Time-trends in life expectancy of people with severe mental illness in Scotland, 2000-2019: a population-based study

Objective To determine time-trends in life expectancy (LE) of people with a severe mental illness (SMI) compared with the general population. Design Observational population-based study. Setting Scotland, 2000-2019. Linked psychiatric hospital admission and death records. Participants Adults with a psychiatric hospital admission record for schizophrenia (28,797), bipolar disorder (16,657) or major depression (72,504) compared with the Scottish population (4.3 million adults in 2011). Main outcome measures Trends over time in life years lost for people with schizophrenia, bipolar disorder or major depression compared with the Scottish population, for all deaths, and natural and unnatural deaths, stratified by sex. Results Among people with SMI, one third died during the study period. Between 2000 and 2019, LE increased in the general Scottish population and the LE gap widened for people with schizophrenia. For 2000-2002, men and women with schizophrenia lost an excess 9.4 (95% CI 8.5 to 10.3) and 8.2 (7.4 to 9.0) life years, respectively, compared to the general population. In 2017-2019, this excess life years lost increased to 11.8 (10.9 to 12.7) and 11.1 (10.0 to 12.1) for men and women, respectively. There was no evidence of a change over time in the LE gap of 5 to 8 years for people with bipolar disorder or major depression. Changes in LE for natural and unnatural causes of death varied by individual SMI and sex. Conclusions The LE gap in people with an SMI persisted or widened in Scotland from 2000-2019. These entrenched disparities reflect intersecting inequalities requiring coordinated solutions at multiple levels to improve LE in this and other marginalised and socially excluded groups.