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Mental illness can lead to 20 year loss in life expectancy: Research


Evelyn Lewin


17/07/2019 4:01:44 PM

The number of years of life lost due to physical health conditions in people with mental illness is increasing, but early intervention can help bridge the gap.

Mental illness can impact physical health.
Patients with mental illness commonly suffer physical comorbidities.

Patients with mental illness commonly suffer physical comorbidities.
 
Now an Australian-led report, published in The Lancet Psychiatry, has found these issues lead to a ‘drastically’ reduced life expectancy for people with mental illness – up to 20 years.
 
The paper examines almost 100 systematic reviews and meta-analyses on the prevalence of physical comorbidities among people with mental illness.
 
While noting that suicide contributes to a considerable proportion of premature deaths in people with mental illness (approximately 17% of mortality attributed to unnatural causes), it states the majority of years of life lost relates to poor physical health, specifically due to comorbid non-communicable and infectious diseases.
 
It found that mental illnesses are associated with a risk of obesity, diabetes and cardiovascular diseases that is 1.4–2 times higher than in the general population.
 
For patients with depression, the risk of developing cardiac disease, hypertension, stroke, diabetes, metabolic syndrome or obesity is around 40% higher than in the general population.
 
‘[These diseases] impact on quality of life and recovery, while contributing towards a 20-year gap in life expectancy currently experienced by this underserved population,’ Western Sydney University researcher Dr Joseph Firth said.
 
The report also found little progress has been made in addressing these trends, with the number of years of life lost due to physical health conditions in people with mental illness potentially increasing.
 
‘It’s not only a gap in life expectancy but it’s also a massive gap in terms of the quality of life and the physical health burden that affects people with mental illness,’ Dr Firth said.
 
Dr Cathy Andronis, Chair of the RACGP Specific Interests Psychological Medicine network, told newsGP the research ties in with previous findings from the Adverse Childhood Experiences (ACE) Study, which found people who reported traumatic childhood adverse events had worse physical health later in life and a decreased life expectancy.
 
‘We’ve known about this for a while, but I think it’s actually only starting to permeate the medical community,’ she said.
 
In addition, Dr Andronis said the effect of early childhood adversity – which can underpin mental health issues – has long been associated with poor physical health in later life.
 
‘Probably that’s what happening in a lot of Aboriginal communities where they do have very low life expectancies,’ she said.
 
‘There’s a clear correlation between a lot of things that have happened to people when they’re young that partly gets reinforced through intergenerational trauma that a lot of Aboriginal peoples have experienced, and they die very young as well.’
 
Dr Firth said the main findings of this paper are that cardiovascular disease and metabolic health outcomes present the ‘key targets’ for reducing the incidence of physical disease in people with mental illness.
 
The key to treatment, he added, is early intervention.
 
‘It’s actually much easier and much more feasible when we’re talking about preventing these conditions from arising rather than trying to reverse the conditions after [they’ve] arisen,’ he said.
 
Dr Andronis agrees, saying the most important step GPs can take to help bridge this gap lies in greater awareness of the issues leading to mental health issues.
 
She believes some GPs can ‘underestimate or underrate’ the effect of mental illness on physical health and emphasised the need to screen patients for mental distress to understand which patients are more at risk.
 
‘People who have more mental health problems are likely to experience more physical problems,’ she said.
 
‘I think we need to be more proactive … we need to be aware that these people are at risk and be actively screening.’
 
If a patient presents to a consultation with a separate issue, Dr Andronis said GPs should take the opportunity to screen patients for other modifiable risk factors, such as blood pressure, exercise, diet and smoking.
 
The authors of the paper offer further suggestions on how to reduce the gap in life expectancy and health burdens. These include measures such as exploring the interplay between psychiatric medications and their effect on physical health.
 
They also discuss emerging solutions to help patients with mental illness engage in lifestyle modification, such as stopping smoking and engaging in more physical exercise, in ways tailored towards this population.
 
Researcher Dr Simon Rosenbaum from the University of New South Wales said the report also highlights the need for redefining how we think of standard healthcare for those with mental illness.
 
He said the evidence is ‘very clear’ that there is a need for non-traditional services such as exercise physiologists, dietitians and allied health, to play a ‘routine part’ in health treatment.
 
He also called for the integration of physical and mental health care – an idea that Dr Andronis supports.
 
‘Mental health and physical health are intrinsically linked, so any patient presenting with frequent somatic complaints requires a mental wellbeing assessment, while any patient with mental health problems needs a thorough physical check,’ she said.
 
‘A holistic GP approach is always warranted.’



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