Bipolar disorder (BD), also known as 'bipolar affective disorder', is a mental health condition associated with mood swings (usually between depression and mania) with periods of stable mood in between. It has a worldwide prevalence of 1.2% (Merikangas, 2009). The extreme mood swings experienced by people with bipolar disorder make everyday life difficult.
The increased mortality rates among bipolar individuals may be partially explained by higher rates of physical illness (see death gap), especially cardiovascular and metabolic diseases (Carvalho et al., 2024). Suicide reported as the leading cause of death among individuals with BH compared to the general population (Hayes et al., 2017) and increased mortality from natural causes due to a higher risk of physical illness among people with BD (Biazus et al., 2023).
Recent studies have attempted to uncover the causes of death among people with bipolar disorder (BD). However, many specific factors contributing to increased mortality among individuals remain unclear. Why is this research important? Paljärvi and colleagues (2023) Why people with bipolar disorder aged 15–64 more likely to die compared to the general population, while also determining specificity causes – both external and somatic.
Bipolar disorder is associated with increased mortality, but the causes of excess mortality compared to the general population are still poorly understood.
Methods
Researchers followed Finnish people between the ages of 15 and 64 with and without a diagnosis of BH from 2004 to 2018, to see if people with BH died earlier and earlier than people without it, and to compare their causes of death. They compared by looking at the causes of death external (unnatural) causes (for example, accidents, suicides) and somatic (natural) causes (eg disease, health problems).
Results
Overall, the study found that individuals with bipolar disorder had higher mortality rates than the general population. by external causes such as accidents and suicidesfiit can withstand extreme mortalityespecially younger age groups.
Interestingly, 64% of the deaths were “excess”, which means that they exceed the mortality rate of the general population. These excess deaths were therefore specifically associated with bipolar disorder.
Elderly people Those with BD (ages 45–64) were at particular risk of death compared to the general population somatic causes.
In general, around 10 years of life lost in those with BD compared to the general population.
In conclusion, overall mortality was 3 times higher among those with BD. Deaths from somatic causes were 2 times higher, and deaths from external causes were 6 times higher! So, suicide It was the highest cause of death increase in people with BD, with an 8-fold increase.
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.
Results
It is clear that individuals with bipolar disorder a higher risk death from external factors (for example, self-harm, accidents)- and no only physical ailments. They were young people aged 15-44 especially it is vulnerable to non-physical causes. So, while heart health is important, we need to shift our focus away from physical health problems in BD and consider external factors that may be associated with premature death.
The authors noted that age plays an important role in the excess mortality of people with bipolar disorder, with young adults being particularly vulnerable.
Strengths and limitations
The study involved a large number of people with bipolar disorder. This means that the findings are unlikely to have occurred by chance and likely reflect a true association between bipolar death and premature death. Researchers used numerous nationwide Finnish databases to identify people with bipolar disorder in many different settings. This is more representative of the sample. In other words, the researchers were able to identify more people with bipolar disorder than if they relied on hospital records alone.
It is important to recognize that the death toll may be higher than officially reported. This may be because some people are never diagnosed with the condition or are mistakenly diagnosed with something else (such as unipolar depression). Thus, the actual impact of the situation may be more significant than the numbers suggest. This is very important because we know that it takes about 7 to 10 years for someone to receive their first diagnosis of bipolar disorder. It's a long time for someone to go without knowing they have the condition.
It should be noted that the study was conducted in Finland, so we should be careful in directly applying its results to other countries, including the UK. Finland has unique factors, such as culture and healthcare, that may make results different elsewhere. we have to ask According to us, the people in this study are so different from people in our country that we can't use these results in some way?
The number of people with bipolar disorder who die prematurely may be higher due to misdiagnosis or lack of diagnosis.
Implications for practice
- This study highlights that we need to employ a number of strategies to reduce excess mortality in individuals with BD. The results suggest that strategies need to be adapted reflect different causes of death for different age groups.
- Interventions aimed at preventing substance abuse are critical to reducing excess mortality in bipolar disorder.especially in older people.
- Clinicians must consider and balance how best to manage symptoms and any other symptoms in bipolar disorder potential long-term side effects of medications can affect physical health.
- Suicide prevention must remain a priority, as it is the leading cause of death among people with bipolar disorder.. Qualitative research may shed more light on the lived experience of suicidal ideation, intention, and behavior in this population, as well as beneficial mechanisms and protective factors for enhancing resilience.
Suicidal ideation and behavior in people with bipolar disorder need to be better understood in order to identify more prevention strategies.
Statement of interest
There are no conflicts of interest to declare.
Contributors
owing to UCL Mental Health MSc students writing this blog from the Bass student body: 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 is written by a group of students MSc in Clinical Mental Health Sciences at University College London. A full list of UCL MSc student blogs can be found hereand you can follow the Mental Health Studies MSc team Twitter.
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Connections
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: a 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. Mol 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 Protective Effects of Lithium After First-Episode Mania Diagnosis in Bipolar Disorder: A Nationwide Retrospective Cohort Study in Taiwan. Psychoter 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, JF, Marston, L., Walters, K., King, MB, & Osborn, DPJ (2017). Mortality difference for patients with bipolar disorder and schizophrenia: a UK-based cohort study 2000–2014. British journal of psychiatry: a journal of the mental sciences, 211(3), 175–181. https://doi.org/10.1192/bjp.bp.117.202606
Merikangas, KR, & Pato, M. (2009). Recent developments in the epidemiology of bipolar disorder in adults and children: Magnitude, correlates, and future directions. Clinical Psychology: Science and Practice, 16(2), 121–133. https://doi.org/10.1111/j.1468-2850.2009.01152.x