Mortality of 403 patients with mood disorders 48 to 52 years after their psychiatric hospitalisation

Abstract

The purpose is to analyse differences in mortality among patients with major depressive disorders (MDD), bipolar-II (BP-II), bipolar-I (BP-I) disorders and mania with or without minor depressive disorders and to identify risk factors of mortality. The sample represents all admissions for depression or mania over 5 years (1959-1963) to the Psychiatric Hospital of Zurich University, serving a large area. 403 patients were included and followed up every 5 years until 1985; thereafter, mortality data were collected repeatedly until 2009 when 352 (87 %) patients had died. Standardised mortality ratios (SMRs) were computed and survival analyses applied. With the exception of BP-II disorder, the three other diagnostic groups showed elevated SMRs. The group with mania had the highest SMR for cardiovascular deaths and the group with MDD the highest for deaths by suicide. Mortality was also high among patients with late-onset MDD. Across the diagnostic spectrum, we found differences in risk factors for mortality, such as a family history of suicides and personality type: more anxious patients with MDD lived longer, and among patients with BP disorders, more tense (aggressive) types had shorter lives. Long-term medication had a protective effect against mortality in patients with MDD during years 1-9 and in patients with BP disorders during years 1-19 after admission. We found marked differences in causes of death and risk factors between subgroups of mood disorders. For the purpose of further research, it would be recommendable to distinguish pure mania from bipolar disorders.

Risk of myocardial infarction and stroke in bipolar disorder: a systematic review and exploratory meta‐analysis

“…There is a discrepancy between our study which showed no evidence of increased risk of myocardial infarction in BD and the relatively higher mortality rate of myocardial infarction in BD, in comparison to the general population (3, 44, 78). We postulate three possible explanations: i) patients with BD and the general population have similar rates of MI, but the lethality is greater in BD; this is supported by data reporting higher mortality rates of patients with severe mental illness (including BD) after admission due to acute heart disease (43); ii) patients with BD receive less medical care for MI than general population, either because they have poor access to health care (17) or lower rates of cardiovascular health care utilization and invasive cardiac diagnostic/therapeutic procedures (43); iii) patients with BD may be at higher risk of post-MI arrhythmias and sudden cardiac death (58) out of the hospital, which may underestimate the true risk of myocardial infarction.…”

Factor structure of the French version of the Hypomanic Personality Scale (HPS) in non-clinical young adults

“…The development of these scales is also essential in order to detect high-risk individuals as soon as possible so that intervention is not delayed and the likelihood that patients will receive appropriate treatment and therapeutic care is increased [3,4]. Such an approach is particularly relevant in the case of bipolar disorder (BD I and II), which is a cause of premature death and leads to a significant impairment of both social and cognitive functioning [5].…”

Suicides and Suicide Attempts during Long-Term Treatment with Antidepressants: A Meta-Analysis of 29 Placebo-Controlled Studies Including 6,934 Patients with Major Depressive Disorder

“…In the Zurich cohort of initially hospitalized patients, roughly 15% of individuals with major depressive disorder had committed suicide after 50 years [1]. Over the same period of time, the risk of completed suicide in a Swedish community sample of patients with depression averaged approximately 6%, whereas the risk amounted to 14% in the subgroup of patients with severe major depressive disorder [2].…”