Severe mental illness (SMI), including psychotic disorders and bipolar disorder, affects 2-3% of the population and constitutes one of the main causes of disability worldwide. Critically, evidence has shown that people with SMI may exhibit increased premature mortality and physical comorbidity relative to the general population. Such physical-health disparities pose a serious public-health challenge and rectification of such lifespan inequalities is now considered an international health priority. Existing data are mainly derived from western countries, and may unlikely be generalizable to other regions due to substantial cross-regional variation in healthcare systems, sociocultural context and population-health indices. In this regard, we have recently conducted a series of studies, comprising population-based health-record data research and meta-analyses, with an aim to examine the association of SMI with risk of excess mortality, reduced life-expectancy, and physical comorbidity in Hong Kong. Briefly, our findings showed that psychotic disorders and bipolar disorder are associated with approximately 2.5-fold increased all-cause (premature) mortality rate and substantially reduced lifespan (ranged between 7-10 excess life-years lost) compared with the general population, with the excess deaths being mainly attributed to natural (physical) causes, particularly cardiovascular diseases, respiratory diseases and cancers. Such differential mortality gap remains similar over time without improvement. People with acute coronary syndrome (ACS) and schizophrenia had higher 30-day and 1-year mortality rate, lower likelihood to receive revascularization procedures and post-discharge cardioprotective medications than those with ACS only. Schizophrenia patients with acute stroke and co-occurring diabetes were also found to display increased risk of excess mortality relative to those with the respective physical condition but no schizophrenia. Our meta-analyses confirmed our aforementioned findings in Hong Kong, and specifically demonstrated that markedly reduced life expectancy is transdiagnostic in nature across a wide spectrum of mental disorders. These findings provide comprehensive overview of physical health inequalities associated with SMI and would facilitate policy formulation, resource allocation, and healthcare service and treatment optimization to reduce preventable deaths and lifelong burden of poor physical-health among people with mental disorders.
