Catatonia and elevated mortality: A population-wide cohort study with healthy, sibling, and schizophrenia spectrum controls

Aim: To determine whether catatonia is associated with increased long-term all-cause and cause-specific mortality. Methods: Using Taiwan's National Health Insurance Database (2000–2022), we assembled a population-based cohort of all adults (≥18 years) with catatonia and matched each to four controls without catatonia on sex and birthdate. Mortality was compared between (1) individuals with catatonia and their unaffected siblings and (2) individuals with schizophrenia spectrum disorders with catatonia and those with schizophrenia spectrum disorders without catatonia. The primary outcome was all-cause mortality; secondary outcomes were natural- and unnatural-cause deaths. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated with Cox models controlling for age, sex, socioeconomic status, urbanization level, and comorbidities. Results: We included 6642 individuals with catatonia and 26,568 matched controls. Over mean follow-ups of 11.4 and 13.1 years, respectively, 2150 versus 3459 deaths occurred (adjusted HR 2.60, 95% CI 2.46–2.75). Risks were higher for natural causes (2.42, 2.28–2.57) and unnatural causes (5.57, 4.59–6.77). Compared with unaffected siblings, catatonia remained associated with excess all-cause (1.82, 1.34–2.49), natural (1.57, 1.07–2.30), and unnatural mortality (2.73, 1.56–4.77). Within schizophrenia spectrum disorders, catatonia conferred higher all-cause (1.20, 1.12–1.28) and natural mortality (1.27, 1.18–1.36), whereas unnatural mortality was similar (1.01, 0.87–1.17). Conclusions: Catatonia conferred a substantial, independent risk of premature mortality across multiple causes. Clinicians should recognize that catatonia is a serious disorder with long-term consequences and should remain vigilant to prevent and manage complications beyond the acute episode.