Almost one-third of South Africans receive a mental health diagnosis at some point in their lives, placing a high toll on life expectancy, a recent study on excess mortality has shown.
The findings, reported on the preprint server medRxiv and not yet peer-reviewed, are based on medical aid claims by more than 1m people between 2011 and the start of the Covid pandemic in March 2020, reports Business Insider.
Because people who use public health “may be at higher risk of experiencing poor mental health outcomes than employed and insured people who access private services”, say the paper’s authors, the toll of mental illness on life expectancy could be even higher.
Mental disorders are among the top 10 leading causes of disease in South Africa, according to the 2019 Global Burden of Disease report, and about 30% of people receive a mental health diagnosis at some point.
Until now, however, the only study into excess mortality linked to mental illness was among people living with HIV, say the authors, led by Yann Ruffieux and Anja Wettstein at Switzerland’s University of Bern, but which also included a team from the University of Cape Town, among other institutions.
“Although most mental disorders do not lead directly to death, they increase the risk of suicide, accidental death and premature mortality from physical illness,” they said.
Deaths from natural causes, which formed the majority in the 282 926 patients with mental health diagnoses in the study, “can be attributed to a higher incidence of physical comorbidities among people with mental illness and worse access to or engagement in health care”.
Out of 1 070 183 medical aid members studied, 30.5% of women and 22.1% of men received mental health diagnoses. The most common were related to anxiety, including generalised anxiety, post-traumatic stress, depression and bipolar disorders.
“Life expectancy after diagnosis of any mental disorder was 3.8 years shorter for men and 2.2 years shorter for women compared with beneficiaries of the same age and sex without diagnoses,” said the authors.
For men, drug use disorders are the most serious threat to life expectancy, costing them 12.32 years (7.89 years for women); for women, the biggest threat to longevity is alcoholism at 10.24 years (11.5 years for men).
Men also lose more than 10 years if they are diagnosed with a mental disorder linked to brain dysfunction (also called organic disorders) or a psychotic disorder; women lose more than 10 years for organic disorders; and for both sexes, eating disorders and developmental disorders such as autism are linked to losses of between seven and 10 years.
Overall, men with mental illness lose more life years than women, and the researchers said at least part of the reason was higher mortality from accidents and suicides among men with bipolar and substance use disorders.
For both sexes, higher rates of physical illness among people with mental disorders, and poorer health care, contribute to premature death.
Study details
Life-years lost associated with mental illness: a cohort study of beneficiaries of a South African medical insurance scheme
Yann Ruffieux , Anja Wettstein, Gary Maartens, Naomi Folb, Cristina Mesa Vieira, Christiane Didden, Mpho Tlali, Chanwyn Williams, Morna Cornell, Michael Schomaker, Leigh Johnson, John A Joska, Matthias Egger, Andreas Haas.
Posted on medRXiv on 19 January 2023
Summary
Background
People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown. Methods We analysed reimbursement claims and vital registration data from South African medical insurance scheme beneficiaries aged 15–85 years. We estimated excess life years lost (LYL) associated with organic, substance use, psychotic, mood, anxiety, eating, personality, developmental or any mental disorders.
Findings
We followed 1 070 183 beneficiaries, of whom 282 926 (26·4%) received mental health diagnoses. Life expectancy of people with mental health diagnoses was 3·83 years (95% CI 3·58–4·10) shorter for men and 2·19 years (1·97–2·41) shorter for women. Excess mortality varied by sex and diagnosis, ranging from 11·50 LYL (95% CI 9·79–13·07) among men with alcohol use disorder to 0·87 LYL (0·40–1·43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (3·42 among men and 1·94 among women). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1·52) or substance use (2·45) disorder.
Interpretation
The burden of premature mortality among persons with mental disorders in South Africa is high. Our findings support implementing interventions for prevention, early detection, and treatment of physical comorbidities among people with mental disorders. Suicide prevention and substance use treatment programmes are needed to reduce excess mortality from unnatural causes, especially among men.
The Lancet – Global burden of disease report (Open access)
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