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Mortality in Mental Disorders and Global Disease Burden Implications: A Systematic Review and Meta-analysis
Open accessAbstract
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, 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]
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“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]
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“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]
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“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]
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“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]
In the citing paper
“Severe mental and behavioral disorders appear to be associated with reduced life expectancy, both in terms of mortality from external causes and mortality from other medical conditions or diseases.10,11”
From Mortality in Persons With Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis (2022) · cites this paper as [11]
In the citing paper
“the leading causes of years of life lost in people with mental illness are due to 'poor physical health', specifically with regards to non-communicable and infectious diseases which exist as a comorbidity to the psychiatric symptoms which characterise mental illness.”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [13]
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“Although suicide contributes to a devastating proportion of these premature deaths (with ~17% of mortality in people with mental illness attributed to unnatural causes) 12,13”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [13]
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“and Campos et al 13 reported the prevalence of syphilis to range from 1.1% to 7.6% in 4 studies.”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [13]
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“Prevalence rates varied from 1.1% to 7.6%.No pooling of data.”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [13]
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Metadata
- Authors
- Walker, E. R., McGee, R. E., & Druss, B. G.
- Affiliations
- Emory University (US)
- Corresponding author
- Walker, Elizabeth Reisinger
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2015-04-01
- Volume
- 72
- Issue
- 4
- Pages
- 334
- ISSN
- 2168-622X (ISSN-L)
- 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
- FWCI
- 307.84
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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