{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:50:01Z","timestamp":1789019401366,"version":"build-2803163510"},"reference-count":33,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"unspecified","delay-in-days":348,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014013","name":"UK Research and Innovation","doi-asserted-by":"publisher","award":["MR\/Y030788\/1"],"award-info":[{"award-number":["MR\/Y030788\/1"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0033291725102110_sec1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People with severe mental illness (SMI) (schizophrenia-spectrum and bipolar disorders) experience a 15\u201320-year reduction in life expectancy. The role of social determinants, including that of social exclusion, in contributing to excess mortality in SMI remains underexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291725102110_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cohort study, comprising 8098 people with clinician-diagnosed SMI, matched to 581,209 population controls, followed for 5.7\u00a0years 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291725102110_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Social exclusion was more common in SMI than in controls and strongly associated with higher mortality. Relative to the least socially excluded controls, adjusted hazard ratios (aHR) for mortality in SMI were: 16\u201344\u00a0years: aHR 7.58 (95% CI: 2.75\u201320.86) in the least socially excluded, increasing to 12.34 (7.92\u201319.24) in the most excluded; 45\u201364\u00a0years: 3.34 (1.98\u20135.64) [least excluded] increasing to 6.58 (5.32\u20138.14) [most excluded]; 65+ years: 2.71 (1.90\u20133.86) [least excluded], increasing to 3.07 (2.48\u20133.80)[most excluded]. Excess mortality among those with SMI was pronounced at younger ages if never married; by mid-life if living alone or economically inactive; and at 65+ years in those with SMI living alone, renting, or with no car ownership. Economic inactivity and lack of qualifications accounted for 16\u201335% of SMI mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291725102110_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Social exclusion is an under-recognized contributor to premature mortality in SMI. Targeting social determinants through novel socially-focused interventions could improve survival in people with SMI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s0033291725102110","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T03:41:28Z","timestamp":1765770088000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Social exclusion as a determinant of excess mortality in people with schizophrenia-spectrum and bipolar disorders: retrospective cohort study in 0.5 million people"],"prefix":"10.1017","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3913-6859","authenticated-orcid":false,"given":"Jayati","family":"Das-Munshi","sequence":"first","affiliation":[{"name":"Institute of Psychiatry"},{"name":"Population Health Improvement UK (PHIUK)"},{"name":"South London & Maudsley NHS Foundation Trust"},{"name":"ESRC Centre for Society and Mental Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukasz","family":"Cybulski","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry"},{"name":"Karolinska Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Byrne","sequence":"additional","affiliation":[{"name":"East London NHS Foundation Trust"},{"name":"Royal College of Psychiatrists"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Dewey","sequence":"additional","affiliation":[{"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosanna","family":"Hildersley","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8755-5935","authenticated-orcid":false,"given":"Sarah","family":"Markham","sequence":"additional","affiliation":[{"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1386-2369","authenticated-orcid":false,"given":"Craig","family":"Morgan","sequence":"additional","affiliation":[{"name":"ESRC Centre for Society and Mental Health"},{"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Stewart","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry"},{"name":"South London & Maudsley NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Wuerth","sequence":"additional","affiliation":[{"name":"Centre for Anthropology and Mental Health Research in Action (CAMHRA), SOAS University of London"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"S0033291725102110_r7","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100228"},{"key":"S0033291725102110_r14","doi-asserted-by":"publisher","DOI":"10.1177\/1745691614568352"},{"key":"S0033291725102110_r8","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-023-02489-x"},{"key":"S0033291725102110_r29","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cky143"},{"key":"S0033291725102110_r1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31869-X"},{"key":"S0033291725102110_r11","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbx082"},{"key":"S0033291725102110_r3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00933-4"},{"key":"S0033291725102110_r30","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"S0033291725102110_r19","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(23)00058-5"},{"key":"S0033291725102110_r16","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2024.68"},{"key":"S0033291725102110_r18","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.106.034942"},{"key":"S0033291725102110_r25","first-page":"287","article-title":"Biological mechanisms whereby social exclusion may contribute to the Etiology of psychosis: A narrative review","volume":"43","author":"Selten","year":"2017","journal-title":"Schizophrenia Bulletin"},{"key":"S0033291725102110_r5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0298085"},{"key":"S0033291725102110_r2","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-022-01228-9"},{"key":"S0033291725102110_r20","unstructured":"Office for National Statistics. (2024). Mortality statistics in England and Wales QMI: Quality and methodology information for mortality statistics in England and Wales, detailing the strengths and limitations of the data, methods used, and data uses and users. https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/methodologies\/mortalitystatisticsinenglandandwalesqmi. 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Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e375"}}