Various studies over the years have noted a link between mortality and mental illness, however, the contribution of violence exposure to mortality in people with mental illness remains under-researched. This latest study, The association between violence exposure and general and cause-specific mortality in people using mental health services: cohort study, closes the gap with the finding that people with mental illness, who are exposed to assault, experience greater mortality than those who are not exposed.

The research team led by Dr Nabihah Rafi (Kings College London) included VISION researchers Professor Robert Stewart and Dr Vishal Bhavsar. They examined the association of violence exposure, such as being physically assaulted, with general and cause-specific mortality in a population using mental health services.

Assembling a cohort study using electronic health records from a mental health and substance use treatment provider in south-east London, records were linked to acute medical admission and emergency department presentation data, as well as to a national mortality register with death certificates for deaths registered in England and Wales.

Results indicated that exposure to violence among users of mental health services is associated with increased mortality compared with non-exposed individuals. They may have worse physical health for a range of reasons, such as the metabolic effects of psychiatric treatment, which in turn might influence cause-specific mortality risk (e.g. diabetes-related mortality). Violence exposure, including repeated exposure, might influence mortality risk through a reduced capability to manage existing physical illness, increasing the risk of progression of pre-existing morbidity.

Further findings about the association between those using mental health services and being exposed to violence also suggest:

1. Psychological stress that could, over time, cause stress to body systems
2. An increase in unhealthy behaviours, including alcohol use and smoking, which are important drivers of mortality in people with mental illness
3. An indication with relationship stress, which some evidence suggests may affect mortality risk
4. An Influence of mortality risk through a reduced capability to manage existing physical illness, increasing the risk of disease progression.

Recommendations

1. The association between violence exposure and mortality from natural causes in people with mental illness warrants further research attention to understand the contributory pathways, including through shared causes of both violence exposure and mortality.
2. Strategies to improve the identification and assessment of violence exposure in people with mental illness could improve the quality of care by reducing health inequalities, as well as by uncovering wider healthcare needs in patients exposed to violence.