RESEARCH WEEKLY: Bridging the Mortality Gap for People with Serious Mental Illness
By Kelli South
While life expectancy for the general population has broadly increased in the past two centuries, from around 30 years old to about 80 years old, there is a significant mortality gap between the general population and the population of people with serious mental illness. Individuals with a serious mental illness have an average life expectancy 10-25 years lower than the rest of the population.
Interventions for some of the most common causes of death in people with serious mental illness, such as smoking cessation programs to prevent lung cancer, can cause a significant increase in life expectancy over time, according to a new study published this March in PLOS One. The study examines the most prominent causes of death in people with serious mental illness, which are diseases like cardiovascular disease, respiratory illness, diabetes and cancer. These causes are linked to increased rates of smoking, sedentary behavior, social isolation, obesity, substance use, lack of healthcare access, and other factors in people with severe mental illness. Certain interventions help reduce the likelihood of developing these diseases and could be administered to people with serious mental illness to increase their life expectancy.
Study details
The study scanned the existing literature on this topic and compiled all recent analyses on mortality rates to calculate the proportion of risk that could be reduced for people with serious mental illness if they were given interventions targeting the most common diseases for this population. The authors calculated the impact of interventions if they started at three different stages in life: at birth, at age 50, and at age 65. This calculation took the effectiveness of each intervention for reducing risk into account as well. For example, the study authors weighted their calculation according to the proven effectiveness of smoking cessation programs to obtain a more accurate estimate of this intervention’s effect on life expectancy.
Results
If exposure to risk factors, like smoking or sedentary behavior, can be reduced or eliminated for people with a serious mental illness from birth, there is a potential gain of four to seven years in life expectancy, depending on the specific illness. If the risk factors are reduced at age 50, the increase is projected between three to five years, and three to four years at age 65.
These findings lead the authors to project a potential 24-28% decrease in the mortality gap between the general population and those with a serious mental illness if the risks can be reduced through targeted interventions. They found smoking was the most changeable behavior to improve life expectancy for those with schizophrenia, while sedentary behavior was the most effective behavior change for those with bipolar disorder.
Discussion
The authors note not just the importance of interventions in reducing mortality, but also the importance of increasing acceptance, access and participation in the interventions among people with serious mental illness. They note that anosognosia, or lack of insight into illness, is one major reason why people with serious mental illness may not participate in healthy behaviors and treatment. The authors argue for increased access to healthcare and treatments for this population to provide services to as many people as possible. People with severe mental illness have a significantly shorter life expectancy than the general population and more research is needed on ways to bridge the mortality gap successfully.
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