A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study

Plana‐Ripoll, Oleguer; Pedersen, Carsten Bøcker; Agerbo, Esben; Holtz, Yan; Erlangsen, Annette; Canudas-Romo, Vladimir; Andersen, Per Kragh; Charlson, Fiona J; Christensen, Maria Klitgaard; Erskine, Holly E.; Ferrari, Alize J.; Iburg, Kim Moesgaard; Momen, Natalie C.; Mortensen, Preben Bo; Nordentoft, Merete; Santomauro, Damian; Scott, James G.; Whiteford, Harvey; Weye, Nanna; McGrath, John J.; Laursen, Thomas Munk

doi:10.1016/s0140-6736(19)32316-5

Cited by 348 publications

(320 citation statements)

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“…In keeping with previous studies 7,8,10 , remaining life expectancy after onset of a combination of disorders compared to the general population of same sex and age was estimated as excess life‐years lost. The technical development of this method has recently been published 8,17 , and a detailed account of how to implement it is available 18 .…”

Section: Methodsmentioning

confidence: 88%

“…However, there are some limitations of the study that need to be taken into consideration. First, in order to make the analyses tractable and allow comparisons to related publications 2,3,7 , we considered broad diagnostic categories, rather than specific disorders. Second, we relied on clinical diagnoses rather than direct structured diagnostic interviews to identify mental disorders; however, several studies have confirmed that many register‐based mental disorder diagnoses have good validity 25‐29 .…”

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

“…It is clear that mental disorders are associated with premature mortality 6‐8 . However, mortality‐related metrics such as mortality rate ratios are usually shown for single types of mental disorders 9,10 , or broad categories of mental disorders 7 . While it is useful to compare these estimates across mental disorders, and some models adjust for prior mental disorders 11 , such studies have not captured the complex nature of comorbidity and its potential impact on mortality.…”

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confidence: 99%

“…Based on our previous observations that common disorders such as mood disorders, neurotic/stress‐related/somatoform disorders and substance use disorders were each associated with appreciable risks of developing a range of other disorders 2 , we predicted that these disorders would be found in many common combinations. Furthermore, since we estimated that substance use disorders were strongly associated with premature mortality (when looking both at mortality rates and life expectancy) 7 , and that life expectancy was shorter for those with two or more types of mental disorders 12 , we predicted that combinations including substance use disorders or a larger number of disorders would be associated with greater risk of premature mortality.…”

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confidence: 99%

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Nature and prevalence of combinations of mental disorders and their association with excess mortality in a population‐based cohort study

et al. 2020

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The nature and prevalence of combinations of mental disorders and their associations with premature mortality have never been reported in a comprehensive way. We describe the most common combinations of mental disorders and estimate excess mortality associated with these combinations. We designed a population‐based cohort study including all 7,505,576 persons living in Denmark at some point between January 1, 1995 and December 31, 2016. Information on mental disorders and mortality was obtained from national registers. A total of 546,090 individuals (10.5%) living in Denmark on January 1, 1995 were diagnosed with at least one mental disorder during the 22‐year follow‐up period. The overall crude rate of diagnosis of mental disorders was 9.28 (95% CI: 9.26‐9.30) per 1,000 person‐years. The rate of diagnosis of additional mental disorders was 70.01 (95% CI: 69.80‐70.26) per 1,000 person‐years for individuals with one disorder already diagnosed. At the end of follow‐up, two out of five individuals with mental disorders were diagnosed with two or more disorder types. The most prevalent were neurotic/stress‐related/somatoform disorders (ICD‐10 F40‐F48) and mood disorders (ICD‐10 F30‐F39), which – alone or in combination with other disorders – were present in 64.8% of individuals diagnosed with any mental disorder. Mortality rates were higher for people with mental disorders compared to those without mental disorders. The highest mortality rate ratio was 5.97 (95% CI: 5.52‐6.45) for the combination of schizophrenia (ICD‐10 F20‐F29), neurotic/stress‐related/somatoform disorders and substance use disorders (ICD‐10 F10‐F19). Any combination of mental disorders was associated with a shorter life expectancy compared to the general Danish population, with differences in remaining life expectancy ranging from 5.06 years (95% CI: 5.01‐5.11) to 17.46 years (95% CI: 16.86‐18.03). The largest excess mortality was observed for combinations that included substance use disorders. This study reports novel estimates related to the “force of comorbidity” and provides new insights into the contribution of substance use disorders to premature mortality in those with comorbid mental disorders.

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Section: Methodsmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Nature and prevalence of combinations of mental disorders and their association with excess mortality in a population‐based cohort study

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Prescription Drug Dispensing and Patient Costs After Implementation of a No Behavioral Health Cost-Sharing Law

Golberstein,

Campbell,

Maclean

et al. 2024

JAMA Health Forum

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ImportanceOn January 1, 2022, New Mexico implemented a No Behavioral Cost-Sharing (NCS) law that eliminated cost-sharing for mental health and substance use disorder (MH/SUD) treatments in plans regulated by the state, potentially reducing a barrier to treatment for MH/SUDs among the commercially insured; however, the outcomes of the law are unknown.ObjectiveTo assess the association of implementation of the NCS with out-of-pocket spending for prescription for drugs primarily used to treat MH/SUDs and monthly volume of dispensed drugs.Design, Settings, and ParticipantsThis retrospective cohort study used a difference-in-differences research design to examine trends in outcomes for New Mexico state employees, a population affected by the NCS, compared with federal employees in New Mexico who were unaffected by NCS. Data were collected on prescription drugs for MH/SUDs dispensed per month between January 2021 and June 2022 for New Mexico patients with a New Mexico state employee health plan and New Mexico patients with a federal employee health plan. Data analysis occurred from December 2022 to January 2024.ExposureEnrollment in a state employee health plan or federal health plan.Main Outcomes and MeasuresThe primary outcomes were mean patient out-of-pocket spending per dispensed MH/SUD prescription and the monthly volume of dispensed MH/SUD prescriptions per 1000 employees. A difference-in-differences estimation approach was used.ResultsThe implementation of the NCS law was associated with a mean (SE) $6.37 ($0.30) reduction (corresponding to an 85.6% decrease) in mean out-of-pocket spending per dispensed MH/SUD medication (95% CI, −$7.00 to −$5.75). The association of implementation of NCS with the volume of prescriptions dispensed was not statistically significant.Conclusions and RelevanceThese findings suggest that the implementation of the New Mexico NCS law was successful in lowering out-of-pocket spending on prescription medications for MH/SUDs, but that there was no association of NCS with the volume of medications dispensed in the first 6 months after implementation. A key challenge is to identify policies that protect from high out-of-pocket spending while also promoting access to needed care.

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Longitudinal Associations of Mental Disorders With Physical Diseases and Mortality Among 2.3 Million New Zealand Citizens

et al. 2021

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IMPORTANCE Excess risk of physical disease and mortality has been observed among individuals with psychiatric conditions, suggesting that ameliorating mental disorders might also be associated with ameliorating the later onset of physical disability and early mortality. However, the temporal association between mental disorders and physical diseases remains unclear, as many studies have relied on retrospective recall, used cross-sectional designs or prospective designs with limited follow-up periods, or given inadequate consideration to preexisting physical illnesses. OBJECTIVE To examine whether mental disorders are associated with subsequent physical diseases and mortality across 3 decades of observation.

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A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study

Abstract: Plana-Ripoll et al. A comprehensive analysis of mortality-related health metrics associated with mental disorders. 1A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study

Cited by 348 publications

References 27 publications

Nature and prevalence of combinations of mental disorders and their association with excess mortality in a population‐based cohort study

Nature and prevalence of combinations of mental disorders and their association with excess mortality in a population‐based cohort study

Prescription Drug Dispensing and Patient Costs After Implementation of a No Behavioral Health Cost-Sharing Law

Longitudinal Associations of Mental Disorders With Physical Diseases and Mortality Among 2.3 Million New Zealand Citizens

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