Around the world, people with mental illness die up to 20 years earlier than the general population, and a comprehensive new report suggests that governments and health care providers must do more to stop the deaths.
“The disparities in physical health outcomes for people with mental illness are currently regarded as a human rights scandal,” said Joseph Firth, a research fellow at the University of Manchester and chairman of the Lancet Psychiatry Commission, which published the research.
His team analyzed nearly 100 studies and found that most people with mental illness die early not because of suicide – although those account for about 17% of unnatural deaths – but because of “poor physical health” that could be largely preventable.
People with mental health disorders face up to twice the risk of cardiometabolic diseases such as diabetes and stroke, researchers found. In people with depression, for example, the risk of cardiac disease, diabetes or obesity is about 40% higher than in the general population.
Mental illness can increase the risk of physical disease, and physical disease itself increases the risk of mental illness, Firth said. “Having obesity or diabetes increases your risk causally of developing a psychiatric condition, and vice versa.”
Sometimes, that’s because treatments for mental illness can trigger or worsen physical health problems. The report found, for example, that many drugs used to treat mental illnesses – including antidepressants, antipsychotics and mood stabilizers – can have adverse effects on metabolism and heart health.
“As a result, patients who gain weight have a reduced adherence to treatment, which can lead to relapse and poor mental health outcomes,” the report said. The drugs still “do more good than harm,” Firth added, but he emphasized that doctors need to monitor and manage any adverse effects.
People with mental illness receive poorer care
Almost all mental illnesses are also associated with some lifestyle risk factors – behaviors that make diseases such as heart disease more likely – and “people with mental illness tend to have more unhealthy lifestyles compared with the general population,” the report found.
People with major depression are more likely to smoke and be dependent on nicotine, for example, and have a significantly worse diet than the general population, according to the researchers. Almost one in five people with anxiety disorders misuse alcohol, and those with social phobia report less physical activity.
But even after controlling for risk factors such as smoking, physical activity and body mass index, the report found that deaths remained higher in those with mental illness. That suggests people with mental illness receive poorer care than those without psychiatric problems, researchers said.
For example, the report found that people with severe mental illness are less likely to have a physical examination than their peers