What is responsible for the shortened lifespan of the mentally ill? Many assume that suicide accounts for the deaths, but a researcher at Washington University School of Medicine disagrees.

   John Newcomer, professor of psychiatry, recently published an article in the Journal of the American Medical Association showing that patients with severe mental illness are at a much higher risk of suffering from cardiovascular disease.

   His observations were drawn from various sources including mortality data provided by states, including Missouri.

   The study contradicts a number of common perceptions about mental illness. According to Newcomer, many psychiatrists and psychologists have assumed that suicide could be blamed for the premature deaths.

   Cardiovascular disease is the leading cause of death for the general population, but Newcomer says that it happens much sooner in those with a mental illness.

   On average, people who suffer from mental disorders such as schizophrenia live 25 to 30 years shorter than the rest of the population.

   "When you look at those key risk factors [like obesity and smoking] in populations with major mental illness, you find an elevated prevalence of all these risk factors," said Newcomer.

   He said that when this kind of trend appears, it raises questions about what kind of care this group of patients receives.

   "Why is it that the person with schizophrenia who presents to the emergency room with a [heart attack] has such a low probability of going to the surgical suite?" said Newcomer. "Why is that over a year after the [heart attack] they have such a low probability of getting the drugs of proven benefit? There are well documented failures in both primary and secondary prevention among the mentally ill."

   Newcomer believes that different branches of medicine need to work together in order to fix the shortcomings.

   "This really involves partnerships with general medicine, primary care providers and cardiovascular specialty providers," he said.

   Newcomer says that lowering risk factors is a very effective way to prevent cardiovascular disease.

   His article states that 50 to 80 percent of these individuals smoke, consuming 34 to 44 percent of all cigarettes in the country. He believes that efforts such as smoking prevention would have a positive effect.

   According to Newcomer, some of the drugs used to treat mental illness may promote weight gain, which could be contributing to the increased risk.

   Newcomer believes that doctors need to consider this risk when deciding what to prescribe.

   "We're not seeing great evidence that [doctors] are altering their prescribing decisions as a function of the patient's risk status," he said.

   Dr. Robert Carney, professor of psychiatry, has also studied the relationship between mental illness and cardiovascular disease and focuses on depression. He says that the problem is that patients are not identified as having depression.

   "Often times it's not even known that someone has depression," said Carney. "It's not always asked appropriately, so we need to identify patients as early as possible. Once that happens there are treatments that might be helpful."

   Carney said that more research needs to be done to find out if treating depression will improve the outcome of patients with cardiovascular disease. He is hopeful, though, that there will be some benefit, either by reducing the chance of cardiovascular disease or by simply improving the quality of life in general for these patients.

   "[Depression] is relatively new in terms of its recognition," noted Carney. "It wasn't until the mid 1990s that people doing work in this area began to recognize that it was a risk factor. It's been within the last three or four years that major groups like the American Heart Association have come to recognize that risk factor."

   Newcomer says more work needs to be done to improve health care.

   "Our commentary is hardly new, but it's part of a broader story of disparities in health care," Newcomer said. "It's going to take a very concerted effort targeting a number of different problems to try to make these numbers better."

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