People with mental disorders still have more than twice the mortality rate of the general population – and the difference has remained nearly unchanged since 2010.

This is shown by a new study from Aarhus University that used anonymised data from the entire Danish population – more than seven million people – followed over 13 years.

Previous research has shown that life expectancy is approximately 10 years shorter for men and 7 years shorter for women with mental disorders. The new study shows that this gap is far from closed.

"On the one hand, it is encouraging to see that mortality rates are falling for many mental disorders. But it is disappointing that the gap with the general population has not narrowed. The initiatives that have been implemented in Denmark have not led to improvements beyond those seen in the general population," says Professor Oleguer Plana-Ripoll from the Department of Public Health at Aarhus University and first author of the study.

Progress for some – regression for others

The study reveals major differences across diagnoses. For those diagnosed with depression, mortality has fallen from around twice that of the general population in 2010-2012 to just under 1.8 times as high in 2022-2023. Progress is also seen for diagnoses of anxiety and personality disorders.

But for schizophrenia, the trend is going in the wrong direction, with mortality rising from just under four times to more than 4.5 times that of the general population. The gap has also widened for dementia and intellectual disabilities.

For people with substance use disorders and bipolar disorder, there has been no improvement – the gap remains unchanged.

Suicide looms large – but chronic illness claims more lives

The risk of suicide is more than five times higher among people with mental disorders than in the rest of the population. Yet suicide does not account for the majority of premature deaths.

"The largest relative difference is seen for suicide. But suicides are still relatively rare events. When we look at what actually claims the most lives, it is largely chronic physical illnesses, which are far more common," explains Assistant Professor Natalie Momen from the Department of Public Health at Aarhus University, one of the other authors behind the study.

Social inequality amplifies the problem

All types of mental disorders are associated with shorter life expectancy. In previous studies, the same research group has shown that social inequality amplifies the problem for some diagnoses.

For people with substance use disorders or schizophrenia, the risk of premature death is significantly greater if they have a low income, compared with people with the same diagnosis but higher income. 

"Low socioeconomic position plays a greater role for some disorders than for others. This means that if we want to make a real difference, initiatives must reach people across all socioeconomic levels," emphasises Natalie Momen.

Need for targeted action

In 2022, the Danish government entered into a political agreement with the goal of reducing excess mortality among people with mental disorders. The study shows that there is still some way to go.

The researchers recommend that diagnoses where the gap has widened – such as schizophrenia  – receive particular attention. At the same time, it is crucial that the progress made for depression and anxiety is not lost.

"The need for good mental and physical healthcare for people with mental disorders is fortunately receiving increasing attention and has been the subject of several initiatives in recent years. There is a will to improve conditions, and that gives hope," says Oleguer Plana-Ripoll.

About the research

Study type: Register-based observational cohort study

External funding: Independent Research Fund Denmark and Lundbeck Foundation.

Conflicts of interest: The authors of the study declared no conflicts of interest.

Link to scientific article: https://onlinelibrary.wiley.com/doi/10.1111/acps.70056

Contact

Professor Oleguer Plana-Ripoll
Aarhus University
Department of Public Health 
Phone: +45 87166034 
Email: opr@ph.au.dk