When people miss doctor appointments, it should be a sign to doctors, clinics and hospitals that something may be very wrong with them. In fact, missed doctor appointments may be the first step in a serious downward health spiral, according to a new study.

Scottish researchers examined three years' worth of appointment histories for over 800,000 people and uncovered a strong connection between missing appointments with a general practitioner (GP) or primary care doctor and higher likelihood of death. And while it can't assert cause and effect, the study did find that the connection between missing doctor appointments and death is a very strong one, particularly for people with mental health conditions.

Missed visits are often an indication of serious health problems.

People with mental health conditions who missed more than two appointments per year had an eight times greater risk of death during the study's 16-month follow-up period than people who missed no appointments. A caveat is that the study controlled for a number of factors but did not control for people who missed appointments because they were too sick to leave home. Common sense suggests that people who are very ill have a heightened risk of death and also tend to miss doctor appointments. Still there may be a lot more behind the study findings than just that.

Ross McQueenie, a research associate at the University of Glasgow, who led the study explains: “Patients diagnosed with long-term mental health problems, who did die during the follow-up period, died prematurely, often from non-natural external factors such as suicide.”

When people intentionally miss or cancel a doctor's appointment, perhaps from lack of faith that the visit will help them, this, too, may lead to a higher risk of death. For example, people with mental health issues might start tuning out their doctors' recommendations and decide there's no point in even seeing them anymore. This could be a crucial step on the road to further mental decline.

The current study cannot tell whether scenarios like this happen often or how much they contributed to the study's findings. But until further research clarifies matters, the increased death risk might serve as a caution to people to think twice before canceling or missing an appointment.

For health care professionals, the message is clearer. As study co-author, Philip Wilson, director of the University of Aberdeen's Centre for Rural Health, emphasizes, missed visits are often an indication of serious health problems: “These findings are crucially important for GPs wishing to identify patients at high risk of premature death. For people with physical conditions missed appointments are a strong independent risk factor for dying in the near future. Among those without long-term physical conditions, the absolute risk is lower, but missing appointments is an even stronger risk marker for premature death from non-natural causes.”

For more details, see the study article, which appears in the open access journal, BMC Medicine.