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Mortality, survival, and causes of death in mental disorders: comprehensive prospective analyses of the UK Biobank cohort

Published online by Cambridge University Press:  06 May 2022

Vivian Boschesi Barros Open the ORCID record for Vivian Boschesi Barros [Opens in a new window] ,
Fernanda Fortti Vianna Schmidt  and
Alexandre Dias Porto Chiavegatto Filho
Vivian Boschesi Barros*
Affiliation:
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
Fernanda Fortti Vianna Schmidt
Affiliation:
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
Alexandre Dias Porto Chiavegatto Filho
Affiliation:
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
*
Author for correspondence: Vivian Boschesi Barros, E-mail: vivian.barros@usp.br
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Abstract

Background

The UK Biobank is a large middle-aged cohort recruited in 2006–2010. We used data from its participants to analyze mortality, survival, and causes of death associated with mental disorders.

Methods

Our exposures were mental disorders identified using (1) symptom-based outcomes derived from an online Mental Health Questionnaire (n = 157 329), including lifetime/current depression, lifetime/current generalized anxiety disorder, lifetime/recent psychotic experience, lifetime bipolar disorder, current alcohol use disorder, and current posttraumatic stress disorder and (2) hospital data linkage of diagnoses within the International Classification of Diseases, 10th revision (ICD-10) (n = 502 422), including (A) selected diagnoses or groups of diagnoses corresponding to symptom-based outcomes and (B) all psychiatric diagnoses, grouped by ICD-10 section. For all exposures, we estimated age-adjusted mortality rates and hazard ratios, as well as proportions of deaths by cause.

Results

We found significantly increased mortality risk associated with all mental disorders identified by symptom-based outcomes, except for lifetime generalized anxiety disorder (with hazard ratios in the range of 1.08–3.0). We also found significantly increased mortality risk associated with all conditions identified by hospital data linkage, including selected ICD-10 diagnoses or groups of diagnoses (2.15–7.87) and ICD-10 diagnoses grouped by section (2.02–5.44). Causes of death associated with mental disorders were heterogeneous and mostly natural.

Conclusions

In a middle-aged cohort, we found a higher mortality risk associated with most mental disorders identified by symptom-based outcomes and with all disorders or groups of disorders identified by hospital data linkage of ICD-10 diagnoses. The majority of deaths associated with mental disorders were natural.

Keywords

Epidemiologymortalitymental disorderspsychiatry
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 8 , June 2023 , pp. 3480 - 3489
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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References

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). AUDIT: The Alcohol Use Disorders Identification Test - Guidelines for use in primary care (2nd ed.). Geneva, Switzerland: World Health Organization.Google Scholar
Brodsky, B. S., Spruch-Feiner, A., & Stanley, B. (2018). The zero suicide model: Applying evidence-based suicide prevention practices to clinical care. Frontiers in Psychiatry, 9, 33. https://doi.org/10.3389/fpsyt.2018.00033.CrossRefGoogle ScholarPubMed
Coleman, J., & Davis, K. A. S. (2019). Code for use in R statistics with UK Biobank Mental Health Questionnaire data (Version 3.0) [Source code]. Mendeley Data. https://doi.org/10.17632/kv677c2th4.3.Google Scholar
Correll, C. U., Solmi, M., Veronese, N., Bortolato, B., Rosson, S., Santonastaso, P., … Stubbs, B. (2017). Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry, 16(2), 163–180. https://doi.org/10.1002/wps.20420.CrossRefGoogle Scholar
Das-Munshi, J., Chang, C.-K., Bakolis, I., Broadbent, M., Dregan, A., Hotopf, M., … Stewart, R. (2021). All-cause and cause-specific mortality in people with mental disorders before and during the COVID-19 pandemic: cohort study. The Lancet Regional Health – Europe, 11, 100228. https://doi.org/https://doi.org/10.1016/j.lanepe.2021.100228.CrossRefGoogle ScholarPubMed
Das-Munshi, J., Chang, C.-K., Dregan, A., Hatch, S. L., Morgan, C., Thornicroft, G., … Hotopf, M. (2020). How do ethnicity and deprivation impact on life expectancy at birth in people with serious mental illness? Observational study in the UK. Psychological Medicine, 51(15), 2581–2589. https://doi.org/10.1017/S0033291720001087.CrossRefGoogle ScholarPubMed
Davis, K. A. S., Coleman, J. R. I., Adams, M., Allen, N., Breen, G., Cullen, B., … Hotopf, M. (2020). Mental health in UK Biobank – Development, implementation and results from an online questionnaire completed by 157 366 participants: a reanalysis. BJPsych Open, 6(2), e18. https://doi.org/10.1192/bjo.2019.100.CrossRefGoogle ScholarPubMed
Davis, K. A. S., Cullen, B., Adams, M., Brailean, A., Breen, G., Coleman, J. R. I., … Hotopf, M. (2019). Indicators of mental disorders in UK Biobank – A comparison of approaches. International Journal of Methods in Psychiatric Research, 28(3), e1796. https://doi.org/10.1002/mpr.1796.CrossRefGoogle ScholarPubMed
Davis, K. A. S., & Hotopf, M. (2019). Mental health phenotyping in UK Biobank. Progress in Neurology and Psychiatry, 23(1), 4–7. https://doi.org/10.1002/pnp.522.CrossRefGoogle Scholar
Elliott, J., Bodinier, B., Whitaker, M., Delpierre, C., Vermeulen, R., Tzoulaki, I., … Chadeau-Hyam, M. (2021). COVID-19 mortality in the UK Biobank cohort: revisiting and evaluating risk factors. European Journal of Epidemiology, 36(3), 299–309. https://doi.org/10.1007/s10654-021-00722-y.CrossRefGoogle ScholarPubMed
Erlangsen, A., Andersen, P. K., Toender, A., Laursen, T. M., Nordentoft, M., & Canudas-Romo, V. (2017). Cause-specific life-years lost in people with mental disorders: a nationwide, register-based cohort study. The Lancet Psychiatry, 4(12), 937–945. https://doi.org/10.1016/S2215-0366(17)30429-7.CrossRefGoogle ScholarPubMed
Fabbri, C., Hagenaars, S. P., John, C., Williams, A. T., Shrine, N., Moles, L., … Lewis, C. M. (2021). Genetic and clinical characteristics of treatment-resistant depression using primary care records in two UK cohorts. Molecular Psychiatry, 26(7), 3363–3373. https://doi.org/10.1038/s41380-021-01062-9.CrossRefGoogle ScholarPubMed
Fridell, M., Bäckström, M., Hesse, M., Krantz, P., Perrin, S., & Nyhlén, A. (2019). Prediction of psychiatric comorbidity on premature death in a cohort of patients with substance use disorders: a 42-year follow-up. BMC Psychiatry, 19(1), 150. https://doi.org/10.1186/s12888-019-2098-3.CrossRefGoogle Scholar
Fry, A., Littlejohns, T. J., Sudlow, C., Doherty, N., Adamska, L., Sprosen, T., … Allen, N. E. (2017). Comparison of sociodemographic and health-related characteristics of UK Biobank participants with those of the general population. American Journal of Epidemiology, 186(9), 1026–1034. https://doi.org/10.1093/aje/kwx246.CrossRefGoogle ScholarPubMed
Ganna, A., & Ingelsson, E. (2015). 5 year mortality predictors in 498 103 UK Biobank participants: a prospective population-based study. The Lancet, 386(9993), 533–540. https://doi.org/10.1016/S0140-6736(15)60175-1.CrossRefGoogle ScholarPubMed
Glanville, K. P., Coleman, J. R. I., Howard, D. M., Pain, O., Hanscombe, K. B., Jermy, B., … Lewis, C. M. (2021a). Multiple measures of depression to enhance validity of major depressive disorder in the UK Biobank. BJPsych Open, 7(2), e44. https://doi.org/10.1192/bjo.2020.145.CrossRefGoogle ScholarPubMed
Glanville, K. P., Coleman, J. R. I., O'Reilly, P. F., Galloway, J., & Lewis, C. M. (2021b). Investigating pleiotropy between depression and autoimmune diseases using the UK Biobank. Biological Psychiatry Global Open Science, 1(1), 48–58. https://doi.org/10.1016/j.bpsgos.2021.03.002.CrossRefGoogle ScholarPubMed
Jarvis, E. (1850). On the comparative liability of males and females to insanity, and their comparative curability and mortality when insane. American Journal of Psychiatry, 7(2), 142–171. https://doi.org/10.1176/ajp.7.2.142.CrossRefGoogle Scholar
Jayatilleke, N., Hayes, R. D., Dutta, R., Shetty, H., Hotopf, M., Chang, C.-K., & Stewart, R. (2017). Contributions of specific causes of death to lost life expectancy in severe mental illness. European Psychiatry, 43, 109–115. https://doi.org/10.1016/j.eurpsy.2017.02.487.CrossRefGoogle ScholarPubMed
Kamphuis, M. H., Geerlings, M. I., Giampaoli, S., Nissinen, A., Grobbee, D. E., & Kromhout, D. (2009). The association of depression with cardiovascular mortality is partly explained by health status. The FINE study. Journal of Affective Disorders, 114(1–3), 184–192. https://doi.org/10.1016/j.jad.2008.07.005.CrossRefGoogle ScholarPubMed
Kessler, R. C., Andrews, G., Mroczek, D., Ustun, B., & Wittchen, H.-U. (1998). The World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF). International Journal of Methods in Psychiatric Research, 7(4), 171–185. https://doi.org/10.1002/mpr.47.CrossRefGoogle Scholar
Kessler, R. C., & Üstün, T. B. (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93–121. https://doi.org/10.1002/mpr.168.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2010). The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. General Hospital Psychiatry, 32(4), 345–359. https://doi.org/10.1016/j.genhosppsych.2010.03.006.CrossRefGoogle ScholarPubMed
Krumholz, H. M. (2009). Registries and selection bias: The need for accountability. Circulation: Cardiovascular Quality and Outcomes, 2(6), 517–518. https://doi.org/10.1161/CIRCOUTCOMES.109.916601.Google ScholarPubMed
Lang, A. J., & Stein, M. B. (2005). An abbreviated PTSD checklist for use as a screening instrument in primary care. Behaviour Research and Therapy, 43(5), 585–594. https://doi.org/10.1016/j.brat.2004.04.005.CrossRefGoogle ScholarPubMed
Levinson, D., Potash, J., Mostafavi, S., Battle, A., Zhu, X., & Weissman, M. (2017). Brief assessment of major depression for genetic studies: Validation of CIDI-SF screening with SCID interviews. European Neuropsychopharmacology, 27, S448. https://doi.org/10.1016/j.euroneuro.2016.09.514.CrossRefGoogle Scholar
Liu, N. H., Daumit, G. L., Dua, T., Aquila, R., Charlson, F., Cuijpers, P., … Saxena, S. (2017). Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry, 16(1), 30–40. https://doi.org/10.1002/wps.20384.CrossRefGoogle ScholarPubMed
Manea, L., Gilbody, S., & McMillan, D. (2012). Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. Canadian Medical Association Journal, 184(3), E191–E196. https://doi.org/10.1503/cmaj.110829.CrossRefGoogle ScholarPubMed
Martin-Subero, M., Kroenke, K., Diez-Quevedo, C., Rangil, T., de Antonio, M., Morillas, R. M., … Navarro, R. (2017). Depression as measured by PHQ-9 versus clinical diagnosis as an independent predictor of long-term mortality in a prospective cohort of medical inpatients. Psychosomatic Medicine, 79(3), 273–282. https://doi.org/10.1097/PSY.0000000000000390.CrossRefGoogle Scholar
Moffitt, T. E., Caspi, A., Taylor, A., Kokaua, J., Milne, B. J., Polanczyk, G., & Poulton, R. (2010). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine, 40(6), 899–909. https://doi.org/10.1017/S0033291709991036.CrossRefGoogle ScholarPubMed
Nemani, K., Li, C., Olfson, M., Blessing, E. M., Razavian, N., Chen, J., … Goff, D. C. (2021). Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry, 78(4), 380–386. https://doi.org/10.1001/jamapsychiatry.2020.4442.CrossRefGoogle ScholarPubMed
Ollier, W., Sprosen, T., & Peakman, T. (2005). UK Biobank: from concept to reality. Pharmacogenomics, 6(6), 639–646. https://doi.org/10.2217/14622416.6.6.639.CrossRefGoogle ScholarPubMed
Patten, S. B., Williams, J. V. A., Lavorato, D. H., Bulloch, A. G. M., D'Arcy, C., & Streiner, D. L. (2012). Recall of recent and more remote depressive episodes in a prospective cohort study. Social Psychiatry and Psychiatric Epidemiology, 47(5), 691–696. https://doi.org/10.1007/s00127-011-0385-5.CrossRefGoogle ScholarPubMed
Plana-Ripoll, O., Pedersen, C. B., Agerbo, E., Holtz, Y., Erlangsen, A., Canudas-Romo, V., … Laursen, T. M. (2019). A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. The Lancet, 394(10211), 1827–1835. https://doi.org/10.1016/S0140-6736(19)32316-5.CrossRefGoogle ScholarPubMed
Ronaldson, A., Arias de la Torre, J., Gaughran, F., Bakolis, I., Hatch, S. L., Hotopf, M., … & Dregan, A. (2020). Prospective associations between vitamin D and depression in middle-aged adults: findings from the UK Biobank cohort. Psychological Medicine, 1–9. Advance online publication. https://doi.org/10.1017/S0033291720003657.Google ScholarPubMed
Sudlow, C., Gallacher, J., Allen, N., Beral, V., Burton, P., Danesh, J., … Collins, R. (2015). UK Biobank: An open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Medicine, 12(3), e1001779. https://doi.org/10.1371/journal.pmed.1001779.CrossRefGoogle ScholarPubMed
Sunderland, M., Andrews, G., Slade, T., & Peters, L. (2011). Measuring the level of diagnostic concordance and discordance between modules of the CIDI-short form and the CIDI-auto 2.1. Social Psychiatry and Psychiatric Epidemiology, 46(8), 775–785. https://doi.org/10.1007/s00127-010-0247-6.CrossRefGoogle ScholarPubMed
Takayanagi, Y., Spira, A. P., Roth, K. B., Gallo, J. J., Eaton, W. W., & Mojtabai, R. (2014). Accuracy of reports of lifetime mental and physical disorders: Results from the Baltimore Epidemiological Catchment Area Study. JAMA Psychiatry, 71(3), 273–280. https://doi.org/10.1001/jamapsychiatry.2013.3579.CrossRefGoogle ScholarPubMed
Thompson, W. D. (1987). Lifetime psychiatric diagnoses. In Hersen, M., & Last, C. G. (Eds.), Issues in diagnostic research (pp. 143–160). New York, NY: Plenum Press.CrossRefGoogle Scholar
Too, L. S., Spittal, M. J., Bugeja, L., Reifels, L., Butterworth, P., & Pirkis, J. (2019). The association between mental disorders and suicide: A systematic review and meta-analysis of record linkage studies. Journal of Affective Disorders, 259, 302–313. https://doi.org/10.1016/j.jad.2019.08.054.CrossRefGoogle ScholarPubMed
UK Biobank. (2018). Index of multiple deprivation scores – Version 1.0. Retrieved June 16, 2021, from https://biobank.ndph.ox.ac.uk/ukb/ukb/docs/imd_baseline.pdf.Google Scholar
UK Biobank. (2019). Mapping inpatient hospital data across England, Scotland and Wales – Version 1.5. Retrieved June 16, 2021, from https://biobank.ndph.ox.ac.uk/ukb/ukb/docs/inpatient_mapping.pdf.Google Scholar
UK Biobank. (2020). UK Biobank research ethics approval. Retrieved June 16, 2021, from https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/about-us/ethics.Google Scholar
UK Biobank. (2021a). Learn more about the UK Biobank. Retrieved June 16, 2021, from https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank.Google Scholar
UK Biobank. (2021b). Online showcase of UK Biobank resources – Category 100000 – Assessment Centre. Retrieved June 16, 2021, from https://biobank.ctsu.ox.ac.uk/crystal/label.cgi?id=100000.Google Scholar
UK Biobank. (2021c). Online showcase of UK Biobank resources – Category 136 – Mental health – Online follow-up. Retrieved June 16, 2021, from https://biobank.ndph.ox.ac.uk/ukb/label.cgi?id=136.Google Scholar
UK Biobank. (2021d). Register to enable your vision. Retrieved June 16, 2021, from https://www.ukbiobank.ac.uk/enable-your-research/register.Google Scholar
UK Biobank. (2021e). UK Biobank death summary report. Retrieved June 16, 2021, from https://biobank.ndph.ox.ac.uk/~bbdatan/DeathSummaryReport.html.Google Scholar
UK Biobank. (n.d.-a). Baseline assessment data collection. Retrieved June 16, 2021, from https://biobank.ndph.ox.ac.uk/ukb/exinfo.cgi?src=baseline_data.Google Scholar
UK Biobank. (n.d.-b). Data providers and dates of data availability. Retrieved December 16, 2021, from https://biobank.ndph.ox.ac.uk/ukb/exinfo.cgi?src=Data_providers_and_dates.Google Scholar
UK Biobank. (n.d.-c). Funding awards to UK Biobank. Retrieved June 16, 2021, from https://www.ukbiobank.ac.uk/media/f32lged4/funding-uk-biobank-summary.pdf.Google Scholar
UK Biobank Coordinating Centre. (2007). UK Biobank: Protocol for a large-scale prospective epidemiological resource. Retrieved June 16, 2021, from https://www.ukbiobank.ac.uk/media/gnkeyh2q/study-rationale.pdf.Google Scholar
UK Biobank Coordinating Centre. (2017). UK Biobank: Mental health web-based questionnaire – Version 1.3. Retrieved June 16, 2021, from https://biobank.ctsu.ox.ac.uk/crystal/crystal/docs/mental_health_online.pdf.Google Scholar
Vittinghoff, E., & McCulloch, C. E. (2007). Relaxing the rule of ten events per variable in logistic and Cox regression. American Journal of Epidemiology, 165(6), 710–718. https://doi.org/10.1093/aje/kwk052.CrossRefGoogle ScholarPubMed
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2008). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Journal of Clinical Epidemiology, 61(4), 344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008.CrossRefGoogle ScholarPubMed
Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry, 72(4), 334–341. https://doi.org/10.1001/jamapsychiatry.2014.2502.CrossRefGoogle ScholarPubMed
Weye, N., Momen, N. C., Christensen, M. K., Iburg, K. M., Dalsgaard, S., Laursen, T. M., … Plana-Ripoll, O. (2020). Association of specific mental disorders with premature mortality in the Danish population using alternative measurement methods. JAMA Network Open, 3(6), e206646. https://doi.org/10.1001/jamanetworkopen.2020.6646.CrossRefGoogle ScholarPubMed
World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Retrieved December 16, 2021, from https://apps.who.int/iris/handle/10665/37958.Google Scholar
World Health Organization. (2018). Management of physical health conditions in adults with severe mental disorders: WHO guidelines. Retrieved September 30, 2021, from https://apps.who.int/iris/handle/10665/275718.Google Scholar
Xie, J., & Liu, C. (2005). Adjusted Kaplan–Meier estimator and log-rank test with inverse probability of treatment weighting for survival data. Statistics in Medicine, 24(20), 3089–3110. https://doi.org/10.1002/sim.2174.CrossRefGoogle ScholarPubMed
Yang, H., Chen, W., Hu, Y., Chen, Y., Zeng, Y., Sun, Y., … Song, H. (2020). Pre-pandemic psychiatric disorders and risk of COVID-19: a UK Biobank cohort analysis. The Lancet Healthy Longevity, 1(2), e69–e79. https://doi.org/10.1016/S2666-7568(20)30013-1.CrossRefGoogle ScholarPubMed
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