Using a systems thinking approach to explore the complex relationships between schizophrenia and premature mortality

Area of Science:

• Systems science
• Public health
• Psychiatry

Background:

• People with schizophrenia face a higher mortality risk than the general population, with no improvement over time.
• Premature deaths are primarily linked to comorbid physical diseases, influenced by individual, health system, and social determinant factors.
• A comprehensive understanding of the causal pathways contributing to this mortality gap is currently lacking.

Purpose of the Study:

• To investigate the reasons behind the persistent mortality gap in individuals with schizophrenia.
• To develop a causal loop diagram (CLD) using a systems thinking approach to visualize causal relationships and feedback loops.

Main Methods:

• Constructed a CLD by synthesizing published quantitative and qualitative literature.
• Refined the CLD through expert consultation.
• Identified key variables, relationships, and feedback loops contributing to the mortality gap.

Main Results:

• The CLD includes 21 variables, 68 connections, and 23 distinct feedback loops.
• Stigma and social support showed the most connections; unemployment was involved in the most feedback loops.
• Feedback mechanisms predominantly reinforced behavioral risk factors, inadequate healthcare, and social disadvantage.

Conclusions:

• The CLD provides a holistic understanding of the persistent mortality gap in schizophrenia.
• Social determinants play a critical role in health outcomes for people with schizophrenia.
• Emphasizes the need for person-centered care models and multisectoral government interventions.