Mortality gap narrows for severe mental health, flattens for schizophrenia

The retrospective population-based cohort study, the first of its kind for more than a decade, tracked data from every adult admission to Queensland hospitals between 2009–2023 (255,448 individuals).

Researchers looked at severe mental health conditions including schizophrenia, affective psychoses disorder (and other psychoses), alcohol or substance use disorders, neurotic disorders, stress and adjustment reactions, and depressive disorders.

The life expectancy gap for people experiencing these conditions generally, narrowed from 13.4 to 9.4 years in females, and 16.7 to 12.1 years in males.

The gap did not narrow significantly, in either sex, however, among people with schizophrenia or other psychoses. 

The gap also did not significantly narrow in females with affective psychoses, or in females with neurotic or alcohol and substance use disorders.

Lead author Dr Mike Trott works with the Metro South Addiction Mental Health Services in Brisbane and at the University of Queensland (UQ) as head of Epidemiology and a Research Fellow in Psychiatric Epidemiology and Evidence Synthesis.

“There have been some improvements,” said Dr Trott.

“But that gap is still there. And it's still massive. That is still a long time to be dying earlier than the general population. Historically that's been called a scandal of premature mortality. And it's still the case.”

A large and necessary study

Dr Trott said that the level of access to data he and his team had was rare. 

“We managed to access every single person in Queensland, who had a hospital admission for what we call an F-chapter diagnosis.”

Dr Trott says that the first takeaway from the study are the positive changes.

“If you look at the graphs, things are going in the right direction.”

“But the real key is that people with psychotic disorders, the people who are arguably the most sick, don't share in the gains.”

“And one of the likely reasons is that there have been no moves forward in treatment in things like schizophrenia for the last 15-20 years.”

“Everything is chipping away. But there [hasn’t] been a kind of therapeutic breakthrough.”

Dr Trott said that this kind of study, or this size, hasn't been done in Australia for a long time. 

The study references another, foundational study done in Western Australia by Lawrence et. al., in 2013, suggesting that the gap was widening, as well as a Scandinavian study of data from 1987 to 2006 that found a two- to threefold higher mortality rate in ‘people admitted to hospital for a mental disorder,’ and which suggested the gap was narrowing.

Physical health issues and mortality

The researchers, similarly to the 2013 WA study, found that most deaths were attributed to physical health conditions.

The 2026 study also found that, although dying by intentional self-harm was the largest single cause of death, the combined mortality rate from physical health issues was substantially greater.

“If you look at the graph, the absolute numbers show that [dying by] self-harm is the leading cause of death.”

“But when you look at premature physical illness, or death caused by physical illness — so including cardiovascular disease, and some cancers as well — [the mortality rate] is so much higher in physical health.”

According to the 2026 study, physical health conditions, combined, accounted for most deaths, with all cancers representing the highest cause-specific mortality rate in both sexes.

The study found that the combined excess mortality rate from physical health causes was approximately 2.7 times the mortality by self-harm rate for males and 5.3 times for females.

“From a premature death perspective, these [physical illnesses] are preventable. You can monitor them,” said Dr Trott.

“So, the key thing is that people with severe mental health should not have their physical health neglected. It needs to be monitored. Because clearly, those are the things that, later in life, are [causing mortality].”

Dr Trott said that solutions could lie in physical health monitoring being linked to performance for health care professionals. 

“I think I'm being a pessimist saying this, but to move the needle in things like physical health screening, then you need to make it someone's KPI.”

“That's what tends to drive change on a system level. Both primary and secondary care. It's challenging in hospitals and emergency rooms because of just how busy they are. But it is important there too.”

“I was talking to a psychiatrist who's in emergency, and he says the amount of times someone comes in with any level of psychosis or a mental health issue, they just want to move them along as fast as they can to a psych ward. It’s not that they don't know how to deal with it; they’re medical professionals. But it's almost as if it's an inconvenience because it's complex.”

“Which is sad. So, if someone comes in then with a psychotic episode but they've also got COPD, they're not looking at the COPD, they're looking at a psychotic episode. When the reality is both should be looked at equally.”

Looking ahead

Dr Trott said that he and his team will look in more detail at the Queensland data.

“We want to do some things that we didn't look at: for example, does the graph look different if it's only metro? Or by socioeconomic status? Does it look different by the amount of comorbidity?”

Dr Trott has plans to analyse the national data in a similar way.

“That takes years to get. But we will get it. And we will basically repeat this and see whether it's different state by state or whether this holds on a national level.”