Bipolar Disorder Increases Death from External Causes

People with bipolar disorder, which is marked by strong mood fluctuations, are six times more likely than those without the condition to die prematurely from external causes such as accidents, violence, and suicide, according to study published in the open access journal BMJ Mental Health.

They are also twice as likely to die from somatic (physical) reasons, with alcohol being a major contributory role, according to the study.

A higher risk of death from any cause has been regularly found in people with bipolar disorder across multiple countries. However, it is unclear whether there are specific factors or how much somatic illness (physical disease) adds to this risk.
Between 2004 and 2018, the Finnish researchers used nationwide medical and social insurance databases to identify and track the health of all 15-64-year-olds with bipolar illness.

The standard mortality ratio (SMR) was calculated by dividing the number of deaths observed over a given period (around eight years of monitoring) among those diagnosed with bipolar disorder by the number expected in the Finnish general population to determine the excess deaths directly attributable to the condition.

They followed the progress of 47,018 persons with bipolar disorder who were 38 years old on average at the start of the study. More over half (57%) of the participants were female.
In total, 3,300 (7%) of them died during the monitoring period, compared to 141,536 people in the general population, resulting in a six-fold increase in the risk of death from external causes and a two-fold increase in the risk of death from somatic causes.

Their average death age was 50, and nearly two-thirds (65%; 2,137) of them were men. 61% (2,027) died from a somatic cause, while 39% (1,273) died from an external cause.

Alcohol was responsible for 29% (595) of the 2,027 somatic illness deaths, followed by heart disease and stroke (27%, 552), cancer (22%, 442), respiratory disease (4%, 78), diabetes (2%, 41), and behavioral problems related with other substance abuse (1%, 23). The remaining 15% (296) was made up of various other causes.

The liver disease accounted for nearly half of the 595 alcohol-related deaths (48%), followed by unintentional alcohol poisoning (28%), and alcohol dependence (10%).

The majority of external cause deaths (58%, 740) were due to suicide, with nearly half (48%) due to overdose with prescribed mental health medications, including those used to treat bipolar disorder.
Overall, nearly two-thirds (64%, 2,104) of all deaths were excess deaths—deaths that were higher than predicted for comparable age and gender and were directly linked to bipolar disorder.

There were 51% (1,043) excess deaths attributable to somatic causes, compared to 83% (1,061) owing to external causes.

The majority of the excess deaths from somatic sickness were caused by alcohol (40%)—a rate three times greater than the overall population—cardiovascular disease (26%), or cancer (10%).

Suicide accounted for 61% (651) of the excess fatalities from external causes, over eight times the proportion of the general population.

Excess fatalities from external causes were significant in all age categories, but whereas external causes accounted for the majority of the excess among 15-44 year olds, external and somatic causes contributed about equally among 45-64 year olds.

The researchers omitted patients with schizophrenia and other psychotic diseases, which they admit may have resulted in an overestimate of the excess mortality caused by bipolar disorder. They explain that a history of persistent symptoms of psychosis, delusions, and hallucinations is known to be connected with a considerably higher risk of death.

Given that external reasons appear to play a larger role than physical disease in excess fatalities among persons with bipolar disorder, the researchers conclude that the present therapeutic focus on preventing physical illness to lessen this excess should be reassessed.

“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.

“Targeting preventive interventions for substance abuse will likely reduce the mortality gap both due to external causes and somatic causes. Suicide prevention remains a priority, and better awareness of the risk of overdose and other poisonings is warranted,” they add.

Source Link