Mortality in Mental Disorders and Global Disease Burden Implications: A Systematic Review and Meta-analysis
TLDR
Estimates suggest that mental disorders rank among the most substantial causes of death worldwide, and efforts to quantify and address the global burden of illness need to better consider the role of mental disorders in preventable mortality.Abstract:
Importance Despite the potential importance of understanding excess mortality among people with mental disorders, no comprehensive meta-analyses have been conducted quantifying mortality across mental disorders. Objective To conduct a systematic review and meta-analysis of mortality among people with mental disorders and examine differences in mortality risks by type of death, diagnosis, and study characteristics. Data sources We searched EMBASE, MEDLINE, PsychINFO, and Web of Science from inception through May 7, 2014, including references of eligible articles. Our search strategy included terms for mental disorders (eg, mental disorders, serious mental illness, and severe mental illness), specific diagnoses (eg, schizophrenia, depression, anxiety, and bipolar disorder), and mortality. We also used Google Scholar to identify articles that cited eligible articles. Study selection English-language cohort studies that reported a mortality estimate of mental disorders compared with a general population or controls from the same study setting without mental illness were included. Two reviewers independently reviewed the titles, abstracts, and articles. Of 2481 studies identified, 203 articles met the eligibility criteria and represented 29 countries in 6 continents. Data extraction and synthesis One reviewer conducted a full abstraction of all data, and 2 reviewers verified accuracy. Main outcomes and measures Mortality estimates (eg, standardized mortality ratios, relative risks, hazard ratios, odds ratios, and years of potential life lost) comparing people with mental disorders and the general population or people without mental disorders. We used random-effects meta-analysis models to pool mortality ratios for all, natural, and unnatural causes of death. We also examined years of potential life lost and estimated the population attributable risk of mortality due to mental disorders. Results For all-cause mortality, the pooled relative risk of mortality among those with mental disorders (from 148 studies) was 2.22 (95% CI, 2.12-2.33). Of these, 135 studies revealed that mortality was significantly higher among people with mental disorders than among the comparison population. A total of 67.3% of deaths among people with mental disorders were due to natural causes, 17.5% to unnatural causes, and the remainder to other or unknown causes. The median years of potential life lost was 10 years (n = 24 studies). We estimate that 14.3% of deaths worldwide, or approximately 8 million deaths each year, are attributable to mental disorders. Conclusions and relevance These estimates suggest that mental disorders rank among the most substantial causes of death worldwide. Efforts to quantify and address the global burden of illness need to better consider the role of mental disorders in preventable mortality.read more
Citations
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Major depressive disorder
Christian Otte,Stefan M. Gold,Stefan M. Gold,Brenda W.J.H. Penninx,Carmine M. Pariante,Amit Etkin,Maurizio Fava,David C. Mohr,Alan F. Schatzberg +8 more
TL;DR: An overview of the current evidence of major depressive disorder, including its epidemiology, aetiology, pathophysiology, diagnosis and treatment, is provided.
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Estimating the true global burden of mental illness.
TL;DR: It is argued that the global burden of mental illness is underestimated and the reasons for under-estimation are examined to identify five main causes: overlap between psychiatric and neurological disorders; the grouping of suicide and self-harm as a separate category; conflation of all chronic pain syndromes with musculoskeletal disorders; exclusion of personality disorders from disease burden calculations; and inadequate consideration of the contribution of severe mental illness to mortality from associated causes.
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The Lancet Commission on global mental health and sustainable development.
Vikram Patel,Shekhar Saxena,Crick Lund,Crick Lund,Graham Thornicroft,Florence Baingana,Paul Bolton,Dan Chisholm,Pamela Y. Collins,Janice Cooper,Janice Cooper,Julian Eaton,Helen Herrman,Helen Herrman,Mohammad M. Herzallah,Mohammad M. Herzallah,Yueqin Huang,Mark J. D. Jordans,Mark J. D. Jordans,Arthur Kleinman,María Elena Medina-Mora,Ellen Morgan,Unaiza Niaz,Unaiza Niaz,Olayinka Omigbodun,Martin Prince,Atif Rahman,Benedetto Saraceno,Bidyut K. Sarkar,Mary De Silva,Ilina Singh,Dan J. Stein,Dan J. Stein,Dan J. Stein,Charlene Sunkel,Jürgen Unützer +35 more
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Synaptic plasticity and depression: new insights from stress and rapid-acting antidepressants
TL;DR: Treatment with new agents results in an improvement in mood ratings within hours of dosing patients who are resistant to typical antidepressants, and these new agents have also been shown to reverse the synaptic deficits caused by stress.
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Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls.
Christoph U. Correll,Marco Solmi,Nicola Veronese,Beatrice Bortolato,Stella Rosson,Paolo Santonastaso,Nita Thapa-Chhetri,Michele Fornaro,Davide Gallicchio,Enrico Collantoni,Giorgio Pigato,Angela Favaro,Francesco Monaco,Cristiano A. Köhler,Davy Vancampfort,Philip B. Ward,Fiona Gaughran,André F. Carvalho,Brendon Stubbs +18 more
TL;DR: This large‐scale meta‐analysis confirms that SMI patients have significantly increased risk of CVD and CVD‐related mortality, and that elevated body mass index, antipsychotic use, andCVD screening and management require urgent clinical attention.
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