Mortality gap persists for elderly men with severe mental disorders

By Laura Cowen, medwireNews Reporter

The excess mortality experienced by men with severe mental disorders, compared with their mentally healthy peers, does not decrease with age, Australian research shows.

Osvaldo Almeida (University of Western Australia, Perth) and colleagues found that elderly men with a history of a severe mental disorder were 2.3 times more likely than their counterparts with no such history to die during 14 years of follow-up and their life expectancy was reduced by an average of 2.8 years.

“The underlying reasons for this increase in mortality are not entirely clear, but hazardous lifestyle choices, the presence of disabling medical comorbidities, poor compliance with treatment, and suboptimal access to health services may all play a part”, the researchers remark.

The study was based on Australian health record linkage and mortality data for a community-representative sample of 37,892 men aged 65 to 85 years in 1996 to 1998, who were followed up to the end of 2010.

The prevalence of schizophrenia spectrum, bipolar, depressive and alcohol-induced disorders in the cohort was 1.2%, 0.3%, 2.5% and 1.8%, respectively.

By the end of 2010, 19,644 (51.8%) men had died, of whom 343 had a schizophrenia spectrum disorder, 63 bipolar disorder, 747 depression and 550 an alcohol-induced disorder. The annual mortality rate increased with increasing age for the entire cohort, but was consistently higher among those with than without a severe mental disorder, the team notes.

Indeed, age-adjusted life expectancy was reduced, on average, by 2.0, 1.1, 2.8 and 3.1 years for men with schizophrenia spectrum, bipolar, depressive and alcohol-induced disorders, respectively.

Cardiovascular disease was the most common cause of death overall, and was a source of excess mortality in the men with schizophrenia, depression and alcohol-induced disorders. Cancer was associated with excess mortality among the men with depression and alcohol-induced disorders, while deaths caused by chronic respiratory diseases were over represented in each of the four groups.

Of note, men with bipolar disorder or depression were a respective 8.6 and 3.6 times more likely to die by suicide than the mentally healthy men, whereas there was no excess suicide risk among those with schizophrenia.

A subgroup of 12,136 men provided detailed information on their educational, sociodemographical, lifestyle and clinical backgrounds. And although there were significant differences in each of these areas between the men with and without mental disorders, they did not explain the difference in mortality between the two groups.

Writing in PLoS One, Almeida et al conclude: “As a community, we are yet to address successfully the excess mortality associated with severe mental disorders.

“Unlike young adults, most older people will be in contact with health services at least once a year, offering policy makers and health professionals a unique opportunity to intervene and improve the clinical outcomes of this segment of the population.”

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