Mental illnesses and disorders

It’s easy to overlook the most important health statistic of the past century. Life expectancy has increased dramatically in the U.S., from 51 years in 1910 to nearly 79 years (81 years in women, 76 years in men) in 2010. This increase converts to nearly 3 years of additional life every decade or a gain of almost 4 months every year. Unfortunately, reductions in mortality are not shared equally in this country across racial, ethnic, and socio-economic groups. The same Centers for Disease Control and Prevention data show that for African Americans, life expectancy is 75 years (78 years for women and 72 years for men). This evident health disparity has been the subject of intense focus by NIH, prompting, among other efforts, the recent formation of a new institute, the National Institute of Minority Health and Health Disparities (NIMHD).

This brings me to a paper by Walker, McGee, and Druss published online earlier this month in JAMA Psychiatry. They ask a simple question: what is the mortality associated with mental illness? Their answer, based on an analysis of 203 studies from 29 countries across 6 continents, should command the attention of anyone who cares about health disparities. The median reduction in life expectancy among those with mental illness was 10.1 years (range from 1.4 to 32 years). Most of this early mortality was attributed to “natural causes” such as acute and chronic co-morbid conditions (heart diseases, pulmonary diseases, infectious diseases); 17.5 percent of deaths appeared related to “unnatural causes” such as suicide and unintentional injuries. Finding more than a doubling of the relative risk of mortality, the authors ask a second question: how many deaths would be averted by eliminating this increased mortality? The answer, based on the prevalence of mental illness globally, is stunning: 8 million people die each year due to mental illness. That is, 8 million deaths could be averted if people with mental illness were to die at the same rate as the general population.