Mental illness can take years off a person’s life, but perhaps not as many as previously thought.
Recent research shows that serious and persistent mental illness can result in patients losing up to four years of life compared to individuals without mental illness.
Dr. Elizabeth E. Piatt from the Department of Behaviors and Community Health Services atNortheastern Ohio Universities Colleges of Medicine and Pharmacy in Rootstown, and her colleagues, examined death records of patients from a community mental health center, and from the general population. The researchers found an increase in premature mortality in the mentally ill patients, not only from suicide, but also cancer, accidents, liver disease and septicemia.
“We found that a community-based sample of adults with severe and persistent mental illness lost 14.5 years of potential life, a difference of 4.2 years from the (control) sample,” said Piatt.
It has been known for years that people with severe psychiatric illness have shorter lifespans, thought to be from 13.5 to 32 years shorter. More than 90 percent of suicides are as a result of a mental illness, and persons with bipolar disorder, for example, have a 10 to 20 percent lifetime risk of suicide. However, recent research has made clear that there is an increased mortality in patients with mental illness that is not directly explained by mental health issues, and is related to general medical problems.
However, most studies have tended to focus on inpatients. In addition, previous research has not directly compared years of potential life lost between mental health patients and individuals without mental illness. Thus the number of potential years of life lost may be lower than previously suggested.
“By not examining differences in premature mortality, the results of these studies may have overestimated (this outcome) in the population with serious mental illness,” note the authors.
To accurately assess the true impact of serious and persistent mental illness on years of potential life lost, Piatt and her colleagues retrospectively matched 647 case management files from patients who had been treated at a community health center prior to their deaths to 15,517 state death records from the general population.
The authors defined serious mental illness as schizophrenia and schizoaffective disorder, bipolar disorder, dysthymia, major depression,anxiety disorder and personality disorders. Individuals with dementiaand substance abuse disorders were not included in the study.
They found that the mean number of years of potential life lost for decedents with serious and persistent mental illness was 14.5 (standard deviation ± 10.6) compared to 10.5 (± 6.7) for the general population. The mean age of death for the psychiatric patients was 73.4 (± 15.4) years compared to 79.6 (± 10.9) years.
Heart disease was the leading cause of death for each group. After statistical adjustments were made for gender, race, education and marital status, the greatest differences in cause of death between the two groups were seen in suicide, cancer, accidents, liver disease, and septicemia.
Differences were also seen in every leading cause of death. However, even after adjusting for all the differences in cause of death, there was still a increased number of years of potential life lost that was not explained.
“Differences in cause of death did not explain the difference in years of potential life lost,” said Piatt.
These results are important in giving a more accurate picture of the true impact of serious and persistent mental illness on life expectency, and the nature of that impact. Patients with psychiatric disorders are not only at risk for psychiatric complications, but are also at greaterrisk for medical illness, and at an increased risk for more complicated medical disease and worse outcomes.
Patients with psychiatric illness may be more likely to engage in risky behaviors that result in accidents, or to smoke, or be less compliant with medications. Another recent study showed that patients with bipolar disorder are at an increased risk for heart disease. Other research has shown that patients admitted to psychiatric hospitals are at risk for increased mortality from general medical problems. In addition, some psychiatric medications, notably antipsychotics, canincrease the risk of diabetes, or heart disease.
Mental health practitioners have an opportunity to intervene not just in preventing suicides, but also in discouraging risky behavior, encouraging a healthy lifestyle, and general primary medical care.
“Integrating mental health care, primary health care, and wellness-promoting activities….may ensure access to the interventions needed to reverse the causes of preventable early death,” say Piatt and her team. “Morbidity and mortality from the most common causes of death in this sample…may be reduced by effective medical care that attempts prevention, early detection, and chronic disease management.”
The authors conclude: “Our work adds to the growing body of literature that highlights the need for better preventative health care for persons with mental illness. Along with ongoing suicide prevention programs, efforts to integrate primary and psychiatric care should focus on these preventable causes of death.”