Early death among people with mental illness mostly due to poor physical health and can be prevented
Most early deaths among people with mental illness is due to poor physical health - which can largely be prevented - and not due to suicides, according to a comprehensive study, which recommends early and effective interventions to stop these premature deaths.
The report says that about 17% of the premature deaths in people with mental illnesses can be attributed to “unnatural causes”, and the remaining are due to poor health and reduced or lack of access to proper healthcare.
“Although premature mortality was initially shown in patients with severe mental illnesses such as schizophrenia and bipolar disorder, there is now evidence that individuals who have diagnoses across the entire spectrum of mental disorders have a substantially reduced life expectancy compared with the general population. Although suicide contributes to a considerable proportion of these premature deaths - with approximately 17% of mortality in people with mental illness attributed to unnatural causes - the majority of years of life lost in people with mental illness relate to poor physical health, specifically due to non-communicable and infectious diseases,” says the report.
The Lancet Psychiatry Commission is the culmination of over 12 months of research conducted by a task force of over 30 international experts, led by researchers from NICM Health Research Institute at Western Sydney University, The University of Manchester, UNSW Sydney, King’s College London and Orygen National Centre of Excellence in Youth Mental Health.
The researchers found that patients with mental illnesses are two to three times as likely to have obesity, diabetes, and cardiovascular diseases, which impact their quality of life and recovery. And many with mental illnesses die up to 20 years earlier than the general population.
“A broad range of mental illnesses are associated with a lifelong burden of obesity, diabetes, and cardiovascular disease - which contributes towards a gap in life expectancy of around 20 years for people with mental illness,” says the report. The key risk factors include lack of physical activity, unhealthy diet, higher rates of smoking, sleep disturbance, the side effects of many psychiatric medications, and a lack of access to adequate physical healthcare.
The high rates of preventable physical health conditions in people with mental illness have to stop, say the researchers. They say protecting the physical health of people with mental illness should be considered an "international priority" for reducing the personal, social, and economic burden of these conditions.
“Despite the increasing amount of research in this area and more general advancements in healthcare and medicine, the poor physical health outcomes (and the associated decrease in life expectancy) of people with mental illness have not improved. The number of years of life lost due to physical health conditions in people with mental illness might be increasing,” says the study.
The researchers say while lifestyle risk factors, such as smoking, poor diet, and inactivity, are modifiable, current interventions for people with mental illness could be imprecise or could focus too much on one behavioral modification at the expense of other important risk factors. The team says it is critical to find innovative and cost-effective ways for making interventions a standard part of care for those treated for mental illness, to improve their physical and cardiovascular health, as well as diet.
“Regular screening is needed for physical disorders and associated risk factors among patients with mental illness, with evidence-based health promotion initiatives for staff and service users. The risk of physical symptoms being wrongly attributed to mental health disorders should be acknowledged, and the stigma that presents barriers to healthcare for people with mental illness must be addressed. More training of healthcare staff and wider access to screening and treatment are required for people with chronic conditions,” says the report.
The team recommends greater integration of physical and mental healthcare services at the service level. They also recommend adopting an early intervention approach towards protecting physical health from initial stages of illness, as well as improvement of screening procedures to support prevention initiatives. The researchers say large-scale interventions that target dual risk factors for physical and mental health disorders in at-risk groups (for example, obesity, smoking, inactivity, and poor diet) are required to reduce the prevalence of both.
The team says the disparities in physical health outcomes for people with mental illness are currently regarded as a human rights scandal, and this needs to change. “People with mental illness are likely to receive a poorer standard of healthcare compared with people without mental illness who have the same physical health problems. To address this discrepancy, changes need to be made in the training of health providers and to the overall health system,” says the study.