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

Association of mental disorders in early adulthood and later psychiatric hospital admissions and mortality in a cohort study of more than 1 million men
Association of mental disorders in early adulthood and later psychiatric hospital admissions and mortality in a cohort study of more than 1 million men
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.
0003-990X
823-831
Gale, Catharine R.
5bb2abb3-7b53-42d6-8aa7-817e193140c8
Batty, G. David
605ce199-493d-4238-b9c8-a2c076672e83
Osborn, David P. J.
f03c238f-98b8-4774-9665-3a86e9730492
Tynelius, Per
ac8bf45c-361b-4ae5-b4a1-234610c39cbd
Whitley, Elise
a61656e6-fdd9-4ff9-affc-661bb2960579
Rasmussen, Finn
3ae452ae-94b8-4bd3-b54f-dd96518a8404
Gale, Catharine R.
5bb2abb3-7b53-42d6-8aa7-817e193140c8
Batty, G. David
605ce199-493d-4238-b9c8-a2c076672e83
Osborn, David P. J.
f03c238f-98b8-4774-9665-3a86e9730492
Tynelius, Per
ac8bf45c-361b-4ae5-b4a1-234610c39cbd
Whitley, Elise
a61656e6-fdd9-4ff9-affc-661bb2960579
Rasmussen, Finn
3ae452ae-94b8-4bd3-b54f-dd96518a8404

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)

Record type: Article

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.

Full text not available from this repository.

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Published date: August 2012
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 343081
URI: http://eprints.soton.ac.uk/id/eprint/343081
ISSN: 0003-990X
PURE UUID: 0b9160b6-9c8a-4a15-9cec-29cd6d628815
ORCID for Catharine R. Gale: ORCID iD orcid.org/0000-0002-3361-8638

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Date deposited: 26 Sep 2012 13:31
Last modified: 18 Feb 2021 16:44

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Contributors

Author: G. David Batty
Author: David P. J. Osborn
Author: Per Tynelius
Author: Elise Whitley
Author: Finn Rasmussen

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