Association of health screening participation with cardiovascular mortality and suicide in patients with schizophrenia and bipolar disorder.

backgroundPatients with schizophrenia (SCZ) and bipolar disorder (BD) face higher risks of premature mortality from both natural (e.g., cardiovascular disease) and unnatural causes (e.g., suicide). Notwithstanding these findings, the impact of general health screening participation on mortality outcomes in this population remains underexplored.

methodsUsing the Korean National Health Insurance Database, this retrospective cohort study included 120,308 patients with SCZ and 147,221 patients with BD patients aged ≥ 20 years, newly diagnosed between 2007 and 2018. The primary exposure was participation in the national health screening program. Time-dependent Cox proportional hazards models, adjusted for demographic and clinical covariates, were used to assess associations between screening participation and all-cause, cardiovascular (CVD), and suicide mortality.

resultsStandardized mortality ratios were 4.67 for SCZ and 2.93 for BD compared to the general population. Screening rates were lower than the general population and varied by age, sex, income, and psychiatric comorbidity. Screening participation was associated with lower mortality hazards across all outcomes. Adjusted hazard ratios for all-cause, CVD, and suicide mortality were 0.63, 0.56, and 0.82 for SCZ, and 0.56, 0.43, and 0.75 for BD. Lower hazards of CVD mortality were most pronounced in those aged ≥ 40 years, while lower hazards of suicide were most notable in those < 40. DISCUSSION: Participation in national health screenings is associated with significantly lower mortality hazards among individuals with SCZ and BD. Integrating physical health assessments into psychiatric care and improving screening participation may help reduce mortality and health disparities in this population.