Life expectancies for individuals with psychiatric diagnoses

doi:10.1038/sj.ph.1900785

Public Health

Volume 115, Issue 5, September 2001, Pages 328-337

https://doi.org/10.1038/sj.ph.1900785 Get rights and content

Abstract

The aim of the study was to estimate life expectancies in different diagnostic groups for individuals treated as inpatients at Swedish psychiatric clinics. All individuals, older than 18 y and alive on the first of January 1983, who had been registered in the National Hospital Discharge Registry by a psychiatric clinic in 1978–82, were monitored for mortality during 1983 by using the National Cause of Death Registry. The study group consisted of 91 385 men and 77 217 women. The patients were divided into nine diagnostic groups according to the principal diagnosis registered at the latest discharge. Actuarial mathematics was used to construct life expectancy tables, which present the number of years expected to live, by gender and diagnostic group.

Expectancies of life were significantly shortened for both genders and in all nine diagnostic groups (with one exception).

Mental disorders in general are life shortening. This fact should be recognised in community health when setting health priorities. It should also be addressed in curricula as well as in treatment and preventive programmes. Public Health (2001) 115, 328–337.

Introduction

From abstracts of 152 mortality studies dealing with a large variety of psychiatric disorders, a recent review article concluded that all mental disorders are associated with an increased risk of premature death.¹ The size of the problem in terms of reduced life expectancy, is, however, not well known. In community health, mental disorders are sometimes prioritised because of their impact on disability and quality of life but not on mortality. This is due to the fact that deaths have traditionally been ascribed to their most proximate causes, not considering the underlying disorders leading to the final crisis.² In a recent Community Health report for Stockholm County Council, using Disability Adjusted Life Years (DALY) to measure the burden of disease, mental disorders were ranked as the largest health problem. However, only 8% of the disease burden was ascribed to mortality whilst 92% was ascribed to disability.³ Nor has the increased mortality in mental disorders been noticed when using other estimates than DALY to set health priorities.⁴ This clearly indicates the need to communicate mortality data for mental disorders in a way that is real, not only to medical researchers, but also to politicians and administrators concerned with public health issues.

Studies that deal with mortality in psychiatric disorders generally present their results in terms of mortality ratios or crude death rates. Since such mortality measures are affected by the age distribution of the population involved, results from different studies are seldom comparable. Life-expectancy tables, which present the number of years expected to live, are, on the other hand, independent of the age distribution and provide reliable statistical measures for future replication and international comparison.⁵ To elucidate the general health status of a nation in relation to that of other nations, life-expectancy tables are periodically produced for practically all countries of the world.⁶ Apart from being comparable, such tables are easy to understand and have led to an increased public awareness of the severity of the health situation in certain countries.

The aim of the present study was to provide life-expectancy tables in 1983 for nine different diagnostic groups in a total cohort of individuals treated as inpatients at Swedish psychiatric clinics in the time period 1978–82.

Section snippets

Material and methods

The persons examined for mortality consisted of all persons registered in the Swedish National Hospital Discharge Registry⁷ in 1978–82 with records that fulfilled the following criteria:

•
The person had a valid Swedish personal identification number
•
The person was still alive and at least 18-y-old on the first of January 1983
•
The discharge clinic was psychiatric
•
The person was not admitted to a psychiatric clinic during December 1982

The study group consisted of 91 385 men and 77 217 women, at the

Results

The life expectancy estimates are given in Table 2 for men and in Table 3> for women. To provide comparison material, the tables include life expectancies for the general population of Sweden, and for people who had survived the acute phase (=1 month) of myocardial infarction (ICD-8=410),⁹ and stroke (ICD-8=430–438).¹¹ The life-expectancy ratios—the expectancy of remaining life as a proportion of that among people of the same gender and age in the general population of Sweden—are given in the

Discussion

In the form of life tables for the calendar year 1983, the present study has provided comparable survival-indices that are independent of the age distributions of the involved populations. The material used has been extensive; virtually all treated psychiatric inpatients (168 602 individuals) during five years. Apart from confirming earlier conclusions that psychiatric disorders are life-shortening conditions, we have illustrated the size of the problem in terms of reduced life expectancy. We

Acknowledgements

The material used in this study was collected as part of a Government initiated review and analysis of the content and quality of psychiatric services in Sweden, carried out by the Swedish National Board of Health and Welfare.

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Mental disorders are associated with premature mortality. There is increasing research examining life expectancy and years-of-potential-life-lost (YPLL) to quantify the disease impact on survival in people with mental disorders. We aimed to systematically synthesize studies to estimate life expectancy and YPLL in people with any and specific mental disorders across a broad spectrum of diagnoses.
In this systematic review and meta-analysis, we searched Embase, MEDLINE, PsychINFO, WOS from inception to July 31, 2023, for published studies reporting life expectancy and/or YPLL for mental disorders. Criteria for study inclusion were: patients of all ages with any mental disorders; reported data on life expectancy and/or YPLL of a mental-disorder cohort relative to the general population or a comparison group without mental disorders; and cohort studies. We excluded non-cohort studies, publications containing non-peer-reviewed data or those restricted to population subgroups. Survival estimates, i.e., life expectancy and YPLL, were pooled (based on summary data extracted from the included studies) using random-effects models. Subgroup analyses and random-effects meta-regression analyses were performed to explore sources of heterogeneity. Risk-of-bias assessment was evaluated using the Newcastle–Ottawa Scale. This study is registered with PROSPERO (CRD42022321190).
Of 35,865 studies identified in our research, 109 studies from 24 countries or regions including 12,171,909 patients with mental disorders were eligible for analysis (54 for life expectancy and 109 for YPLL). Pooled life expectancy for mental disorders was 63.85 years (95% CI 62.63–65.06; I² = 100.0%), and pooled YPLL was 14.66 years (95% CI 13.88–15.98; I² = 100.0%). Disorder-stratified analyses revealed that substance-use disorders had the shortest life expectancy (57.07 years [95% CI 54.47–59.67]), while neurotic disorders had the longest lifespan (69.51 years [95% CI 67.26–71.76]). Substance-use disorders exhibited the greatest YPLL (20.38 years [95% CI 18.65–22.11]), followed by eating disorders (16.64 years [95% CI 7.45–25.82]), schizophrenia-spectrum disorders (15.37 years [95% CI 14.18–16.55]), and personality disorders (15.35 years [95% CI 12.80–17.89]). YPLLs attributable to natural and unnatural deaths in mental disorders were 4.38 years (95% CI 3.15–5.61) and 8.11 years (95% CI 6.10–10.13; suicide: 8.31 years [95% CI 6.43–10.19]), respectively. Stratified analyses by study period suggested that the longevity gap persisted over time. Significant cross-study heterogeneity was observed.
Mental disorders are associated with substantially reduced life expectancy, which is transdiagnostic in nature, encompassing a wide range of diagnoses. Implementation of comprehensive and multilevel intervention approaches is urgently needed to rectify lifespan inequalities for people with mental disorders.
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Excess mortality in people with schizophrenia has been extensively reported. However, little is known about the life expectancy and potential years of life lost (PYLL) in western China. This study aimed to estimated life expectancy and PYLL for people with schizophrenia in western China. A total of 228,572 people with schizophrenia were included from National Information System for Psychosis in one province of western China. Life-expectancy was calculated by using Chiang's method. One-way ANOVA was used to compare the age-sex standardized PYLL for different causes of death among different demographic characteristics groups. Life expectancy for men and women with schizophrenia was 52.8 years and 59.0 years respectively. The overall PYLL of people with schizophrenia was 18.4 years, and suicide had the largest PYLL (31.2 years) among all causes of mortality. The PYLL due to suicide was significantly higher among men, high school and above, non-poverty, non-farmer and divorced people with schizophrenia. The PYLL due to diseases and medical conditions was higher among men, illiteracy, farmer and unmarried people with schizophrenia. Strategies to prevent causes of premature death in schizophrenia are urgently required in western China, particularly in the promotion of physical health and prevention of suicide.
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Substance use disorders (SUD) are associated with increased morbidity, mortality, and higher health care costs (Darke et al., 2006; Hannerz et al., 2001).
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Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis
2017, The Lancet Psychiatry
Citation Excerpt :
All but seven (1%) were selected for inclusion by one author (CH or AES), and all disagreements were resolved through discussion by these two authors. Reading of full-text papers detected 13 publications that met the inclusion criteria.12–24 Two of these publications were conference abstracts12,20 for which full-text publications were also available;13,21 therefore, 11 relevant studies were represented, nine (82%) presenting information on years of potential life lost and six (55%) on life expectancy (figure 1, table).
Several studies and meta-analyses have shown that mortality in people with schizophrenia is higher than that in the general population but have used relative measures, such as standardised mortality ratios. We did a systematic review and meta-analysis to estimate years of potential life lost and life expectancy in schizophrenia, which are more direct, absolute measures of increased mortality.
We searched MEDLINE, PsycINFO, Embase, Cinahl, and Web of Science for published studies on years of potential life lost and life expectancy in schizophrenia. Data from individual studies were combined in meta-analyses as weighted averages. We did subgroup analyses for sex, geographical region, timing of publication, and risk of bias (estimated with the Newcastle-Ottawa Scale).
We identified 11 studies in 13 publications covering all inhabited continents except South America (Africa n=1, Asia n=1, Australia n=1, Europe n=7, and North America n=3) that involved up to 247 603 patients. Schizophrenia was associated with a weighted average of 14·5 years of potential life lost (95% CI 11·2–17·8), and was higher for men than women (15·9, 13·8–18·0 vs 13·6, 11·4–15·8). Loss was least in the Asian study and greatest in Africa. The overall weighted average life expectancy was 64·7 years (95% CI 61·1–68·3), and was lower for men than women (59·9 years, 95% CI 55·5–64·3 vs 67·6 years, 63·1–72·1). Life expectancy was lowest in Asia and Africa. Timing of publication and risk of bias had little effect on results.
The effects of schizophrenia on years potential life lost and life expectancy seem to be substantial and not to have lessened over time. Development and implementation of interventions and initiatives to reduce this mortality gap are urgently needed.
None.

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ArticlesLife expectancies for individuals with psychiatric diagnoses

Abstract

Introduction

Section snippets

Material and methods

Results

Discussion

Acknowledgements

Theor Popul Biol.

J Affect Disord

Lancet

Compr Psychiatry

Soc Sci Med.

Excess mortality of mental disorder

Br J Psychiat.

Setting health priorities in a Swiss canton: what do different methods tell us?

J Epidemiol Community Health

Life expectancy of mentally retarded persons in Canadian institutions

Am J Ment Defic.

Demographic yearbook 1992

Klassifikation av sjukdomar

Korttidsdödlighet bland hjärtinfarktpatienter vid svenska akutsjukhus 1987–91

Korttidsdödlighet bland hjärtinfarktpatienter vid svenska akutsjukhus 1992–94

Methodology and applications of a new law of mortality

Dödsorsaker 1994

Applied mathematical demography

Past and recent attempts to model mortality at all ages

JOS

Mortality among persons with a history as psychiatric inpatients with functional psychosis

Soc Psychiatry Psychiatr Epidemiol

Outcome in Mania. A 4-year prospective follow-up of 75 patients utilizing survival analysis

Arch Gen Psychiatry

Predictors of relapse during fluoxetine continuation or maintenance treatment of major depression

J Clin Psychiatry

Articles
Life expectancies for individuals with psychiatric diagnoses