Externally caused deaths for adults with substance use and mental disorders

Abstract

For decades, there have been reports of shorter life expectancy among those with mental illness, especially those with more serious psychiatric disorders. The purpose of this study was to compare the risk of mortality among Medicaid beneficiaries, aged 18-64 years, treated for mental illness to a comparable group who were not mentally ill and to the general population. The data used were from the Massachusetts Division of Medical Assistance and records of deaths from the Department of Public Health in Massachusetts. Individuals treated for both psychiatric illness and substance use disorders (dual diagnoses) were compared separately from those whose treatment was only for a psychiatric disorder. For all Medicaid beneficiaries, the most common causes of death were attributed to heart disease and cancer. When compared to the general population, adjusted odds ratios estimated death by injury to be twice as likely among the mentally ill when compared to the general population. Medicaid beneficiaries with dual diagnoses are 6-8 times more likely to die of injury, primarily poisoning, than their counterparts treated for medical conditions only.

Life expectancy at birth and all-cause mortality among people with personality disorder

“…More generally, mental disorders are linked to poor health through unhealthy lifestyle [25,26], physical consequences of psychotropic medication [3], and problems accessing medical care [27]; some or all of these factors may account for reduced survival in people with PD. Substance use disorders are a major cause of death and disability [1,9] and frequently co-occur with PD, particularly in young people with Cluster B PD [28], and the particularly high SMR for Cluster B PD may reflect unhealthy lifestyles characterised by heavy substance use and smoking. Patients with PD are often prescribed excessive doses of psychotropic and non-psychotropic medications [29] which themselves may potentially lead to unwanted physical consequences.…”

“…People with mental disorders die prematurely for a variety of reasons, including poor physical health [3][4][5], adverse physiological consequences of long term psychotropic medication, unhealthy lifestyle [5], as well as increased death rates as a result of suicide, accidents and homicide [6][7][8]. The risk of increased mortality has been shown to vary according to type of mental disorder, with substance use disorders conferring a particularly high risk of early death [1,9,10].…”

Analysis of Causes of Death for All Decedents in Ohio With and Without Mental Illness, 2004–2007

“…Individuals with undiagnosed or untreated mental illness have a higher risk of dying prematurely from unintentional and intentional violence. 1,2,3,4 Evert, et al 5 , recommend that public health planners have better access to mortality information to identify and prioritize policy, resources, and health promotion activities for special populations.…”

“…2,6,7,8,9 Previously published studies in this area have been limited to mental illness population subgroups, e.g., severe mental illness patients using inpatient, residential or case management services, or Medicaid enrollees. 2,4,10 To address the sample limitations of previous studies, we linked all Ohio deaths (438,749) with deaths within the Ohio publicly-funded system (30,219 deaths identified, including 14,506 with mental health service claims, out of 1.3 million living individuals). We did not include in the analysis of this study deaths of individuals identified within the ODMH databases who did not receive services through ODMH.…”

“…2,6 This finding is particularly troubling when increased mortality is due to treatable medical conditions and preventable complications. Chronic conditions may be modified by consumer-level interventions, e.g.…”