Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders
Open accessAbstract
Background: People with mental disorders evince excess mortality due to natural and unnatural deaths. The relative life expectancy of people with mental disorders is a proxy measure of effectiveness of social policy and health service provision. Aims: To evaluate trends in health outcomes of people with serious mental disorders. Method: We examined nationwide 5-year consecutive cohorts of people admitted to hospital for mental disorders in Denmark, Finland and Sweden in 1987–2006. In each country the risk population was identified from hospital discharge registers and mortality data were retrieved from cause-of-death registers. The main outcome measure was life expectancy at age 15 years. Results: People admitted to hospital for a mental disorder had a two- to threefold higher mortality than the general population in all three countries studied. This gap in life expectancy was more pronounced for men than for women. The gap decreased between 1987 and 2006 in these countries, especially for women. The notable exception was Swedish men with mental disorders. In spite of the positive general trend, men with mental disorders still live 20 years less, and women 15 years less, than the general population. Conclusions: During the era of deinstitutionalisation the life expectancy gap for people with mental disorders has somewhat diminished in the three Nordic countries. Our results support further development of the Nordic welfare state model, i.e. tax-funded community-based public services and social protection. Health promotion actions, improved access to healthcare and prevention of suicides and violence are needed to further reduce the life expectancy gap.
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In the Nordic countries, women and men with severe mental disorders have an approximately 15 and 20 years shorter life expectancy, respectively, than the general population.
“In the Nordic countries, women and men with severe mental disorders have an approximately 15 and 20 years shorter life expectancy, respectively, than the general population [8].”
From Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries. (2013) · cites this paper as [8]
Mental illness is broadly associated with poorer physical health outcomes, epitomised by a 15- to 20-year mortality gap between individuals with serious mental illness and the general population.
“Mental illness is broadly associated with poorer physical health outcomes; the severity of which is epitomised by a 15- to 20-year mortality gap between individuals with serious mental illness and the general population [104••, 105, 106].”
From Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety (2018) · cites this paper as [106]
People with schizophrenia and other psychotic disorders die earlier than their peers in the general population, by around 15-20 years according to recent estimates.
“People with schizophrenia and other psychotic disorders die earlier than their peers in the general population, with recent estimates suggesting by around 15–20 years.1–10”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [10]
Wahlbeck et al noted that variation in unnatural-cause mortality by sex may result from differences in help-seeking behavior.
“Wahlbeck et al 10 noted that variation in unnatural-cause mortality by sex may result from differences in help-seeking behavior”
From Mortality in Schizophrenia and Other Psychoses: A 10-Year Follow-up of the ӔSOP First-Episode Cohort (2015) · cites this paper as [10]
Mental disorder is an established risk factor for increased mortality.
“Mental disorder is an established risk factor for increased mortality [1, 2].”
From Life expectancy at birth and all-cause mortality among people with personality disorder (2012) · cites this paper as [2]
A Nordic research collaboration has shown that mortality among patients with severe mental disorders decreased slightly from 1987 to 2006, and that it still is at a very high level.
“A Nordic research collaboration to exploit these register-based possibilities has shown that this mortality decreased slightly from 1987 to 2006, and also that it still is at a very high level.”
From Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden (2013) · cites this paper as [14]
Patients with severe mental disorders have a life expectancy that is approximately 15-20 years shorter than the general population in Denmark, Finland and Sweden.
“Patients with severe mental disorders have a life expectancy that is approximately 15–20 years shorter than the general population in Denmark, Finland and Sweden. [14]”
From Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden (2013) · cites this paper as [14]
In a large register-based study for Denmark, Finland and Sweden, the authors could not confirm that the mortality gap increased over time.
“However, in a large register-based study for Denmark, Finland and Sweden, we could not confirm this finding. [14].”
From Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden (2013) · cites this paper as [14]
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- Authors
- Wahlbeck, K., Westman, J., Nordentoft, M., Gissler, M., & Laursen, T. M.
- Affiliations
- Nordic School of Public Health (SE)
- Bispebjerg Hospital (DK)
- Finnish Institute for Health and Welfare (FI)
- Aarhus University (DK)
- Corresponding author
- Wahlbeck, Kristian
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2011-12
- Volume
- 199
- Issue
- 6
- Pages
- 453-458
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2105984674
- Cited by
- 623
- References
- 37
- Citations by year
- 2026: 9 · 2025: 25 · 2024: 32 · 2023: 31 · 2022: 42 · 2021: 45 · 2020: 41 · 2019: 53 · 2018: 44 · 2017: 40 · 2016: 44 · 2015: 44 · 2014: 53 · 2013: 90 · 2012: 24
- FWCI
- 75.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- WOS
- Funders
- Nordisk Ministerråd
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- life expectancy, mental illness, mortality gap, severe mental illness, deinstitutionalization, welfare state typology, sex differences, suicide prevention, mental health services, Nordic countries, Denmark, Finland, Sweden
- MeSH terms
- Suicide Prevention, Adolescent, Adult, Aged, Mental Disorders, Cause of Death, Denmark, Female, Finland, Health Policy, Hospitalization, Hospitals, Psychiatric, Humans, Institutionalization, Life Expectancy, Male, Mental Health Services, Middle Aged, Organizational Innovation, Sweden, Outcome Assessment, Health Care, Sex Distribution, Health Status Disparities, Young Adult
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