Association of mental disorders in early adulthood and later psychiatric hospital admissions and mortality in a cohort study of more than 1 million men

Gale, Catharine R., Batty, G. David, Osborn, David P. J., Tynelius, Per, Whitley, Elise and Rasmussen, Finn (2012) Association of mental disorders in early adulthood and later psychiatric hospital admissions and mortality in a cohort study of more than 1 million men. Archives of General Psychiatry, 69 (8), 823-831. (doi:10.1001/archgenpsychiatry.2011.2000). (PMID:22868936)

Abstract

Context: Mental disorders have been associated with increased
mortality, but the evidence is primarily based on
hospital admissions for psychoses. The underlying mechanisms
are unclear.
Objectives: To investigate whether the risks of death
associated with mental disorders diagnosed in young men
are similar to those associated with admission for these
disorders and to examine the role of confounding or mediating
factors.
Design: Prospective cohort study in which mental disorders
were assessed by psychiatric interview during a
medical examination on conscription for military service
at a mean age of 18.3 years and data on psychiatric hospital
admissions and mortality during a mean 22.6 years
of follow-up were obtained from national registers.
Setting: Sweden.
Participants: A total of 1 095 338 men conscripted between
1969 and 1994.
Main Outcome Measure: All-cause mortality
according to diagnoses of schizophrenia, other nonaffective
psychoses, bipolar or depressive disorders, neurotic
and adjustment disorders, personality disorders,
and alcohol-related or other substance use disorders at
conscription and on hospital admission.
Results: Diagnosis of mental disorder at conscription or
on hospital admission was associated with increased mortality.
Age-adjusted hazard ratios according to diagnoses
at conscription ranged from 1.81 (95% CI, 1.54-2.10) (depressive
disorders) to 5.55 (95% CI, 1.79-17.2) (bipolar
disorders). The equivalent figures according to hospital
diagnoses ranged from 5.46 (95% CI, 5.06-5.89) (neurotic
and adjustment disorders) to 11.2 (95% CI, 10.4-
12.0) (other substance use disorders) in men born from
1951 to 1958 and increased in men born later. Adjustment
for early-life socioeconomic status, body mass index,
and blood pressure had little effect on these associations,
but they were partially attenuated by adjustment for
smoking, alcohol intake, intelligence, educational level,
and late-life socioeconomic status. These associations were
not primarily due to deaths from suicide.
Conclusion: The increased risk of premature death associated
with mental disorder is not confined to those
whose illness is severe enough for hospitalization or those
with psychotic or substance use disorders.

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Contributors

Author: Catharine R. Gale

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