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People living with serious mental illness (SMI), including schizophrenia, bipolar disorder, and recurrent major depression, die, on average, 10 to 25 years earlier than individuals without these conditions. As life expectancy improves across the general population, this mortality gap has widened, highlighting a critical challenge for mental healthcare: Early mortality in SMI is not inevitable, yet it remains insufficiently addressed.

At Sheppard Pratt, clinician-led research is reshaping how the field understands and intervenes in this disparity. Research led by Faith Dickerson, PhD, MPH, Sheppard Pratt senior psychologist and adjunct professor of psychiatry at the University of Maryland and The Johns Hopkins School of Medicine, reframes early mortality in SMI as a modifiable public health issue, rather than a fixed consequence of psychiatric illness.

Although suicide and accidental death occur at higher rates among people with SMI, most premature deaths are due to natural causes, including cardiovascular and respiratory disease. Through a 25-year research program that has followed more than 2,500 individuals, Dickerson and her team have identified key risk factors for early mortality in people with schizophrenia. Among these, tobacco use has emerged as the strongest predictor of death from natural causes when adjusting for age and other demographic factors. Smoking rates among individuals with schizophrenia and related conditions far exceed those in the general population, amplifying established health risks. Additional contributors include higher body mass index (BMI), chronic medical conditions such as chronic obstructive pulmonary disease (COPD) and cardiac arrhythmias, autoimmune disorders, lower cognitive functioning, and social factors, including divorced or separated marital status.

Unlike large registry-based studies, Sheppard Pratt’s research integrates detailed clinical assessments with biological data, including blood markers and microbiome samples, providing a more precise understanding of how physical and mental health interact over time. Findings published in JAMA Network Open reflect years of clinician-researcher collaboration and longitudinal patient data.

The implications are clear: Psychiatric care must fully integrate physical health interventions. Dickerson’s research highlights actionable strategies for psychiatrists and care teams, including treating nicotine dependence as a core clinical priority, strengthening integration between psychiatric and primary care, addressing metabolic and cardiovascular risk proactively, and reducing stigma within medical settings.

The goal is not simply to document risk, but to redesign care models so longevity becomes an expected outcome. By treating physical health as inseparable from mental health, clinicians can help ensure that people living with serious mental illness have the opportunity not only to recover, but to live longer, healthier lives.