|
Citation
|
Ruffieux Y, Wettstein A, Maartens G, Folb N, Vieira CM, Didden C, Tlali M, Williams C, Cornell M, Schomaker M, Johnson LF, Joska JA, Egger M, Haas AD. medRxiv 2023; e23284778. |
|
Abstract
|
BACKGROUND: People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown.
METHODS: We analysed reimbursement claims and vital registration data from South African medical insurance scheme beneficiaries aged 15-85 years. We estimated excess life years lost (LYL) associated with organic, substance use, psychotic, mood, anxiety, eating, personality, developmental or any mental disorders.
FINDINGS: We followed 1 070 183 beneficiaries, of whom 282 926 (26·4%) received mental health diagnoses. Life expectancy of people with mental health diagnoses was 3·83 years (95% CI 3·58-4·10) shorter for men and 2·19 years (1·97-2·41) shorter for women. Excess mortality varied by sex and diagnosis, ranging from 11·50 LYL (95% CI 9·79-13·07) among men with alcohol use disorder to 0·87 LYL (0·40-1·43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (3·42 among men and 1·94 among women). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1·52) or substance use (2·45) disorder.
INTERPRETATION: The burden of premature mortality among persons with mental disorders in South Africa is high. Our findings support implementing interventions for prevention, early detection, and treatment of physical comorbidities among people with mental disorders. Suicide prevention and substance use treatment programmes are needed to reduce excess mortality from unnatural causes, especially among men. FUNDING: Swiss National Science Foundation and National Institutes of Health. RESEARCH IN CONTEXT: Evidence before this study: We searched PubMed with no language restriction from inception until April 12, 2022, for studies from sub-Saharan African countries on excess mortality among people with mental illness. We used the search string "mental disorders/mortality" as a major MeSH term and a filter for African countries. We identified four relevant studies: three from Ethiopia and one from South Africa. In Ethiopia, mortality in people with schizophrenia was six times higher than in the general population (standardised mortality ratio [SMR] 5.98; 95% confidence interval (CI) 4.09-7.87) and three to four times higher in those with major depression (SMR 3.55; 95% CI 1.97-6.39). Another study from Ethiopia found that people with severe mental disorders, including schizophrenia, bipolar disorder, and severe depression, died 28 years earlier than the general population. Most patients with severe mental disorders died from infectious diseases, suicides, or traffic accidents. Among people living with HIV in South Africa, those diagnosed with or treated for mental illness had a three times higher mortality risk (adjusted hazard ratio 2.98, 95% CI 2.69-3.30) than those without diagnoses or not treated for mental health conditions.Added value of our study: This study is one of Africa's most comprehensive analyses of excess mortality among people with mental illness. We compared mortality rates between 280,000 medical insurance beneficiaries receiving mental health diagnoses in primary, secondary and tertiary care, and 785,000 without mental health diagnoses. In contrast to earlier studies -conducted mainly among people with severe mental illness-our study included a broader sample of people with a spectrum of mental disorders, including common mental disorders. We found life expectancy of people with mental health diagnoses was about 4 years shorter for men and about 2 years shorter for women compared with beneficiaries of the same age and sex without mental health diagnoses. Eating, developmental, psychotic, substance use, and organic mental disorders were associated with high excess mortality, especially among men and people diagnosed in hospitals. In contrast, women diagnosed with anxiety or depression had lower excess mortality. Most LYL associated with mental disorders were attributable to death by natural causes. Among men with alcohol use, drug use, or bipolar disorders, death by unnatural causes accounted for a considerable excess mortality burden.Implications of available evidence: Our study demonstrates a considerable burden of premature death from natural causes among a relatively small group of people with certain mental disorders. Our findings support recommendations to implement interventions for prevention, early detection, and appropriate treatment of physical comorbidities among people with these disorders. To reduce excess mortality from unnatural causes among men with bipolar and substance use disorders, we recommend suicide prevention and substance use treatment programmes.
Language: en |