KUOPIO, Finland — Bipolar disorder increases the risk of premature death more than six times, a new study reveals. Individuals with severe depression, characterized by extreme mood swings, are significantly more likely to die through accidents, violence, or suicide, scientists explain. Additionally, they are twice as likely to die from physical causes, with alcohol use being a major contributing factor.
“Improved interventions aimed at reducing the risk of death due to external causes, and alcohol abuse should be developed to prevent premature excess mortality associated with bipolar disorder,” the study authors, led by Dr. Tapio Paljarvi of Niuvanniemi Hospital, write in BMJ Mental Health.
Bipolar disorder is one of the world’s most prevalent health problems. Case numbers have surged in recent years, particularly among young adults, leading to an increase in suicides. In the United States alone, the medical expenses related to bipolar disorder amount to $326 billion annually. Bipolar disorder is a severe mental health condition characterized by manic highs and depressive lows, with the majority of patients experiencing alternating episodes.
Almost as many people live with bipolar disorder as with cancer. It is more than twice as prevalent as dementia, epilepsy, autism, and rheumatoid arthritis.
Dr. Paljarvi’s team highlights that the excess risk of death from external causes is substantial across all age groups. A significant implication of the high number of deaths due to suicide is the necessity for personalized approaches to prediction and prevention.
Simple, scalable models have been developed and validated to assist with risk prediction in people with bipolar disorders. The researchers suggest that if these models can be linked to effective interventions for suicide prevention, such as safety planning, they could further reduce the mortality gap. Similar prediction models could be developed for premature mortality from other causes, citing the well-calibrated prediction models used in cardiovascular medicine as examples.
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The team utilized nationwide medical and social insurance registers to identify and monitor the health of all individuals between 15 and 64 years-old with bipolar disorder from 2004 to 2018. They calculated the ratio of observed deaths over approximately eight years of monitoring among those diagnosed with bipolar disorder and compared it to the expected number in the Finnish general population.
The study tracked the outcomes of 47,018 people with bipolar disorder, 57 percent of whom were women. During the monitoring period, seven percent of them (3,300 individuals) died compared to 141,536 people in the general population. This equates to a six-fold higher risk of death from external causes and a two-fold higher risk of death from physical causes for those with bipolar disorder.
The average age at death was 50. Almost two-thirds of cases involved men. In 61 percent of cases, the cause of death was physical, while in 39 percent, the cause was external. Of the former, alcohol was the most common cause (29%), followed by cardiovascular disease (27%), cancer (22%), respiratory disease (4%), diabetes (2%), and behavioral disorders related to substance misuse (1%). The remaining 15 percent were due to various other causes.
Of the latter, most deaths were due to suicide (58%), nearly half of which were the result of overdoses with prescribed mental health medications, including those used to treat bipolar disorder.
“A balanced consideration between therapeutic response, potential serious long term somatic side effects of different medicines, and risk of cause-specific premature mortality is needed, especially in younger persons,” the study authors write in a media release.
“Targeting preventive interventions for substance abuse will likely reduce the mortality gap both due to external causes and somatic causes. Suicide prevention remains a priority, and better awareness of the risk of overdose and other poisonings is warranted.”
South West News Service writer Mark Waghorn contributed to this report.
