Much Lower Life Expectancy in the Mentally Ill

Caroline Cassels

December 06, 2011

December 6, 2011 — Individuals with serious mental illness have a lifespan that is 15 to 20 years shorter than that of the general population in 3 countries with high-quality healthcare, new research shows.

Investigators from the Nordic Research Academy in Mental Health in Gothenburg, Sweden, studied the life expectancy of individuals admitted with a mental disorder to a hospital in Denmark, Finland, and Sweden between 1987 and 2006, and found that these individuals had mortality rates that were 2- to 3-fold higher than those of the general population in all 3 countries.

"Our study shows that major health inequalities persist between people with mental disorders and the rest of the population. Men with mental disorders still live 20 years less, and women 15 years less, than the general population," lead author Professor Kristian Wahlbeck, DMedSc, said in a release.

The study was published online May 18 and in the December print issue of the British Journal of Psychiatry.

Similar to many other developed countries, Sweden, Denmark, and Norway have undergone an era of deinstitutionalization, with a major shift away from inpatient psychiatric care to outpatient care and social participation.

Noting that the "relative life expectancy of people with mental disorders is a proxy measure of effectiveness of social policy and health service provision," the researchers set out to "evaluate the achievements of the Nordic mental healthcare reforms."

To do this, the investigators examined hospital admission and mortality data for all individuals with at least 1 hospital admission resulting from a mental health disorder. The cohort was divided into four 5-year periods. Mortality rates were calculated for age groups 15 to 29 years, 30 to 44 years, 45 to 59 years, 60 to 74 years, and 75 years or older.

Mortality rates for mental health patients were calculated and compared with general population mortality rates.

The investigators found that although there was a 15- to 20-year difference in life expectancy between the mentally ill and the general population, the gap is narrowing, with the exception of male patients in Sweden.

Further, the researchers found that the increase in life expectancy is lower among mentally ill men than among women in all 3 countries.

The investigators list several potential explanations for the high mortality rate among the mentally ill, including unhealthy lifestyle, inadequate access to adequate medical care, and "a culture of not taking physical disease into consideration when treating psychiatric patients."

In addition, they point out that individuals with mental disorders are "more often poor, unemployed, single and marginalised, all known risk factors for poor health and premature mortality."

In an accompanying editorial Graham Thornicroft, FRCPscyh, PhD, professor of community psychiatry at the Institute of Psychiatry, King's College London, United Kingdom, described the study's findings as "a scandal."

"Even in three Scandinavian countries that provide among the best-quality and most equitably distributed healthcare in the world, this mortality gap has narrowed only by a modest extent over the past two decades and remains stubbornly wide," Dr. Thornicroft writes.

The authors and Dr. Thornicroft have disclosed no relevant financial relationships.

Br J Psychiatry. 2011;199:453-458, 441-442. Article abstract, Editorial abstract

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