Frailty in individuals with depression, bipolar disorder and anxiety disorders: longitudinal analyses of all-cause mortality

Abstract

Background: Frailty is a medical syndrome that is strongly associated with mortality risk, and an emerging global health burden. Mental disorders are associated with reduced life expectancy and elevated levels of frailty. In this study, we examined the mortality risk associated with frailty in individuals with a lifetime history of mental disorders compared to non-psychiatric controls. Methods: The UK Biobank study recruited >500,000 adults, aged 37-73, between 2006-2010. We derived the two most common albeit distinctive measures of frailty, the frailty phenotype and the frailty index. Individuals with lifetime depression, bipolar disorder or anxiety disorders were identified from multiple data sources. The primary outcome was all-cause mortality. We have also examined differences in frailty, separately by sex and age. Outcomes: Analyses included up to 297,380 middle-aged and older adults with a median follow-up of 12.19 (IQR=1.31) years, yielding 3,516,706 person-years of follow-up. We observed higher levels of frailty in individuals with mental disorders for both frailty measures. For key comparisons, individuals with a mental disorder had greater all-cause mortality hazards than their controls. The highest hazard ratio (3.65, 95% CI 2.40-5.54) was observed among individuals with bipolar disorder and frailty, relative to the non-frail controls. Interpretation: Our findings highlight elevated levels of frailty across three common mental disorders. The increased mortality risk associated with frailty and mental disorders represents a potentially modifiable target for prevention and treatment to improve life expectancy. Funding: Biotechnology and Biological Sciences Research Council.

Socioeconomic deprivation is an important risk factor for frailty in middle-aged and older adults

“…Socioeconomic deprivation has been demonstrated as a risk factor for poor mental health [17,23,24]. Furthermore, Mutz et al [25]. showed that higher levels of frailty in individuals with mental disorders.…”

Metabolomic Age (MileAge) predicts health and lifespan: a comparison of multiple machine learning algorithms

“…and multiple health indicators: having a long-standing illness, disability or infirmity (yes/no), self-rated health (“poor”, “fair”, “good” or “excellent”) and overall health status (unhealthy/healthy) derived from 81 cancer and 443 non-cancer illnesses (Mutz & Lewis, 2022; Mutz et al, 2021). Next we examined associations with the frailty phenotype and frailty index (Mutz, Choudhury, Zhao, & Dregan, 2022). The frailty phenotype summarises data on weight loss, exhaustion, physical activity, walking speed and hand-grip strength.…”

Psychological frailty in older adults: a systematic scoping review

“…As such, few existing frailty assessments include psychological dimensions. Nevertheless, a few mental health items, such as depression, have been used in some studies to identify psychological plus other frailty domains in the context of frailty indices (Mutz, Choudhury, Zhao, & Dregan, 2022). Incorporating psychological features under the cumulative deficit approach of frailty facilitates a more thorough evaluation of the multiple factors that may lead to an older adult being frail.…”

“…As such, few existing frailty assessments include psychological dimensions. Nevertheless, a few mental health items, such as depression, have been used in some studies to identify psychological plus other frailty domains in the context of frailty indices (Mutz, Choudhury, Zhao, & Dregan, 2022).…”