Mortality among People with Severe Mental Disorders Who Reach Old Age: A Longitudinal Study of a Community-Representative Sample of 37892 Men

Abstract

BackgroundSevere mental illnesses are leading causes of disability worldwide. Their prevalence declines with age, possibly due to premature death. It is unclear, however, if people with severe mental disorders who reach older age still have lower life expectancy compared with their peers and if their causes of death differ.Methods and FindingsCohort study of a community-representative sample of 37892 Australian men aged 65–85 years in 1996–1998. Follow up was censored on the 31st December 2010. Lifetime prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorder was established through record linkage. A subsample of 12136 consented to a face-to-face assessment of sociodemographic, lifestyle and clinical variables. Information about causes of death was retrieved from the Australian Death Registry. The prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorders was 1.2%, 0.3%, 2.5% and 1.8%. The mortality hazard for men with a severe mental disorder was 2.3 and their life expectancy was reduced by 3 years. Mortality rates increased with age, but the gap between men with and without severe mental disorders was not attenuated by age. Cardiovascular diseases and cancer were the most frequent causes of death. The excess mortality associated with severe mental disorders could not be explained by measured sociodemographic, lifestyle or clinical variables.ConclusionsThe excess mortality associated with severe mental disorders persists in later life, and the causes of death of younger and older people with severe mental disorders are similar. Hazardous lifestyle choices, suboptimal access to health care, poor compliance with treatments, and greater severity of medical comorbidities may all contribute to this increased mortality. Unlike young adults, most older people will visit their primary care physician at least once a year, offering health professionals an opportunity to intervene in order to minimise the harms associated with severe mental disorders.

Mortality and Its Determinants in Late-Life Schizophrenia: A 5-Year Prospective Study in a Dutch Catchment Area

“…14 In the sample of Chang and colleagues, 15 year follow-up. 19 The excess mortality in men compared to women in schizophrenia may be related to various factors, such as smoking, 8 substance abuse, 20 and treatment noncompliance, 21 that are all more prevalent in men. A milder disease course in women may be of significance as well, although in later onset cases the reverse may be true.…”

Does bipolar disorder have a benign course?

“…Consistent with this idea, a Danish case-register study found that the risk of dementia in bipolar disorder increased with the number of affective episodes (Kessing and Andersen, 2004), and was less marked among patients receiving continuous treatment with lithium (but not with other mood stabilizers) (Kessing et al, 2010). Bipolar disorder has also been associated with increased mortality (Almeida et al, 2014), including death by suicide (Schaffer et al, 2015). A systematic review and meta-analysis of 31 studies that included over 300,000 people with bipolar disorder found that the condition more than doubled the risk of premature death both from natural and non-natural causes (such as suicide or accidents) (Hayes et al, 2015).…”

“…However, recent data suggest that the euthymic periods are not entirely free of impairments, and that the long-term outcome of people with bipolar disorder is, in at least some cases, associated with cognitive deficits, poor function, and increased risk of dementia and death (Kessing et al, 1999;Bourne et al, 2013;Almeida et al, 2014;Almeida et al, 2016b).…”

A Randomized Clinical Trial Investigating the Effect of a Healthcare Access Model for Individuals with Severe Psychiatric Disabilities

“…There is burgeoning evidence that individuals with severe psychiatric disabilities experience higher than average rates of chronic and life-threatening diseases, including, among others, diabetes, cardiovascular disease, and pulmonary diseases, all of which lead to premature mortality and elevated rates of morbidity within the United States (Capasso et al 2008;Chacón et al 2011;Chafetz et al 2006;Colton and Manderscheid 2006;Lambert et al 2003;Scott and Happell 2011; Substance Abuse and Mental Health Services Administration 2012; Weber et al 2011) and throughout the world (Harris and Barraclough 1998;Saha et al 2007;Currie et al 2014;Almeida et al 2014). Studies suggests that this excess mortality and morbidity are influenced by problems of healthcare access, socioeconomic, and clinical risk factors (Almeida et al 2014;Druss et al 2011).…”

“…Studies suggests that this excess mortality and morbidity are influenced by problems of healthcare access, socioeconomic, and clinical risk factors (Almeida et al 2014;Druss et al 2011). This accumulating evidence has prompted an increased emphasis on improved physical health as an important dimension in promoting recovery (Hutchinson et al 2006; Substance Abuse and Mental Health Services Administration, & Center for Behavioral Health Statistics and Quality 2009; Druss and Mauer 2010), research on new interventions to promote health and wellness (Druss et al 2010a, b), as well as a focus on comprehensive and coordinated treatment (Parks et al 2006;President's New Freedom Commission on Mental Health 2003;Thompson et al 2006).…”