Suboptimal treatment of physical illness in persons with severe mental illness: identification and quantification of contributing factors to excess mortality


Severe mental illnesses (SMI) are considered some of the most disabling disorders worldwide. People with SMI, such as schizophrenia and bipolar disorder, also have 20 years of reduced life expectancy compared to the general population.

Explanations for the reduced life expectancy are multiple, but suboptimal treatment of physical illnesses like cancer and cardiovascular disease seems to play a major role. Evidence indicates that persons with schizophrenia have not benefitted from the improvements in cardiovascular and cancer treatment seen in the general population during the past decades, which may imply that the mortality gap may even increase over the next years.

Suboptimal treatment of physical illness includes patient delay, diagnostic delay, under-detection, under-treatment, lower participation in screening programmes, lower compliance when patients are transferred from one section in the health care system into another and lower quality of medical care that requires routine follow-up, for example relating to cardiovascular disease or diabetes.

Hence, the reduced life expectancy and suboptimal treatment of physical illnesses in persons with SMI is not only a major public health issue, but also places major burdens on the individual patient.


The objective of this PhD project is thus:

  • To identify and quantify contributing factors which are related to suboptimal treatment of cancer, diabetes and cardiovascular disease and thereby also to excess mortality in these persons with SMI.


Epidemiological register-based cohort studies will be performed by using data from nationwide population-based Danish registers, and health-related data will be combined with socio-economic data.

The new research-based evidence provided from this PhD project will expand the existing knowledge on suboptimal treatment of physical illness as a contributing factor to the excess mortality in persons with SMI.

This evidence may also contribute to better treatment of physical disorders, such as cancer, diabetes and cardiovascular disease, among persons with SMI and thereby help reduce the excess mortality in this group.