Mental Illness Associated with 10 Years Lost Life Expectancy
Severe mental illness is one of the leading causes of death worldwide. Recently researchers led by E.R. Walker performed a meta-analysis of all cohort studies comparing people with mental illness to non-ill populations. They used five databases to find 203 eligible studies from 29 countries. Their findings, published in the journal JAMA Psychiatry in 2015, show that people with mental illness have a mortality rate 2.22 times higher than people without mental illness. People with mental illness lose a potential 10 years of life compared to those without severe mental disorders. The researchers estimated that 14.3% of deaths worldwide are attributable to mental illness.
Editor’s Note: Comorbid cardiovascular illness accounts for a large part of the disparity in life expectancy between people with and without mental illness. Those at risk for serious mental illness should pay close attention to their cardiovascular as well as psychiatric risk factors.
Gap in Life Expectancy Between Psychiatric Patients and the General Population Grows
A study published by Lawrence et al. in the journal BMJ in 2013 suggests that the gap in life expectancy between psychiatric patients and the general population is widening. This was due more to poor physical health than to suicide.
Investigators at the University of Western Australia in Perth found that within that geographic region, the gap in life expectancy for males with all mental disorders combined compared to males in the general population increased from 13.5 years in 1985 to 15.9 years in 2005. For females, the gap increased from 10.4 years in 1985 to 12.0 years in 2005.
Editor’s Note: Data from the US suggest even greater loss of years of life expectancy in those with serious mental illnesses. In the best case, in Virginia patients lost an average of 13 years of life expectancy compared to the general population, while in some western states up to 28 years of life expectancy was lost by the average patient.
Cardiovascular disease is one of the biggest contributors to these almost unbelievable statistics. It is possible that short telomeres resulting from stressors, episodes of depression, abused substances, and a variety of poor lifestyle factors such as smoking and lack of exercise also contribute to this huge deficit in longevity. Other factors that can co-occur with bipolar illness, such as inflammation, high cortisol, and oxidative stress, are likely problematic as well.
Lithium Reduces Suicide Rate and Increases Longevity
Suicide is an unfortunate consequence of bipolar disorder in 10-15% of patients. A study by Manchia et al. examined suicidal behavior in 737 families of bipolar patients, including 4,919 first-degree relatives. Suicidal behavior ran in families and was more prevalent in those with an early age of onset and a shorter duration of illness. The good news: lithium treatment decreased suicide risk independent of its degree of effectiveness in treating bipolar disorder. Those on lithium also had a longer median age of survival (73 versus 65 years).
Editor’s Note: These data are consistent with a variety of other studies and raise the question why lithium is used less frequently in the US than in many European countries and Canada. Given its neuroprotective effects, its prevention of suicide and dementia, and its positive effects on longevity, it is hard to see why lithium is not included in the treatment regimens of more patients (at whatever dosage is well-tolerated), even if it alone is not sufficient for treating their manic and depressive episodes.
Research (by this editor Robert Post and colleagues) shows that bipolar disorder is a more pernicious illness in almost all respects in the US compared to the Netherlands and Germany (International Journal of Neuropsychopharmacology, 2011). Whether bipolar illness would be less severe in the US if it were more often treated with lithium is an unanswered question. The field cannot provide an answer with systematic prospective controlled data, as most study designs would be unethical (i.e. would deny useful treatment to suffering patients), although one large randomized comparative study called BALANCE did show the superiority of lithium over valproate. However, individual patients in consultation with their physician could evaluate the evidence and request that lithium be considered in their treatment regimen.
If a patient has some clinical predictors of a likely good response to lithium, the decision to include lithium should be a slam-dunk. Some of these include: a positive family history of mood disorder, especially bipolar disorder; a classic course with distinct episodes and clear periods of wellness; manic episodes that are euphoric as opposed to dysphoric (i.e. anxious/irritable); lack of an anxiety disorder or substance abuse comorbidity; the absence of mood-incongruent delusions; and a sequence of episodes of mania followed by a depression and then a well interval (MDI) rather than the sequence of DMI.
