- South African men who use drugs shorten their lives by about twelve years, according to a new study.
- For women, alcoholism has a higher cost in terms of years of life.
- The scientists analyzed data on more than a million health care patients and say excess mortality may be worse in the public sector.
- They call for measures to improve the prevention, early detection and treatment of physical comorbidities among people with mental illness.
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South Africans with alcoholism pay the price of losing more than 10 years of their lives, according to a new study on excess mortality.
For men, that’s significantly more than the cost in life expectancy for those with a mental health diagnosis, nearly four fewer years compared to men without a mental illness, the researchers found.
But for women, alcohol abuse comes at a worse cost than drug use.
The findings, reported on the medRxiv preprint server and not yet peer-reviewed, are based on requests for medical help from more than a million people between 2011 and the start of the covid pandemic in March 2020.
Because people who rely on the public health sector “may be at greater risk of experiencing poor mental health outcomes than employed and insured people who access private services,” say the paper’s authors, the cost of mental illness in life expectancy may be even higher.
Mental disorders are among the top 10 causes of illness in South Africa, according to the 2019 Global Burden of Disease report, with around 30% of people receiving a mental health diagnosis at some point.
Until now, however, the only study on excess mortality related to mental illness was conducted among people living with HIV, say 14 authors led by Yann Ruffieux and Anja Wettstein of the University of Bern in Switzerland.
“Although most mental disorders do not lead directly to death, they do increase the risk of suicide, accidental death, and premature mortality from physical illness,” they say.
Deaths from natural causes, which made up the majority of the 282,926 patients with mental health diagnoses in the study, “may be attributed to a higher incidence of physical comorbidities among people with mental illness and poorer access to or participation in health care.” .
Of 1,070,183 health care members who observed, 30.5% of women and 22.1% of men received mental health diagnoses. The most common were related to anxiety, including generalized 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 age- and sex-matched recipients without a diagnosis,” the authors say. , half of whom are from South Africa.
For men, drug use disorders emerge as the most serious threat to life expectancy, with a cost of 12.32 years (7.89 years for women); for women, the greatest 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 related to brain dysfunction (also called organic disorders) or a psychotic disorder; women lose more than 10 years due to organic disorders; and for both sexes, eating disorders and developmental disorders such as autism are linked to losses of between seven and 10 years.
In general, men with mental illness lose more years of life than women, and the researchers said that at least part of the reason was higher mortality from accidents and suicides among men with bipolar and substance use disorders.
“For other disorders, lower rates of health care utilization among men may contribute, stemming from the gendered nature of health services that create barriers to care for men, harmful masculine norms, self-stigmatizing beliefs, or differences in coping strategies”, they say.
For both sexes, higher rates of physical illness among people with mental disorders and poorer medical care contribute to premature death.
“Experts recommend interventions to reduce the burden of physical disease among people with mental health problems to close the mortality gap.
“These may focus on lifestyle and behaviors to prevent physical illness, or early detection and appropriate treatment of common physical comorbidities. In addition, interventions aimed at reducing the stigma towards mental illness among health care providers should be considered.
The study, funded by the Swiss National Science Foundation and the US National Institutes of Health, was approved by the human research ethics committee of the University of Cape Town and the ethics committee of the Canton of Bern. in Switzerland.
