Poor Physical Health Blamed for Shorter Lives in Mentally Ill

Pam Harrison

May 21, 2013

The gap in life expectancy between psychiatric patients and the general population is widening, a phenomenon that is being blamed on poor physical health rather than suicide, new research shows.

Investigators at the University of Western Australia, Perth, Australia, found that the gap in life expectancy for males in that geographic region increased from 13.5 years in 1985 to 15.9 years in 2005 for all mental disorders combined.

For females, the gap increased from 10.4 years in 1985 to 12.0 years in 2005.

"The majority of excess mortality was attributed to physical health conditions, such as cardiovascular disease, respiratory disease and cancer," the researchers, led by David Lawrence, MD, Telethon Institute for Child Health Research, write.

Results of this study "are significant in that they show that outcomes for people with mental illnesses have worsened since the 1990s despite increasing knowledge about the impacts of such illness."

The study was published online May 21 in the BMJ.

Worsening Outcomes

Of the few studies of life expectancy in individuals with mental illness, some have reported a gap of 14 years for males and 6 for females, although others have reported a gap of 20 years for males and 15 for females.

Little is known as to whether the difference in life expectancy between people with mental illness and the general population has changed over time. Two studies have shown different results, with one suggesting that the gap has increased, and one showing a modest narrowing.

The investigators therefore carried out an analysis of Australian population registers between 1985 and 2005 to examine the life expectancy gap. They also calculated the contribution of major causes of death, including cancer, heart disease, respiratory disease, and unnatural causes of death.

Overall, 292,585 individuals were in contact with mental health services in Western Australia between 1983 and 2007, of whom 47,669 died during that period.

"In the general population, life expectancy for males increased from 73.1 years in 1985 to 79.1 years in 2005," the investigators write.

Life expectancy for female in the general population increased from 79.3 years to 83.8 years during the same period.

Among psychiatric patients, men and women with alcohol or drug disorders had the lowest life expectancy in 1985, and this gap exceeded 20 years at all time points, the researchers add.

However, the largest increase in the life expectancy gap was in individuals with affective psychoses and other psychoses.

The gap in life expectancy in males with this psychiatric disorder widened from 14.8 years in 1985 to approximately 22 years in 2005.

The gap in life expectancy for females with the same disorder widened from 14.1 years in 1985 to approximately 22 years in 2005 as well.

"These results show the substantial impact of mental illness on life expectancy in Western Australia," investigators write.

"With most excess deaths being due to physical health conditions, public efforts should be directed towards improving physical health to reduce mortality in people with mental illness."

Human Rights Disgrace

In an accompanying editorial, Graham Thornicroft, MD, PhD, Kings College of London, Institute of Psychiatry, United Kingdom, notes that it has been clear for more than 50 years that people with the more disabling forms of mental illness do not live as long as those without mental illness.

"We are coming to understand that this excess mortality is not the result of higher suicide rates, but rather a combination of socioeconomic, healthcare and clinical risk factors," he adds.

The study findings, he adds, raise "disturbing" questions about our "disregard for the duration and value of the lives of people with mental illness."

He suggests that evidence-based interventions that can reduce excess mortality, such as smoking cessation and lifestyle programs, are needed to reduce excess mortality in this vulnerable patient population. The sheer scale of the problem also dictates that it be placed high on the public health priority list, he adds.

"Thirdly, this huge loss of life among people with mental illness needs to be recognised as a human rights disgrace," he notes

World mental health surveys show that in some countries, treatment for severe mental illness is as low as 2%, as Dr. Thornicroft points out.

"We continue to disregard the physical health needs of people with mental illness and act as if they are of less worth than others. We now know that these forms of discrimination can have lethal consequences," he says

The investigators and Dr. Thornicroft report no relevant financial relationships.

BMJ. Published online May 21, 2013. Full article

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