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22-May-2014

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Many mental illnesses reduce life expectancy more than heavy smoking

Oxford researchers say figures should galvanise governments to make mental health more of a priority

Serious mental illnesses reduce life expectancy by 10-20 years, an analysis by Oxford University psychiatrists has shown a loss of years that's equivalent to or worse than that for heavy smoking.

Yet mental health has not seen the same public health priority, say the Oxford scientists, despite these stark figures and the similar prevalence of mental health problems.

1 in 4 people in the UK will experience some kind of mental health problem in the course of a year, it is estimated. Around 21% of British men and 19% of women smoke cigarettes.

The researchers say the figures should galvanise governments and health and social services to put a much higher priority on how mental health services can prevent early deaths.

The Oxford University researchers report their findings in the open access journal World Psychiatry. The study was funded by the Wellcome Trust.

The researchers searched for the best systematic reviews of clinical studies which reported mortality risk for a whole range of diagnoses mental health problems, substance and alcohol abuse, dementia, autistic spectrum disorders, learning disability and childhood behavioural disorders. 20 review papers were identified, including over 1.7 million individuals and over 250,000 deaths.

They repeated searches for studies and reviews reporting life expectancy and risk of dying by suicide, and compared the results to the best data for heavy smoking.

The average reduction in life expectancy in people with bipolar disorder is between 9 and 20 years, it's 10-20 years for schizophrenia, between 9 and 24 years for drug and alcohol abuse, and around 7-11 years for recurrent depression.

The loss of years among heavy smokers is 8-10 years.

All diagnoses studied showed an increase in mortality risk, though the size of the risk varied greatly. Many had risks equivalent to or higher than heavy smoking (see table in notes for editors).

Dr Seena Fazel of the Department of Psychiatry at Oxford University said: 'We found that many mental health diagnoses are associated with a drop in life expectancy as great as that associated with smoking 20 or more cigarettes a day.

'There are likely to be many reasons for this. High-risk behaviours are common in psychiatric patients, especially drug and alcohol abuse, and they are more likely to die by suicide. The stigma surrounding mental health may mean people aren't treated as well for physical health problems when they do see a doctor.'

One problem is the tendency to separate mental and physical illness, explains Dr Fazel. 'Many causes of mental health problems also have physical consequences and mental illness worsen the prognosis of a range of physical illnesses, especially heart disease, diabetes and cancer. Unfortunately, people with serious mental illnesses may not access healthcare effectively,' says Dr Fazel.

Dr Fazel is certain: 'All of this can be changed. There are effective drug and psychological treatments for mental health problems. We can improve mental health and social care provision. That means making sure people have straightforward access to health care, and appropriate jobs and meaningful daytime activities. It'll be challenging, but it can be done.'

He notes: 'Beyond that, psychiatrists have a particular responsibility as doctors to ensure that the physical health of their patients is not neglected. De-medicalization of psychiatric services mitigates against that.'

He adds: 'What we do need is for researchers, care providers and governments to make mental health a much higher priority for research and innovation. Smoking is recognised as a huge public health problem. There are effective ways to target smoking, and with political will and funding, rates of smoking-related deaths have started to decline. We now need a similar effort in mental health.'

Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust, said: 'People with mental health problems are among the most vulnerable in society. This work emphasises how crucial it is that they have access to appropriate healthcare and advice, which is not always the case. We now have strong evidence that mental illness is just as threatening to life expectancy as other public health threats such as smoking.'

###

Notes to Editors

* Table of all-cause mortality for various mental health and other diagnoses as compared to general population and the mortality risk for heavy smoking. This summarises the best available evidence from reviews of research studies.

DiagnosisRisk of mortality compared with general population Risk normalised to that for heavy smoking
Opioid users14.75.8
Amphetamine users6.22.4
Cocaine users6.0*2.4
Anorexia nervosa5.92.3
Disruptive behaviour disorder5.0**1.9
Methamphetamine use4.71.8
Acute and transient psychotic disorder4.71.8
Alcohol use disorder4.61.8
Personality disorder4.21.7
Intellectual disability (moderate to profound)2.81.1
Heavy smoking2.6**1.0
Schizophrenia2.51.0
Bipolar disorder2.2*0.8
Bulimia nervosa1.90.8
Eating disorder (not otherwise specified)1.90.8
Adults with childhood ADHD1.90.8
Depression1.60.6
Dysthymic disorder1.40.6
Co-morbid anxiety/depression1.40.6
Cannabis use1.2*,**0.5

* Mid-point of range; ** Mean value of male and female mortality

* The paper 'Risks of all-cause and suicide mortality in mental disorders: a meta-review' by Chesney, Goodwin and Fazel is to be published in the journal World Psychiatry with an embargo of 00:01 UK time on Friday 23 May 2014.

* Oxford University's Medical Sciences Division is one of the largest biomedical research centres in Europe, with over 2,500 people involved in research and more than 2,800 students. The University is rated the best in the world for medicine, and it is home to the UK's top-ranked medical school.

From the genetic and molecular basis of disease to the latest advances in neuroscience, Oxford is at the forefront of medical research. It has one of the largest clinical trial portfolios in the UK and great expertise in taking discoveries from the lab into the clinic. Partnerships with the local NHS Trusts enable patients to benefit from close links between medical research and healthcare delivery.

A great strength of Oxford medicine is its long-standing network of clinical research units in Asia and Africa, enabling world-leading research on the most pressing global health challenges such as malaria, TB, HIV/AIDS and flu. Oxford is also renowned for its large-scale studies which examine the role of factors such as smoking, alcohol and diet on cancer, heart disease and other conditions.



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