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Cited by 2,976Mental Health Treatment and AccessSuicide and Self-Harm StudiesSchizophrenia research and treatment

Mortality in Mental Disorders and Global Disease Burden Implications: A Systematic Review and Meta-analysis

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Walker, Elizabeth Reisinger, McGee, Robin E., Druss, Benjamin G.·2015·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2014.2502PMC PMC4461039
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Abstract

IMPORTANCE: Despite the potential importance of understanding excess mortality among people with mental disorders, no comprehensive meta-analyses have been conducted quantifying mortality across mental disorders. OBJECTIVE: To conduct a systematic review and meta-analysis of mortality among people with mental disorders and examine differences in mortality risks by type of death, diagnosis, and study characteristics. DATA SOURCES: We searched EMBASE, MEDLINE, PsychINFO, and Web of Science from inception through May 7, 2014, including references of eligible articles. Our search strategy included terms for mental disorders (eg, mental disorders, serious mental illness, and severe mental illness), specific diagnoses (eg, schizophrenia, depression, anxiety, and bipolar disorder), and mortality. We also used Google Scholar to identify articles that cited eligible articles. STUDY SELECTION: English-language cohort studies that reported a mortality estimate of mental disorders compared with a general population or controls from the same study setting without mental illness were included. Two reviewers independently reviewed the titles, abstracts, and articles. Of 2481 studies identified, 203 articles met the eligibility criteria and represented 29 countries in 6 continents. DATA EXTRACTION AND SYNTHESIS: One reviewer conducted a full abstraction of all data, and 2 reviewers verified accuracy. MAIN OUTCOMES AND MEASURES: Mortality estimates (eg, standardized mortality ratios, relative risks, hazard ratios, odds ratios, and years of potential life lost) comparing people with mental disorders and the general population or people without mental disorders. We used random-effects meta-analysis models to pool mortality ratios for all, natural, and unnatural causes of death. We also examined years of potential life lost and estimated the population attributable risk of mortality due to mental disorders. RESULTS: For all-cause mortality, the pooled relative risk of mortality among those with mental disorders (from 148 studies) was 2.22 (95% CI, 2.12-2.33). Of these, 135 studies revealed that mortality was significantly higher among people with mental disorders than among the comparison population. A total of 67.3% of deaths among people with mental disorders were due to natural causes, 17.5% to unnatural causes, and the remainder to other or unknown causes. The median years of potential life lost was 10 years (n = 24 studies). We estimate that 14.3% of deaths worldwide, or approximately 8 million deaths each year, are attributable to mental disorders. CONCLUSIONS AND RELEVANCE: These estimates suggest that mental disorders rank among the most substantial causes of death worldwide. Efforts to quantify and address the global burden of illness need to better consider the role of mental disorders in preventable mortality.

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  • Individuals with mental disorders are at an increased risk of early mortality from a range of physical illnesses and injuries, such as suicide and homicide, but these are categorised as separate causes within GBD.

    “Individuals with mental disorders are at an increased risk of early mortality from a range of physical illnesses and injuries, such as suicide and homicide, 2,38 but these are categorised as separate causes within GBD.”

    From Updated trends in the global prevalence and burden of mental disorders, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023 (2026) · cites this paper as [38]

    The Results (Mortality) report elevated mortality among people with mental disorders from both natural and unnatural causes. The Discussion identifies cardiovascular disease and suicide as examples, but the passages do not specifically identify homicide. The GBD classification clause follows the citation and is not judged as attributed to this source. (LLM, conf=0.82)

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  • Mortality rates are approximately two to three times increased in people with severe mental illness.

    “A recent meta-analysis 4 documented that mortality rates are approximately two to three times increased in these people.”

    From Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis (2017) · cites this paper as [4]

    The Discussion reports a mortality rate 2.22 times higher for people with mental disorders than for the general population or people without mental disorders. The Results > Mortality section says mortality is elevated for psychoses, but the 2.22 estimate pools a broader range of disorders; it is not an estimate specifically for people with severe mental illness. (LLM, conf=0.86)

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  • Excess deaths in people with mental disorders occur not just from suicide and other external causes but also from infectious diseases, neoplasms, diabetes, and circulatory system and respiratory diseases.

    “Alternative mortality-based metrics have shown that excess deaths in people with mental disorders occur not just from suicide and other external causes but also from infectious diseases, neoplasms, diabetes, and circulatory system and respiratory diseases.34, 35”

    From Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. (2022) · cites this paper as [35]

    The Results (Mortality; page unavailable) find elevated mortality from both natural and unnatural causes among people with mental disorders. The Discussion identifies suicide and cardiovascular disease, and the introductory passage mentions infections, heart disease, and other chronic diseases. Our copy does not establish the claim’s more specific list of excess deaths from neoplasms, diabetes, and respiratory diseases. (LLM, conf=0.88)

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  • Psychotic illness presents unique challenges in engaging patients and, along with other mental illnesses, contributes to excess early mortality in international studies and in the DTES.

    “Psychotic illness itself presents unique challenges in engaging patients and, along with other mental illnesses, contributes to excess early mortality in international studies 16-18 as well as in the DTES. 19,20”

    From The Hotel Study—Clinical and Health Service Effectiveness in a Cohort of Homeless or Marginally Housed Persons (2017) · cites this paper as [17]

  • 67.3% of deaths in individuals with mental disorders result from physical illnesses, while 17.5% are due to unnatural causes.

    “67.3% of deaths in individuals with mental disorders result from physical illnesses, while 17.5% are due to unnatural causes[18].”

    From A retrospective and comprehensive analysis of excess life-years lost, mortality risk, and cause of death among severe mental illness in China (2025) · cites this paper as [18]

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Authors
Walker, E. R., McGee, R. E., & Druss, B. G.
Affiliations
Emory University (US)
Corresponding author
Walker, Elizabeth Reisinger
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2015-04-01
Volume
72
Issue
4
Pages
334
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2014.2502
PMC
PMC4461039
OpenAlex
W2097572674
Cited by
2,976
References
43
Citations by year
2026: 222 · 2025: 322 · 2024: 335 · 2023: 338 · 2022: 334 · 2021: 317 · 2020: 303 · 2019: 234 · 2018: 202 · 2017: 186 · 2016: 139 · 2015: 36 · 2014: 1 · 2013: 1
FWCI
307.84
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (5K24 MH07586703, K24MH075867)
  • National Institute of General Medical Sciences (K12 GM 00680-05, K12GM000680)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
mental illness, excess mortality, all-cause mortality, severe mental illness, schizophrenia, depression, anxiety, bipolar disorder, years of potential life lost, population attributable risk, global burden of disease, causes of death, standardized mortality ratio, relative risk, health equity, health disparities, health workforce shortage, health care costs
MeSH terms
Mental Disorders, Cause of Death, Humans, Life Expectancy, Risk Factors, Cohort Studies, Cost of Illness, Internationality

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