun 10; 116 (23-24): 405411405-411.

BackgroundMentally ill patients die on average 10 years earlier than the general population, largely due to general medical disorders. This study is the first to explore in a large German sample the prevalence, mortality, and medical comorbidity in pa- tients with severe mental illness (SMI). The patients were affected by borderline personality disorder (BPD), psychotic disorders, bipolar disorder, or severe unipolar depression.MethodsOur database consists of billing data from all adults with statutory health insurance in Germany. Twelve-month administrative SMI prevalence and medical comorbidity were estimated using cross-sectional data from 2016 (age ≥ 18; N = 59 561 310). Two-year mortality was established longitudinally in a randomly selected subset of the billing data (most recent mortality information available for 2012 to 2014; 2012: n = 15 590 107).ResultsSevere unipolar depression had the highest prevalence (2.01%), followed by psychotic disorders (1.25%), BPD (0.34%), and bipolar disorder (0.29%). While the prevalence of malignant neoplasms showed moderate deviations from reference values [severe unipolar depression: OR = 1.30 (95% CI = 1.29; 1.31), BPD: OR = 1.11 (1.09; 1.14), psychotic dis- orders: OR = 0.90 (0.89; 0.90), bipolar disorder: OR = 1.07 (1.06; 1.09)], other disease groups (infectious, endocrine/nutritional/ metabolic, circulatory, respiratory) were substantially elevated in all categories of SMI. Mortality rates for psychotic disorders, BPD, bipolar disorder, and severe unipolar depression were increased (OR = 2.38 [95% CI=2.32; 2.44], 2.30 [2.08; 2.54], 1.52 [1.42; 1.62], and 1.40 [1.37; 1.44], respectively), with a loss of 2.6 to 12.3 years, depending on age, sex, and SMI.ConclusionMortality is substantially elevated in all SMI patients. The results underline the need to remove barriers to adequate general medical care, both on the patient and the provider side, to reduce excess mortality.

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