A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study
Open accessAbstract
BACKGROUND: Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder. METHODS: In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death. FINDINGS: 7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57-28·82] vs 12·95 deaths [12·93-12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91-1·94) for mood disorders to 3·91 (3·87-3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36-5·48) for organic disorders in females to 14·84 years (14·70-14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher. INTERPRETATION: Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death. FUNDING: Danish National Research Foundation.
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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”
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.
“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 [10]
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- Authors
- Plana-Ripoll, O., Pedersen, C. B., Agerbo, E., Holtz, Y., Erlangsen, A., Canudas-Romo, V., Andersen, P. K., Charlson, F. J., Christensen, M. K., Erskine, H. E., Ferrari, A. J., Iburg, K. M., Momen, N., Mortensen, P. B., Nordentoft, M., Santomauro, D. F., Scott, J. G., Whiteford, H. A., Weye, N., McGrath, J. J., & Laursen, T. M.
- Affiliations
- Aarhus University (DK)
- The University of Queensland (AU)
- Australian National University (AU)
- University of Copenhagen (DK)
- Lundbeck Foundation (DK)
- Corresponding author
- McGrath, John J
- ORCID
- Pedersen, Carsten Bøcker
- Agerbo, Esben
- Holtz, Yan
- Erlangsen, Annette
- Andersen, Per Kragh
- Charlson, Fiona J
- Christensen, Maria K
- Erskine, Holly E
- Ferrari, Alize J
- Iburg, Kim Moesgaard
- Momen, Natalie
- Mortensen, Preben Bo
- Nordentoft, Merete
- Santomauro, Damian F
- Scott, James G
- Whiteford, Harvey A
- Weye, Nanna
- McGrath, John J
- Laursen, Thomas M
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 394
- Issue
- 10211
- Pages
- 1827-1835
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2982028900
- Cited by
- 595
- References
- 29
- Citations by year
- 2026: 64 · 2025: 101 · 2024: 105 · 2023: 96 · 2022: 98 · 2021: 83 · 2020: 46 · 2019: 2
- FWCI
- 71.90
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (acceptedVersion, cc-by-nc-nd)
- ANU Open Research (Australian National University) (submittedVersion)
- Funders
- Danish National Research
- John Cade Fellowship (APP1056929)
- NHMRC (APP1138488, APP1137969, APP1121516, APP1105807)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- mental illness, premature mortality, mortality rate ratio, years of life lost, substance use disorders, mood disorders, organic mental disorders, suicide, homicide, accidents, external causes of death, sex differences, age differences, life expectancy, causes of death, Denmark, psychiatric hospitalization, mental health service utilization, mental health professionals
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Mental Disorders, Cause of Death, Denmark, Female, Humans, Male, Middle Aged, Registries, Suicide, Cohort Studies, Mood Disorders, Substance-Related Disorders, Quality Indicators, Health Care, Young Adult, Mortality, Premature
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