Summary: People with mood and substance use disorders have a reduced lifespan compared to their peers without a mental health disorder. Those with mood disorders have an increased death risk as a result of health conditions such as cancer, cardiovascular disease, and diabetes. Men with mood disorders experience a reduced life expectancy of 7.9 years, and women 6.2 years, compared to those with no history of depression or anxiety.
Source: Aarhus University
Based on register data from 7,4 million persons living in Denmark between 1995 and 2015, the new nationwide study from the National Centre for Register-based Research at Aarhus BSS, Aarhus University, is the most comprehensive study ever done on mortality in persons with mental disorders.
“It is well known that people with mental disorders die earlier than the general population. However, for the first time, we present a comprehensive study where we investigate mortality in specific types of mental disorders. We have used new ways to measure life expectancy that are more accurate than the ones used in the past,” says Dr. Oleguer Plana-Ripoll, who is a postdoctoral researcher at the National Centre for Register-based Research, Aarhus University, and the lead author of the study.
The results have just been published in The Lancet, which is one of the world’s most prestigious medical journals.
The new study explores mortality for those with different types of mental disorders. The researchers were able to explore anonymous data within Danish health registers – the findings provide new insights into how mental disorders impact on the lives of people with disorders such as depression, anxiety disorders and substance use disorders.
“Most studies provide “mortality rates”, which is a way to estimate the risk of death in those with mental disorders compared to those without. We investigated how mortality rates changed for each type of disorder, for each age, for males and females. In addition to looking at premature mortality, we were able to explore specific causes of death such as cancer, diabetes, and suicide,” says Oleguer Plana-Ripoll.
“The risk of an early death was higher for people with mental disorders across all ages,” Oleguer Plana-Ripoll adds.
When looking at differences in life expectancy, the researchers found that men and women with mental disorders on average had life expectancies respectively 10 and 7 years shorter after the diagnosis of the disease compared to an overall Danish person of the same age.
“For example, people with depression or another type of mood disorder, which are among the most common mental disorders, had higher mortality rates. Apart from an increased risk of death due to suicide, we also confirm an increased risk of death due to somatic conditions such as cancer, respiratory diseases, diabetes etc. We found that men and women with mood disorders experienced life expectancies respectively 7.9 and 6.2 years shorter after disease diagnosis compared to the overall Danish person with the same age,” says Dr Plana-Ripoll.
The study was completed as part of the Niels Bohr Professorship research programme at Aarhus University, which is led by Professor John McGrath. Funded by the Danish National Research Foundation, this research aims to explore innovative methods related to psychiatric epidemiology. According to John McGrath the research reveals worrying aspects of mortality among people with mental disorders.
“For example: we found an unusual pattern in men with a mental disorder. Contrary to our expectations, when we looked at life expectancy, they lost relatively few years of life due to cancer-related deaths compared to the general population. This was because, although they have a higher risk of dying from cancer, they are much more likely to die from cardiovascular and lung disorder at a younger age compared to the general population. This is a new and rather disappointing finding.”, says Professor John McGrath.
“Our study emphasises the urgent need to improve general health for people with mental disorders, “John McGrath adds.
Oleguer Plana-Ripoll – Aarhus University
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Original Research: Closed access
“A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study”. Oleguer Plana-Ripoll et al.
The Lancet doi:10.1016/S0140-6736(19)32316-5.
A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study
Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder.
In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death.
7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57–28·82] vs 12·95 deaths [12·93–12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91–1·94) for mood disorders to 3·91 (3·87–3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36–5·48) for organic disorders in females to 14·84 years (14·70–14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher.
Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death.
Danish National Research Foundation.