IMPORTANCE Despite the potential importance of understanding excess mortality among people with mental disorders, no comprehensive meta-analyses have been conducted quantifying mortality across mental disorders.OBJECTIVE To conduct a systematic review and meta-analysis of mortality among people with mental disorders and examine differences in mortality risks by type of death, diagnosis, and study characteristics.DATA SOURCES We searched EMBASE, MEDLINE, PsychINFO, and Web of Science from inception through May 7, 2014, including references of eligible articles. Our search strategy included terms for mental disorders (eg, mental disorders, serious mental illness, and severe mental illness), specific diagnoses (eg, schizophrenia, depression, anxiety, and bipolar disorder), and mortality. We also used Google Scholar to identify articles that cited eligible articles.STUDY SELECTION English-language cohort studies that reported a mortality estimate of mental disorders compared with a general population or controls from the same study setting without mental illness were included. Two reviewers independently reviewed the titles, abstracts, and articles. Of 2481 studies identified, 203 articles met the eligibility criteria and represented 29 countries in 6 continents. DATA EXTRACTION AND SYNTHESISOne reviewer conducted a full abstraction of all data, and 2 reviewers verified accuracy. MAIN OUTCOMES AND MEASURESMortality estimates (eg, standardized mortality ratios, relative risks, hazard ratios, odds ratios, and years of potential life lost) comparing people with mental disorders and the general population or people without mental disorders. We used random-effects meta-analysis models to pool mortality ratios for all, natural, and unnatural causes of death. We also examined years of potential life lost and estimated the population attributable risk of mortality due to mental disorders.RESULTS For all-cause mortality, the pooled relative risk of mortality among those with mental disorders (from 148 studies) was 2.22 (95% CI, 2.12-2.33). Of these, 135 studies revealed that mortality was significantly higher among people with mental disorders than among the comparison population. A total of 67.3% of deaths among people with mental disorders were due to natural causes, 17.5% to unnatural causes, and the remainder to other or unknown causes. The median years of potential life lost was 10 years (n = 24 studies). We estimate that 14.3% of deaths worldwide, or approximately 8 million deaths each year, are attributable to mental disorders. CONCLUSIONS AND RELEVANCEThese estimates suggest that mental disorders rank among the most substantial causes of death worldwide. Efforts to quantify and address the global burden of illness need to better consider the role of mental disorders in preventable mortality.

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Objective The purpose of this study was to provide updated national estimates and correlates of service use, unmet need, and barriers to mental health treatment among adults with mental disorders. Method The sample included 36,647 adults aged 18–64 years (9723 with any mental illness and 2608 with serious mental illness) from the 2011 National Survey on Drug Use and Health. Logistic regression models were used to examine predictors of mental health treatment and perceived unmet need. Results Substantial numbers of adults with mental illness did not receive treatment (any mental illness: 62%; serious mental illness: 41%) and perceived an unmet need for treatment (any mental illness: 21%; serious mental illness: 41%). Having health insurance was a strong correlate of mental health treatment use (any mental illness: private insurance: AOR=1.63 (95% CI=1.29–2.06), Medicaid: AOR=2.66, (95% CI=2.04–3.46); serious mental illness: private insurance: AOR=1.65 (95% CI=1.12–2.45), Medicaid: AOR=3.37 (95% CI=2.02–5.61)) and of reduced perceived unmet need (any mental illness: private insurance: AOR=.78 (95% CI:.65–.95), Medicaid: AOR=.70 (95% CI=.54–.92)). Among adults with any mental illness and perceived unmet need, 72% reported at least one structural barrier and 47% reported at least one attitudinal barrier. Compared to respondents with insurance, uninsured individuals reported significantly more structural barriers and fewer attitudinal barriers. Conclusions Low rates of treatment and high unmet need persist among adults with mental illness. Strategies to reduce both structural barriers, such as cost and insurance coverage, and attitudinal barriers are needed.

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Objectives We compared the mortality of persons with and without anxiety and depression in a nationally representative survey and examined the role of socioeconomic factors, chronic diseases, and health behaviors in explaining excess mortality. Methods The 1999 National Health Interview Survey was linked with mortality data through 2011. We calculated the hazard ratio (HR) for mortality by presence or absence of anxiety/depression and evaluated potential mediators. We calculated the population attributable risk of mortality for anxiety/depression. Results Persons with anxiety/depression died 7.9 years earlier than other persons. At a population level, 3.5% of deaths were attributable to anxiety/depression. Adjusting for demographic factors, anxiety/depression was associated with an elevated risk of mortality (HR=1.61, 95% confidence interval [CI]=1.40, 1.84). Chronic diseases and health behaviors explained much of the elevated risk. Adjusting for demographic factors, people with past-year contact with a mental health professional did not demonstrate excess mortality associated with anxiety/depression while those without contact did. Conclusions Anxiety/depression presents a mortality burden at both an individual and population level. Our findings are consistent with targeting health behaviors and physical illnesses as strategies for reducing this excess mortality among people with anxiety/depression.