Life years lost associated with mental illness: A cohort study of beneficiaries of a South African medical insurance scheme.

Ruffieux, Yann; Wettstein, Anja; Maartens, Gary; Folb, Naomi; Mesa Vieira, Cristina; Didden, Christiane; Tlali, Mpho; Williams, Chanwyn; Cornell, Morna; Schomaker, Michael; Johnson, Leigh F; Joska, John A; Egger, Matthias; Haas, Andreas D (2023). Life years lost associated with mental illness: A cohort study of beneficiaries of a South African medical insurance scheme. Journal of Affective Disorders, 340, pp. 204-212. Elsevier 10.1016/j.jad.2023.08.013

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BACKGROUND

People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown.

METHODS

We analysed reimbursement claims from South African medical insurance scheme beneficiaries aged 15-85 years. We estimated excess life years lost (LYL) associated with organic, substance use, psychotic, mood, anxiety, eating, personality, developmental or any mental disorders.

RESULTS

We followed 1,070,183 beneficiaries for a median of three years, of whom 282,926 (26.4 %) received mental health diagnoses. Men with a mental health diagnosis lost 3.83 life years (95 % CI 3.58-4.10) compared to men without. Women with a mental health diagnosis lost 2.19 life years (1.97-2.41) compared to women without. Excess mortality varied by sex and diagnosis, from 11.50 LYL (95 % CI 9.79-13.07) among men with alcohol use disorder to 0.87 LYL (0.40-1.43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (men: 3.42, women: 1.94). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1.52) or substance use (2.45) disorder.

LIMITATIONS

Mental diagnoses are based on reimbursement claims.

CONCLUSIONS

Premature mortality among South African individuals with mental disorders is high. Our findings support interventions for the prevention, early detection, and treatment of physical comorbidities in this population. Targeted programs for suicide prevention and substance use treatment, particularly among men, can help reduce excess mortality from unnatural causes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Ruffieux, Yann, Wettstein, Anja Elisabeth, Mesa Vieira, Cristina, Didden, Christiane Helene, Egger, Matthias, Haas, Andreas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0165-0327

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation ; [215] National Institute of Health (NIH)

Language:

English

Submitter:

Pubmed Import

Date Deposited:

07 Aug 2023 14:35

Last Modified:

05 Aug 2024 00:25

Publisher DOI:

10.1016/j.jad.2023.08.013

PubMed ID:

37544483

Additional Information:

Fuffieux and Wettstein contributed equally to this work (joint first authors).

Uncontrolled Keywords:

Excess mortality Life years lost Mental disorders South Africa

BORIS DOI:

10.48350/185247

URI:

https://boris.unibe.ch/id/eprint/185247

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