Schizophrenia Life Expectancy: What Shortens It and What Helps

Pooled studies estimate that schizophrenia is associated with about 15 years of potential life lost, averaged across large groups. A 2017 meta-analysis of 11 studies involving up to 247,603 patients estimated 14.5 years of potential life lost (95% CI 11.2-17.8).¹ A 2023 meta-analysis put the figure for schizophrenia-spectrum disorders at 15.37 years (95% CI 14.18-16.55).²

These are averages across large populations and can't predict how long any one person will live. In a Swedish national cohort that included 8,277 adults with schizophrenia, men died 15 years earlier and women 12 years earlier than the rest of the population, and unnatural deaths didn't account for the difference.³

The NIMH statistics page gives a larger number, 28.5 years of potential life lost in the US, and cites a Medicaid study of adults aged 20 to 64.^{4, 5} That study measured mean years of potential life lost per death, a different quantity from a gap in life expectancy.

Cardiovascular disease had the highest death rate

The US Medicaid study followed 1,138,853 adults with schizophrenia aged 20 to 64 from 2001 through 2007 and recorded 74,003 deaths. They were 3.7 times as likely to die during follow-up as adults in the general population (standardized mortality ratio, SMR, 3.7).⁵

Source: Olfson et al., 2015.⁵

Relative to the general population, the ratios were particularly elevated for chronic obstructive pulmonary disease (SMR 9.9) and influenza and pneumonia (SMR 7.0). Accidental deaths accounted for more than twice as many deaths as suicide.⁵

Heart disease appeared to be underdiagnosed in the Swedish cohort. Among people who died of ischemic heart disease, 26.3% of those with schizophrenia had been diagnosed with it beforehand, compared with 43.7% of others.³

Lifetime risk of death by suicide is estimated at about 5%

A 2005 reexamination estimated lifetime suicide prevalence at 4.9%, with deaths usually near illness onset, and NIMH uses the same figure.^{6, 4} Among 668,836 Medicare patients with schizophrenia, the suicide rate was 4.5 times that of the general US population (SMR 4.54). The ratio fell with age, from 10.19 at ages 18 to 34 to 1.53 at 65 and older.⁷ I've written separately about clozapine and suicide risk.

Antipsychotic use is associated with lower mortality than non-use

A 2022 meta-analysis found that antipsychotic use was associated with lower all-cause mortality than no antipsychotic use (RR 0.71, 95% CI 0.59-0.84). Versus no antipsychotic use, the associations were largest for second-generation long-acting injectables (RR 0.39) and clozapine (RR 0.43).⁸ In a Finnish cohort of 62,250 patients, antipsychotic use was associated with lower all-cause mortality than non-use (adjusted hazard ratio 0.48). Cumulative mortality over a maximum of 20 years was 46.2% with no antipsychotic use, 25.7% with any antipsychotic use and 15.6% with clozapine use.⁹

For clozapine, a meta-analysis of 24 studies found that continuous clozapine treatment was associated with lower all-cause mortality than other antipsychotic use (mortality rate ratio 0.56, 95% CI 0.36-0.85). The ratio for patients ever treated with clozapine wasn't significantly lower, and deaths from suicide and ischemic heart disease showed no significant difference versus other antipsychotics.¹⁰

All of these estimates are observational, and the groups compared may differ in ways other than medication. Atypical antipsychotics have also been associated with metabolic changes, including weight gain.¹¹ Decisions about starting, continuing or changing an antipsychotic are made with the prescriber.

Metabolic monitoring is often missed

The Clozaril label recommends fasting blood glucose testing at the beginning of treatment and periodically for patients with diabetes risk factors who are starting atypical antipsychotics, along with baseline and periodic lipid evaluations.¹¹

A meta-analysis of 48 studies (n=290,534) conducted between 2000 and 2011 examined people prescribed antipsychotics. Before explicit guidelines, glucose was measured in 44.3% and lipids were monitored in less than 25%. After guideline implementation, monitoring reached 56.1% for glucose and 28.9% for lipids.¹² A 2016 report from one state Medicaid program found annual testing rates of 79.6% for glucose and 41.2% for lipids.¹³

Smoking is common, and cessation medication has been tested

In a sample from routine clinical settings between 1999 and 2011, 64% of people with schizophrenia were current smokers, compared with 19% of people without psychiatric illness.¹⁴

EAGLES was a trial in 8,144 smokers with and without psychiatric disorders, and a later analysis covered the 390 with a primary psychotic disorder.^{15, 16} In that subgroup, the estimated odds ratio for abstinence versus placebo was above 3.00 for varenicline, and neuropsychiatric adverse events occurred in 5.1% to 6.3% across treatments.¹⁶

A second trial enrolled smokers with schizophrenia or bipolar disorder who had quit on 12 weeks of open-label varenicline and cognitive behavioral therapy. At week 52, 60% of those who continued varenicline were abstinent, compared with 19% on placebo.¹⁷

Is the gap widening? The sources disagree

A 2007 systematic review of 37 articles found that standardized mortality ratios for all-cause mortality had increased during recent decades (P = .03).¹⁸ A 2018 literature review of eight longitudinal studies reported a mean ratio of 2.2 in pre-1970s studies and 3.0 in later reports.¹⁹ The 2022 meta-analysis found a slight increase with study year (p=0.02).⁸

In Finland, the gap in life expectancy did not widen between 1996 (25 years) and 2006 (22.5 years).²⁰ The 2017 meta-analysis concluded that the loss seemed not to have lessened over time, the 2023 meta-analysis found that the gap for mental disorders overall persisted, and a 2025 meta-analysis of 2,700,825 people with schizophrenia found that the increased mortality risk did not improve over time.^{1, 2, 21}

In an Australian cohort published in 2026, the life expectancy gap for people with mental illness narrowed, from 16.7 to 12.1 years in men and from 13.4 to 9.4 years in women. It did not narrow significantly among people with schizophrenia or other psychoses.²²

Limitations of the evidence

This evidence has limitations. First, every mortality comparison involving antipsychotics or clozapine is observational, and the results cannot establish causal relationships. Second, the US figures are mortality ratios in Medicaid and Medicare populations, and none of the trials described here tested whether quitting smoking or metabolic monitoring extends life in schizophrenia. Nevertheless, the US and Swedish data agree that heart disease is a leading cause of death, and in Sweden it appeared to be underdiagnosed.

The clinical implication is concrete: glucose and lipid testing on schedule, a direct conversation about smoking cessation medication, attention to respiratory illness, and continued psychiatric treatment planned with the prescriber.

In a crisis: call or text 988, or go to the nearest emergency department. A first episode of psychosis belongs in a hospital-based or coordinated specialty care program.

I start and manage clozapine in an outpatient practice in Chelsea, Manhattan. Details are on the schizophrenia care in NYC page. Clozapine should not be stopped, skipped, or restarted without the prescriber. This page is general information and does not replace an evaluation.

Related: Schizophrenia and psychosis treatment guide · When to start clozapine · Clozapine blood tests after the REMS ended · Clozapine side effects · Missed clozapine doses · Clozapine and suicide risk · Cannabis and psychosis · Schizoaffective vs schizophrenia · Cobenfy vs clozapine · Postpartum psychosis · Injections vs pills · Stimulants and psychosis · Drug-induced psychosis · Clozapine levels · CBT for psychosis · Clozapine myocarditis · Cannabis after psychosis · Clozapine constipation · Work and school · Clozapine drooling · Early signs in teens · Clozapine weight gain · Genetic and family risk · Who can prescribe clozapine · Schizophrenia and violence · Clozapine in teenagers · Sleepiness, bedwetting, heart rate · When clozapine isn't enough · Clozapine interactions · Benign ethnic neutropenia · Clozapine off-label uses · Starting clozapine · Clozapine and pneumonia · Clozapine seizures · Clozapine in pregnancy · Clozapine rechallenge · Relative refuses treatment · Late-onset schizophrenia · Negative symptoms · First-episode psychosis · Tardive dyskinesia · Stopping antipsychotics · Key clozapine studies