Demystifying Psychiatry

A resource for patients and families

Persons with Psychiatric Illnesses Die Prematurely

Medical conditions cause premature deaths in people with mental illness.

It has been known for some time that people who suffer from psychiatric illnesses die earlier than those without mental illness. According to a recent large study published in the British Medical Journal by David Lawrence and colleagues, persons with psychiatric illness die an average of 14 years earlier than those without such illnesses. This research group also found that this gap in life expectancy has been increasing over the last 25 years.

Almost 80% of excess deaths resulted from physical (medical) conditions. Heart disease and stroke accounted for about 30% of premature deaths, while cancer resulted in another 14%. Suicides were responsible for 14%, and accidents, injuries, and violent deaths accounted for 9%. 

One might think that shorter life expectancies for persons with mental illness pertain only to individuals with severe illnesses like schizophrenia, bipolar disorder, or drug addictions. Although alcohol/drug addictions and psychotic disorders were associated with the greatest decreases in life expectancy, this study demonstrated that people with non-psychotic illnesses, including depressive disorders and “neurotic” disorders, also died prematurely. (Neurotic disorders include anxiety disorders, certain subtypes of depressive disorders, phobias, somatoform disorders, and more.)

As mentioned previously, suicide accounted for about 14% of excess deaths in this study. However, this percentage varied with specific psychiatric disorders. For example, suicide accounted for 20% of excess deaths in persons with schizophrenia, 23% in persons with depressive disorder, and a dramatic 46% of those with affective psychosis, including bipolar disorder. Affective psychosis is a severe form of mood disorder that typically includes delusions (fixed false beliefs) and/or hallucinations.  

Why do persons with psychiatric disorders die prematurely from medical causes? The authors of the article suggest several potential factors. The use of cigarettes and abused drugs (including alcohol) is common in persons with psychiatric disorders, and cigarettes and alcohol both increase the risk for heart disease and cancer. Also, psychiatrically ill persons often do not seek or receive healthcare as readily as those without psychiatric illnesses. They also may not comply with recommended treatments and follow up. Some psychiatric medications can result in increased body weight, increased body lipids, and increased blood sugar levels, which are all components of the “metabolic syndrome.” Untreated, the metabolic syndrome can lead to cardiovascular and cerebrovascular illnesses. Finally, certain psychiatric illnesses are associated with lower socioeconomic status (SES), and poorer health outcomes are linked to low SES. Other variables, including more sedentary lifestyles, may also contribute.

A lot can be done to help persons with psychiatric disorders. Mental health professionals must be aware that persons with these disorders have a substantially increased risk for unrecognized or poorly treated physical illnesses. All healthcare professionals should encourage patients to pay attention to lifestyle factors, such as exercise, healthy eating habits, and sleep hygiene, and encourage the avoidance of smoking, abused drugs, and excessive alcohol consumption. 

As prejudice against mental illness diminishes, it is important that persons afflicted with these disorders receive better health care and the support necessary for living longer and more productive lives.

 

This column was cowritten by Eugene Rubin MD, PhD and Charles Zorumski MD.

Eugene Rubin, M.D., Ph.D., is Professor and Vice-Chair for Education in the Department of Psychiatry at Washington University in St. Louis - School of Medicine.

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