Research published in the open access journal BMJ Mental Health reveals that individuals with bipolar disorder, which is marked by intense mood swings, face a significantly higher risk of premature death from external causes like accidents, violence, and suicide. In fact, they are six times more likely to die before their expected lifespan compared to people without this condition.
The research also indicates that individuals with bipolar disorder are twice as likely to die from physical causes, with alcohol being a significant contributing factor to these deaths. This means that people with bipolar disorder have a higher risk of succumbing to health-related issues, and alcohol plays a notable role in increasing this risk.
People with bipolar disorder have consistently been found to face a higher risk of premature death from various causes in multiple countries. However, the specific reasons for this increased risk remain unclear. Researchers are uncertain about the specific factors that drive this phenomenon, and they are particularly interested in understanding the role of physical diseases, or somatic illnesses, in contributing to this elevated risk. Further investigation is necessary to gain a better understanding of the underlying causes and to develop appropriate strategies to address this significant health concern.
In their study, the Finnish researchers used nationwide medical and social insurance registers to identify and monitor the health of all individuals aged 15 to 64 years who had been diagnosed with bipolar disorder. They collected data from 2004 to 2018 to gain insights into the health outcomes and potential risk factors associated with this condition over a 15-year period.
To determine the excess deaths directly related to bipolar disorder, the researchers calculated the Standard Mortality Ratio (SMR). They compared the number of observed deaths among individuals diagnosed with bipolar disorder during the monitoring period (around 8 years) to the number of deaths expected in the general population of Finland over the same period. By analyzing this ratio, they were able to identify the additional deaths that could be directly attributed to the presence of bipolar disorder in the studied population.
They tracked the outcomes of 47,018 people with bipolar disorder who were 38, on average, at the start of the monitoring period. More than half (57%) were women.
During the monitoring period, a total of 3,300 individuals with bipolar disorder (about 7% of the studied population) passed away. In comparison, 141,536 people from the general population died over the same period. This equates to a six-fold higher risk of death from external causes (such as accidents, violence, and suicide) and a two-fold higher risk of death from somatic causes (physical diseases) among those with bipolar disorder, as compared to the general population. These findings highlight the significantly increased mortality risk faced by individuals living with bipolar disorder.
Their average age at death was 50; almost two thirds (65%; 2137) of these deaths were among men. The cause of death was somatic in 61% (2027) and external in 39% (1273).
Out of the 2,027 deaths attributed to somatic illnesses, alcohol was the leading cause, accounting for 29% of these deaths (595 cases). The next most common causes were heart disease and stroke, responsible for 27% of the deaths (552 cases), followed by cancer at 22% (442 cases). Respiratory disease contributed to 4% of the deaths (78 cases), while diabetes accounted for 2% of the deaths (41 cases). Additionally, behavioral disorders associated with other substance misuse caused 1% of the deaths (23 cases). The remaining 15% of deaths (296 cases) were due to various other causes. These findings shed light on the major contributors to mortality related to somatic illnesses among individuals with bipolar disorder.
Of the 595 alcohol-related deaths, liver disease accounted for nearly half (48%), followed by accidental alcohol poisoning (28%), and alcohol dependence (10%).
Among the external cause deaths, most were due to suicide (58%, 740), nearly half of which (48%) were due to overdose with prescribed mental health meds, including those used to treat bipolar disorder.
Overall, nearly two thirds (64%, 2104) of the deaths from any cause were excess deaths—higher than would be expected for comparable age and sex and directly attributable to bipolar disorder.
Of those due to somatic causes, 51% (1043) were excess deaths compared with 83% (1061) of those due to external causes.
Most of the excess deaths from somatic illness were either due to alcohol-related causes (40%)—a rate that is 3 times higher than that of the general population—cardiovascular disease (26%), or cancer (10%).
Of the excess deaths from external causes, 61% (651) were due to suicide, a proportion that is around 8 times higher than that of the general population.
The excess deaths resulting from external causes were significant across all age groups. However, among individuals aged 15 to 44 years, most of the excess deaths were attributed to external causes like accidents, violence, and suicide. On the other hand, among those aged 45 to 64 years, both external causes and somatic (physical) causes contributed almost equally to the excess mortality. This indicates that while external causes pose a greater risk for younger individuals with bipolar disorder, the impact of somatic illnesses becomes more significant in the older age group, leading to a more balanced distribution of excess deaths from both types of causes.
The researchers acknowledged that they excluded individuals diagnosed with schizophrenia and other psychotic illnesses from their study. By doing so, there is a possibility that they might have underestimated the number of excess deaths directly attributable to bipolar disorder. The reason behind this is that a history of persistent symptoms of psychosis, including delusions and hallucinations, is known to be strongly associated with a significantly higher risk of death. Therefore, by excluding such cases, the study may not fully capture the complete extent of mortality risk in individuals with bipolar disorder who also experience symptoms of psychosis.
The researchers suggest that we should rethink our current approach to reducing excess deaths among people with bipolar disorder. They believe that external factors play a bigger role in these deaths than physical illnesses. Instead of just focusing on preventing physical illnesses, they recommend considering other factors that may contribute to these deaths.
“A balanced consideration between therapeutic response, potential serious long term somatic side effects of different medicines, and risk of cause-specific premature mortality is needed, especially in younger persons,” they write.
The researchers also mention that if we focus on preventive measures for substance abuse, it could help decrease the difference in mortality rates caused by both external factors and physical health issues. They emphasize that preventing suicide remains crucial, and there should be improved awareness about the risk of overdose and other types of poisoning. (DPK/NW)
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