Association of Mental Disorders in Early Adulthood and Later Psychiatric Hospital Admissions and Mortality in a Cohort Study of More Than 1 Million Men

Abstract

Context: Mental disorders have been associated with increased mortality, but the evidence is primarily based on hospital admissions for psychoses. The underlying mechanisms are unclear.Objectives: To investigate whether the risks of death associated with mental disorders diagnosed in young men are similar to those associated with admission for these disorders and to examine the role of confounding or mediating factors.Design: Prospective cohort study in which mental disorders were assessed by psychiatric interview during a medical examination on conscription for military service at a mean age of 18.3 years and data on psychiatric hospital admissions and mortality during a mean 22.6 years of follow-up were obtained from national registers. Setting: Sweden.Participants: A total of 1 095 338 men conscripted between 1969 and 1994.Main Outcome Measure: All-cause mortality according to diagnoses of schizophrenia, other nonaffective psychoses, bipolar or depressive disorders, neurotic and adjustment disorders, personality disorders, and alcohol-related or other substance use disorders at conscription and on hospital admission.Results: Diagnosis of mental disorder at conscription or on hospital admission was associated with increased mortality. Age-adjusted hazard ratios according to diagnoses at conscription ranged from 1.76 (95% CI, 1.65-1.86) (neurotic and adjustment disorders) to 5.55 (95% CI, 1.79-17.2) (bipolar disorders). The equivalent figures according to hospital diagnoses ranged from 5.46 (95% CI, 5.06-5.89) (neurotic and adjustment disorders) to 11.2 (95% CI, 10.4-12.0) (other substance use disorders) in men born from 1951 to 1958 and increased in men born later. Adjustment for early-life socioeconomic status, body mass index, and blood pressure had little effect on these associations, but they were partially attenuated by adjustment for smoking, alcohol intake, intelligence, educational level, and late-life socioeconomic status. These associations were not primarily due to deaths from suicide.

Mental symptoms and cause-specific mortality among midlife employees

“…However, milder and self-reported mental symptoms are prevalent also among employed people, with repercussions on their functioning, work ability and even mortality [4]. In our study, all-cause mortality, after considering covariates, showed no associations with either prior GHQ or MCS.…”

“…It is estimated that people with mental disorders may lose 10 years of potential life, and that up to 14 % of deaths worldwide, i.e. each year eight million deaths, involve people with mental disorders [3, 4]. Such excess mortality risk concerns those with severe and diagnosed mental disorders, including schizophrenia, bipolar disorder, major depression and psychoses [3].…”

Tobacco-related mortality among persons with mental health and substance abuse problems

“…While large epidemiologic studies have examined mortality among persons with mental illness [18][19][20][21][22][23][24][25] and smaller studies have examined tobacco-related deaths among persons with substance abuse problems, [33][34] this is the first study of tobacco-related deaths among persons with mental health or substance abuse problems using population based data and including a general population comparison. First, as compared to the general population, tobacco-related deaths are much higher among persons who recently received substance abuse services alone or in combination with mental health services.…”

Increased intrasubject variability in response time in unaffected preschoolers at familial risk for bipolar disorder

“…BD is a chronic disease associated with high morbidity and mortality (Gale et al, 2012). Childhood-onset BD tends to be particularly severe and debilitating (Geller et al, 2004).…”