Some Mental Health Issues as Harmful as a Pack a Day

Serious mental disorders reduced life expectancy by 10 to 20 years

(RxWiki News) Mental health isn't just about what's going on in patients' heads. Mental health issues also can affect physical health. And the lack of awareness about the physical side of mental health may have serious consequences.

A recent review of studies found that many mental health diagnoses had the potential to reduce life expectancy by as much as smoking 20 or more cigarettes per day.

The researchers suggested that many mental health patients may not get the physical health attention that they need because mental health and physical health are often treated as two separate public health problems.

"Learn how your mental health condition may affect physical health."

The lead author of this review was Seena Fazel, MD, FRCPsych, from the Department of Psychiatry at the University of Oxford and the Warneford Hospital in Oxford, United Kingdom.

The review included 20 study reviews published between January 1, 1998 and February 19, 2014 on the risk of death by any cause and suicide death risk associated with 21 different mental disorders.

The papers included over 1.7 million people with mental health issues and over 250,000 deaths.

The included diagnoses involved a range of mental health issues, substance and alcohol abuse, dementia, autism spectrum disorders, learning disability and childhood behavioral disorders.

The current review also included 14 previously published individual studies on the links between mental health issues and life expectancy.

Dr. Fazel and colleagues compared the risk of death for each disorder with that of heavy smoking (20 or more cigarettes per day), which carried a 2.6-fold increased risk of all-cause death compared to the death risk of the general population. Heavy smoking also reduced life expectancy by an average of 8 to 10 years.

The findings showed that all of the participants with mental disorders had an increased risk of death from any cause compared to the general population. However, the risk of all-cause death significantly varied according to mental disorder.

Compared to the risk of all-cause death among the general population, dysthymia (a mild form of chronic depression) was associated with a 40 percent increased risk of all-cause death, whereas opiate use disorders increased that risk by almost 15 times.

Substance abuse disorders and anorexia had the highest all-cause death risks among the considered disorders.

Schizophrenia and autism carried all-cause death risks that were equal to that of heavy smoking.

The researchers also discovered that the pattern of suicide risks differed from that of all-cause death.

The highest suicide risks were associated with borderline personality disorder, depression, bipolar disorder, opioid use and schizophrenia, as well as anorexia and alcohol use disorder among women.

Borderline personality disorder carried the highest suicide risk among all the disorders, with the suicide risk being 45 times that of the general population.

The average reduction in life expectancy was 7 to 11 years for depression, 9 to 24 years for substance use, 13 to 22 years for personality disorders, 10 to 20 years for schizophrenia, and 9 to 20 years for bipolar disorder.

"There are likely to be many reasons for this. High-risk behaviors are common in psychiatric patients, especially drug and alcohol abuse, and they are more likely to die by suicide. The stigma surrounding mental health may mean people aren't treated as well for physical health problems when they do see a doctor," Dr. Fazel said in a press statement.

He explained that mental and physical health tend to be seen as two separate things, despite the fact that mental health issues often have physical side effects, such as heart disease, cancer and diabetes. In addition, mental health patients may not have access to effective health care because of their condition.

However, Dr. Fazel maintained, “All of this can be changed. There are effective drug and psychological treatments for mental health problems. We can improve mental health and social care provision. That means making sure people have straightforward access to health care, and appropriate jobs and meaningful daytime activities. It'll be challenging, but it can be done.”

Dr. Fazel and team concluded that mental health should be pushed as a public health issue the same way that cigarettes are recognized as a big issue.

This review was limited because the quality of the research reviewed varied from study to study. In addition, suicide rates were self-reported, and underreporting is common in some countries.

Furthermore, the researchers only looked at inpatient data, which represent the most severe cases of mental disorders, so the findings may overestimate the risks associated with various disorders.

Lastly, a lot of the data came from large databases.

This open access review was published on May 22 in World Psychiatry.

The Wellcome Trust provided funding.

Review Date: 
May 22, 2014