Social exclusion as a determinant of excess mortality in people with schizophrenia-spectrum and bipolar disorders: retrospective cohort study in 0.5 million people (Byrne, 2025)

Das-Munshi J; Cybulski L; Byrne P; Dewey M; Hildersley R; Markham S; Morgan C; Stewart R; Wuerth M

Psychol Med. 55:e375, 2025 Dec 15.

Available online at this link

BACKGROUND: People with severe mental illness (SMI) (schizophrenia-spectrum and bipolar disorders) experience a 15-20-year reduction in life expectancy. The role of social determinants, including that of social exclusion, in contributing to excess mortality in SMI remains underexplored.

METHODS: Retrospective cohort study, comprising 8098 people with clinician-diagnosed SMI, matched to 581,209 population controls, followed for 5.7 years using person-level linked health/ census records. A social exclusion index was derived from census indicators: marital status, social isolation, economic inactivity, education, tenure, housing stability, and material assets.