Psychotic Symptoms Increase Risk of Death in Patients With Severe Depression

Psychotic symptoms markedly increase the mortality risk associated with severe depression, according to study findings published online in the British Journal of Psychiatry

“These results underline the need to treat psychotic depression promptly with a combination of an antidepressant and an antipsychotic,” wrote corresponding author Tapio Paljärvi, PhD, of the University of Eastern Finland, and coauthors. “Early intervention may reduce the excess mortality associated with psychotic depression, particularly as a result of suicides and other external causes.”

The finding stemmed from an analysis of data for 109,941 adults in Finland diagnosed with severe depression between 2000 and 2018. Among them, 19,064 people had psychotic depression, and 90,877 had nonpsychotic depression.

Over a follow-up period that lasted up to 18 years, 2188 adults with psychotic depression died. Half of those deaths occurred within 5 years of diagnosis, according to the study. The highest relative risk for death occurred in the first year after diagnosis, although increased mortality with psychotic depression was observed during the full 18-year follow-up compared with nonpsychotic depression.

After controlling for potential confounders, including preexisting personality disorder, preexisting substance use disorder, and conversion to schizoaffective disorder, bipolar disorder, or schizophrenia, adults with psychotic depression had hazard ratios of 1.59 for all-cause mortality, 2.36 for suicide, and 1.63 for fatal accidents compared with those with nonpsychotic depression during the 5-year period after diagnosis, the study found.

“These results add to the evidence base by showing that compared with severe nonpsychotic depression, the excess risk of death in psychotic depression was not explained by these psychiatric comorbidities,” researchers wrote. “To our knowledge, this is the first study to establish this association.”

—Jolynn Tumolo


Paljärvi T, Tiihonen J, Lähteenvuo M, Tanskanen A, Fazel S, Taipale H. Mortality in psychotic depression: 18-year follow-up study. Br J Psychiatry. Published online October 17, 2022. doi: 10.1192/bjp.2022.140