Cause of death in people with bipolar disorder

Bipolar disorder (BD), also known as bipolar affective disorder, is a mental health condition characterized by mood swings (usually between depression and mania), with periods of stable mood in between. It has a global prevalence of 1.2% (Merikangas, 2009). The extreme mood swings that people with bipolar disorder experience often make daily functioning difficult.

The higher mortality rates among people with bipolar disorder can be partly explained by higher rates of physical illness (the so-called mortality gap), particularly cardiovascular and metabolic diseases (Carvalho et al., 2024). is considered the leading cause of death among individuals with BD compared to the general population (Hayes et al., 2017) and due to a higher risk of physical illness in people with BD, higher mortality rates from natural causes are observed (Biazus et al., 2023).

Recent studies have attempted to understand the causes of mortality among individuals with bipolar disorder (BD). However, many of the specific factors that lead to increased mortality among individuals remain unclear. Why is this study important? Paljärvi and colleagues (2023) wanted to understand why people with bipolar disorder between the ages of 15 and 64 more likely to die compared to the general population, while also the specific causes – both external and somatic.

An association has been found between bipolar disorder and higher mortality, but the causes of the higher mortality compared to the general population are less well known.

Methods

The researchers followed Finnish people aged 15 to 64, with and without a diagnosis of BD, from 2004 to 2018 to monitor whether people with BD died more often and earlier than people without BD, and to compare causes of death. They compared causes of death, looking at external (unnatural) causes (e.g. accidents, suicides) and somatic (natural) causes (e.g. illness, health problems).

Results

Overall, the study found that individuals with bipolar disorder had a higher mortality rate compared to the general population, where external causes such as accidents and suicides make a significant contributionIbarely avoided this excessive mortalityespecially in younger age groups.

Interestingly, 64% of the deaths were ‘excess’, meaning that they exceeded the mortality rates of the general population. This excess mortality was therefore specifically linked to having bipolar disorder.

Elderly with BD (aged 45-64) were at particularly high risk of death compared to the general population. somatic causes.

Overall, around 10 years of my life were lost in people with BD compared to the general population.

In conclusion, the total number of deaths was 3 times higher among those with BD. Deaths from somatic causes were 2 times higher, and deaths from external causes were even 6 times higher! With that, suicide was the leading cause of increased mortality among people with BD, being 8 times higher.

The difference in mortality between people with bipolar disorder and the general population can be attributed to external causes of death, such as suicide or accidents.

Conclusions

It is clear that people with bipolar disorder face a Higher risk of death due to external factors (e.g. self-harm, accidents) – and not only physical illnesses. The younger people, from 15 to 44 years old, were special vulnerable to these nonphysical causes. So while heart health is important, we need to shift our focus from just physical health issues in BD, and also think about external factors that may be linked to premature death.

The authors point out the important role of age in excess mortality among people with bipolar disorder, with younger people being particularly vulnerable.

Strong and weak points

Many people with bipolar disorder participated in the study. This means that the findings are unlikely to have occurred by chance, and likely reflect a real relationship between bipolar and premature death. The researchers used multiple Finnish national databases to identify people with bipolar disorder from different settings. This makes the sample more representative. In other words, the researchers were able to identify more people with bipolar disorder than if they had relied on hospital registers alone.

It is important to recognize that the number of people who have died may be higher than what is officially reported. This may be because some individuals were never diagnosed with the condition, or were incorrectly diagnosed with another condition (e.g. unipolar depression). The true impact of the situation may therefore be greater than what the numbers suggest. This is crucial because we know that it takes about 7-10 years for someone to receive their first diagnosis of bipolar disorder. That is a long time for someone to live without knowing that they have this condition.

It should be noted that the study was conducted in Finland, so caution should be exercised in applying the findings directly to other countries, including the UK. Finland has unique factors, such as culture and healthcare, which may mean that the results elsewhere are different. We should ask Do you wonder whether the people in this study are so different from people in our country that we cannot use these results in any way?

The number of people with bipolar disorder who die prematurely may be higher due to misdiagnosis or underdiagnosis.

Implications for practice

• This study highlights that we need to use a range of strategies to reduce excess mortality in individuals with BD. The findings indicate that strategies need to be tailored to reflect different causes of death for different age groups.
• Interventions aimed at preventing substance abuse are crucial for reducing excess mortality in bipolar disorderespecially in older people.
• Clinicians must consider and weigh how best to treat the symptoms of bipolar disorder, and which possible long-term side effects of medications that may have an influence physical health.
• Suicide prevention must remain a priority as it is the leading cause of death among people with bipolar disorder. Qualitative research can provide more insight into the experience of suicidal thoughts, intentions and behavior in this population group. It can also help identify mechanisms and protective factors that can increase resilience.

More insight into suicidal thoughts and behavior in people with bipolar disorder is needed so that more prevention strategies can be developed.

Declaration of interests

There are no conflicts of interest to report.

Staff

Thanks to MSc Mental Health UCL students who wrote this blog from the Bass student group: Rianna Patterson, Katherine Ede, Tarini Sharma, Vanessa Eastick, Asha Mohanlal, Hemanshi Mehta, Yu Yue and Amber Jarvis.

UCL MSc in Mental Health Studies

This blog was written by a group of students at the Clinical Mental Health Sciences MSc at University College London. A full list of blogs from UCL MSc students can be found here , and you can follow the Mental Health Studies MSc team on Twitter.

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Links

Primary paper

Paljärvi T, Herttua K, Taipale H, Lähteenvuo M, Tanskanen A, Fazel S, Tiihonen J. Cause-specific excess mortality after first diagnosis of bipolar disorder: population-based cohort study. BMJ Ment Health. 2023 May;26(1):e300700. doi: 10.1136/bmjment-2023-300700.

Other references

Biazus, T., Beraldi, G., Tokeshi, L. Rotenberg, L., Dragitoti, E., Carvalho, A., Solmi, M. Lafer, B. (2023). All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis. Mole Psychiatry 28, 2508–2524. https://doi.org/10.1038/s41380-023-02109-9

Carvalho, A., Hsu, C., Vieta, E., Solmi, M., Marx, W., Berk, M., Liang, C., Tseng, P., Wang, L. (2024). Mortality and lithium-protective effects after first-episode mania diagnosis in bipolar disorder: a nationwide retrospective cohort study in Taiwan. Psychother Psychosom. https://doi.org/10.1159/000535777

Chan, JKN, Wong, CSM, Yung, NCL, Chen, EYH, & Chang, WC (2021). Excess mortality and years of life lost in people with bipolar disorder: an 11-year population-based cohort study. Epidemiology and psychiatric sciences, 30e39. https://doi.org/10.1017/S2045796021000305

Hayes, J.F., Marston, L., Walters, K., King, M.B., & Osborn, D.P.J. (2017). Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014. The British Journal of Psychiatry: The Journal of Mental Science, 211(3), 175–181. https://doi.org/10.1192/bjp.bp.117.202606

Merikangas, KR, & Pato, M. (2009). Recent advances in the epidemiology of bipolar disorder in adults and children: scope, correlates, and future directions. Clinical Psychology: Science and Practice, 16(2), 121–133. https://doi.org/10.1111/j.1468-2850.2009.01152.x