“decade of life lost”: excess mortality due to mental disorders. JAMA Psych. ahead of print.2015

24.02.2015

Burden of mental illness is growing worldwide. It is widely known that mental disorders are associated with excess disability as well as excess mortality.

Elizabeth Reisinger Walker,Robin E. McGee & Benjamin G. Druss from Emeroy University report the results of a meta analysis of studies looking at excess mortality in mental disorders.

Comprehensive search ( up to 2014)  was carried out to identify all cohort studies that used appropriate methods to identify mental disorders and  where outcomes ( mortality) were reported in comparison to control/ general population . They estimated one estimate of risk from each study analysis. 203 studies met all criteria.These came form 29 countries. Mental disorders were mostly identified from medical records or administrative data .Quarter of studies did this by diagnostic interviews. Follow up ranged between one to 52 years, with a median of 10 years.

Results

The overall pooled Relative Risk for mortality among people with mental disorders was 2.22 (95% CI, 2.12-2.33). All-cause mortality was significantly elevated for psychoses, mood disorders, and anxiety.Mortality risk for psychoses was significantly higher than those for depression,bipolar disorder , and anxiety.Analysis of natural causes of death resulted in a pooled RR of 1.80 . For unnatural causes, the pooled RR from 106 studies was 7.22.The authors estimate that 67.3% of deaths were due to natural causes and 17.5% were due to unnatural causes, with the remainder being unknown or unidentified.

The reduction in life expectancy ranged from 1.4 to 32 years, with a median of 10.1 years .

8 million deaths worldwide are attributable to mental disorders each year.

Conclusions:

People with mental disorders have a mortality rate that is 2.22 times higher than the general population or people without mental disorders, with a decade of potential life lost.

Estimation of Population Attributable Risk show that nearly 15% of deaths worldwide, (= 8 million deaths each year), are attributable to mental disorders.

Natural causes accounted for more than two-thirds of deaths among people with mental disorders, suggesting that physical health problems ( like Cardiovascular health) requires much more attention. Behavioral and lifestyle factors, access to and quality of health care, and social determinants of health, such as poverty and social connectedness, all are important factors contributing to this excess mortality among mentally ill.

Summary of the article:

Mortality in Mental Disorders and Global Disease Burden Implications A Systematic Review and Meta-analysis.  Elizabeth Reisinger Walker, PhD, MPH, MAT; Robin E. McGee, MPH; Benjamin G. Druss, MD, MPH. JAMA Psychiatry.  Published online February 11, 2015.

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