A recent study published in the open-access journal BMJ Mental Health reveals that individuals with bipolar disorder are six times more likely to die prematurely from external causes—such as accidents, violence, and suicide—compared to those without the disorder. Additionally, these individuals face double the risk of dying from somatic (physical) health issues, with alcohol consumption identified as a significant contributing factor.
This heightened risk of early mortality has been consistently observed across various countries among people with bipolar disorder. However, the specific factors contributing to this increased risk and the role of physical illnesses remain unclear.
To investigate further, researchers from Finland utilized national medical and social insurance databases to track the health outcomes of 15 to 64-year-olds diagnosed with bipolar disorder from 2004 to 2018. They analyzed the ratio of observed deaths to expected deaths within the Finnish general population—calculating the standard mortality ratio (SMR)—to determine excess deaths attributable to the condition.
The study monitored 47,018 individuals with bipolar disorder, averaging 38 years of age at the start of the study period, with 57% being women. During the eight-year follow-up, 3,300 (7%) of these individuals died, compared to 141,536 individuals in the general population, indicating a sixfold increased risk of death from external causes and a twofold increased risk from somatic causes.
The average age at death for those with bipolar disorder was 50 years, with men accounting for nearly two-thirds (65%) of these fatalities. Causes of death included somatic illness (61%, or 2,027 cases) and external causes (39%, or 1,273 cases).
Among the 2,027 somatic deaths, alcohol-related issues were the leading cause, accounting for 29% (595 deaths), followed by cardiovascular diseases (27%, 552 deaths) and cancer (22%, 442 deaths). The remaining deaths were attributed to various other health conditions.
Of the alcohol-related fatalities, liver disease was the most common cause, comprising nearly half (48%), followed by accidental poisoning (28%) and alcohol dependence (10%). In terms of external causes, suicide was the most prevalent, making up 58% (740 deaths), with nearly half of these attributed to overdoses involving prescribed mental health medications, including those for treating bipolar disorder.
Overall, nearly two-thirds (64%, or 2,104 deaths) of fatalities among individuals with bipolar disorder were classified as excess deaths directly linked to the condition. Specifically, 51% (1,043) of deaths from somatic causes were excess deaths, as were 83% (1,061) of those from external causes.
The findings indicate that excess mortality was substantial across all age groups, with external causes predominating among those aged 15 to 44, while both external and somatic causes contributed nearly equally in the 45 to 64 age bracket.
The researchers noted that their analysis excluded individuals diagnosed with schizophrenia and other psychotic disorders, which may lead to an underestimation of the excess deaths associated with bipolar disorder. They highlighted that a history of persistent psychotic symptoms is linked to significantly increased mortality risk.
Given the significant role of external causes in the elevated mortality rates among individuals with bipolar disorder, the researchers suggest reevaluating the current therapeutic focus on preventing physical illnesses. They emphasize the need for a balanced approach that considers the serious long-term somatic side effects of various medications and the risks of cause-specific premature mortality, particularly in younger populations.
The researchers advocate for targeted preventive measures against substance abuse to mitigate the mortality gap associated with both external and somatic causes. They underscore the importance of suicide prevention and greater awareness of overdose risks, particularly regarding prescribed medications.
