Risks of all-cause and suicide mortality in mental disorders: a meta-review

Abstract

A meta-review, or review of systematic reviews, was conducted to explore the risks of all-cause and suicide mortality in major mental disorders. A systematic search generated 407 relevant reviews, of which 20 reported mortality risks in 20 different mental disorders and included over 1.7 million patients and over a quarter of a million deaths. All disorders had an increased risk of all-cause mortality compared with the general population, and many had mortality risks larger than or comparable to heavy smoking. Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa. These higher mortality risks translate into substantial (10-20 years) reductions in life expectancy. Borderline personality disorder, anorexia nervosa, depression and bipolar disorder had the highest suicide risks. Notable gaps were identified in the review literature, and the quality of the included reviews was typically low. The excess risks of mortality and suicide in all mental disorders justify a higher priority for the research, prevention, and treatment of the determinants of premature death in psychiatric patients.

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…While there is consistent evidence showing the high prevalence of comorbid medical conditions in BD768, 769, 770, 771, 772, 773, 774 and the negative impact these diagnoses have on longevity,775, 776 these conditions frequently go undiagnosed or undertreated. In a large UK cross‐sectional analysis of electronic data sets involving 1.7 million patients in primary care, those diagnosed with BD, when compared with healthy controls, had lower rates of diagnoses (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.54‐0.63) and treatment of medical conditions, despite higher rates of one (OR 1.2, 95% CI 1.16‐1.39) or multiple illnesses (OR 1.44, 95% CI 1.3‐1.64) 769…”

Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis

“…[5][6][7][8][9][10][11][12][13][14] The reduction in life expectancy associated with this increased risk is estimated to be greater than loss of years associated with heavy smoking alone. 15 Autonomic regulation of the heart plays a key role in cardiovascular functioning. 16,17 Poor cardiac autonomic regulation has been implicated in heart failure, 18,19 and increased vagal input (through vagal nerve stimulation or pharmacological modulators) is protective against ventricular fibrillation 20,21 and sudden cardiac death.…”

A mixed-method systematic review and meta-analysis of mental health professionals' attitudes toward smoking and smoking cessation among people with mental illnesses

“…Smoking rates stand at above 70% for those with severe mental illnesses such as schizophrenia and bipolar disorder 1, 2, 3, are similarly high among individuals with substance use disorders 4, 5 and are also above average for those with common mental disorders, including depression and anxiety 1. People with mental illness or substance use disorders are more likely to be heavier and more dependent smokers 6, 7, and their life expectancy is reduced by up to 20 years 8, 9, mainly because of smoking 7. It is therefore vital that smokers from this population receive effective smoking cessation interventions.…”