This week our new article, Lung Function Predicts Mortality in People with Serious Mental Illness: A six-year follow-up study, has been published in European Psychiatry. Although the paper is short, the story behind it is long. We began thinking about this project in 2017, when our research group was still taking shape and we were trying to understand something very simple but largely unexplored: could lung function help identify individuals with serious mental illness (SMI) who are at higher risk of premature mortality?
People with SMI live between 12 and 15 years less than the general population. Most of these lost years are due to physical diseases, not psychiatric causes. Smoking, metabolic risk, sedentary lifestyle and poorer living conditions create a lifelong accumulation of threats that start early and remain invisible for too long. Respiratory health sits at the crossroads of many of these factors, yet it has received far less attention than cardiovascular or metabolic disease.
Spirometry is a simple, inexpensive test. It tells us how well a person can exhale, and two volumes –FEV₁ and FVC– are powerful predictors of mortality in the general population. Our question was whether the same might be true in people with schizophrenia or bipolar disorder, all of whom were active smokers but free of diagnosed respiratory disease at baseline.
We followed 107 individuals over six years. During that time, eight participants died, mostly from cardiovascular and oncological causes. What we found was striking:
lower baseline lung function, especially lower FEV₁ (expressed as a z-score), predicted all-cause mortality, even after adjusting for age, abdominal circumference and cardiometabolic comorbidities.
lower baseline lung function, especially lower FEV₁ (expressed as a z-score), predicted all-cause mortality, even after adjusting for age, abdominal circumference and cardiometabolic comorbidities.
Other factors we expected to play a role –hypertension, diabetes, dyslipidaemia or even smoking intensity– did not show a clear relationship with mortality. Lung function did.
These results echo findings from large population cohorts, where FEV₁ is consistently one of the strongest predictors of survival. The mechanisms are complex, involving obstructive and restrictive patterns, systemic inflammation, smoking-related damage and a broad network of environmental and lifestyle risks. But the implication is simple: reduced lung function may act as a “canary in the coal mine”, signalling an overall vulnerability to physical illness.
From a clinical perspective, this matters. Spirometry is feasible in community mental health settings, requires little equipment and offers immediate results. Used wisely, it could help identify individuals who would benefit most from early, intensive preventive interventions, especially smoking cessation.
This study also highlights how much work remains to be done. Our sample was modest, and larger longitudinal cohorts are needed to clarify patterns, refine risk levels and understand the specific causes of mortality involved. But for us, this publication represents an important step in a research line that started with a simple question eight years ago.
As with many projects, the journey –the fieldwork, the repeated spirometry tests, the learning curve, the teamwork across centres and disciplines– has been as meaningful as the final result.
For anyone interested, the article is available Open Access here: