BACKGROUND: It remains unknown whether severe mental disorders contribute to fatally harmful effects of physical illness. AIMS: To investigate the risk of all-cause death and loss of life-years following the onset of a wide range of physical health conditions in people with severe mental disorders compared with matched counterparts who had only these physical health conditions, and to assess whether these associations can be fully explained by this patient group having more clinically recorded physical illness. METHOD: Using Czech national in-patient register data, we identified individuals with 28 physical health conditions recorded between 1999 and 2017, separately for each condition. In these people, we identified individuals who had severe mental disorders recorded before the physical health condition and exactly matched them with up to five counterparts who had no recorded prior severe mental disorders. We estimated the risk of all-cause death and lost life-years following each of the physical health conditions in people with pre-existing severe mental disorders compared with matched counterparts without severe mental disorders. RESULTS: People with severe mental disorders had an elevated risk of all-cause death following the onset of 7 out of 9 broadly defined and 14 out of 19 specific physical health conditions. People with severe mental disorders lost additional life-years following the onset of 8 out 9 broadly defined and 13 out of 19 specific physical health conditions. The vast majority of results remained robust after considering the potentially confounding role of somatic multimorbidity and other clinical and sociodemographic factors. CONCLUSIONS: A wide range of physical illnesses are more likely to result in all-cause death in people with pre-existing severe mental disorders. This premature mortality cannot be fully explained by having more clinically recorded physical illness, suggesting that physical disorders are more likely to be fatally harmful in this patient group.

Department of Clinical Epidemiology Aarhus University Aarhus Denmark; Aarhus University Hospital Aarhus Denmark; and National Centre for Register based Research Aarhus University Aarhus Denmark

Department of Mental Health and Substance Use World Health Organization Geneva Switzerland

Department of Psychiatry University Hospital Hradec Králové Hradec Králové Czech Republic; and Faculty of Medicine Charles University Hradec Králové Czech Republic

Department of Psychiatry University of Cambridge Cambridge UK; and Cambridgeshire and Peterborough NHS Foundation Trust Cambridge UK

Department of Psychiatry University of Cambridge Cambridge UK; and Department of Public Mental Health National Institute of Mental Health Klecany Czech Republic

Department of Psychiatry University of Cambridge Cambridge UK; Cambridgeshire and Peterborough NHS Foundation Trust Cambridge UK; Institute of Clinical Sciences Imperial College London UK; MRC London Institute of Medical Sciences London UK; and South London and Maudsley NHS Foundation Trust London UK

Department of Public Mental Health National Institute of Mental Health Klecany Czech Republic; and Department of Psychiatry Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

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