Reduced mortality, the ultimate indicator of treatment efficacy. Review and perspectives

Since psychiatric patients are at risk for increased mortality, one of the strongest indicators of treatment efficacy is a normalized mortality. The question arises as to whether it is possible to change the mortality by different treatment strategies. Surprisingly, intervention studies using death or survival as an endpoint are relatively rare in psychiatry, although in other medical disciplines this approach is very common. A review of the few existing investigations of the influence of somatic therapy on mortality--these mainly relate to affective disorders--suggests that in principle adequate somatic treatment can reduce the high mortality risk in these disorders. A reduced mortality can be observed, particularly during long-term lithium treatment. The question to what extent a somatic therapy can protect psychiatric patients against premature death cannot be answered in a one-dimensional way. There are various factors that can strengthen or weaken the possible benefits of drug therapy. Such influencing factors are the patient, the physician, and the treatment setting. Mortality studies are important to identify the individual factors that influence treatment efficacy. With reference to the role of the moderating variables, the aims of future research in the area of treatment efficacy in psychiatry will be addressed.