Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
J Affect Disord. 2023 Nov 1;340:204-212. doi: 10.1016/j.jad.2023.08.013. Epub 2023 Aug 6.
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.
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.
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.
Mental diagnoses are based on reimbursement claims.
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.
精神疾病患者的预期寿命缩短，但在南非，精神疾病患者的死亡率差距有多大，以及自然和非自然原因对其超额死亡率的贡献有多大尚不清楚。
我们分析了南非医疗保险计划受益人的报销索赔数据，这些受益人年龄在 15-85 岁之间。我们估计了与器质性疾病、物质使用障碍、精神病性、心境、焦虑、进食、人格、发育或任何精神障碍相关的超额寿命损失（LYL）。
我们对 1070183 名受益人进行了中位数为 3 年的随访，其中 282926 人（26.4%）被诊断患有精神健康障碍。与没有精神健康诊断的男性相比，患有精神健康诊断的男性失去了 3.83 年的寿命（95%CI 3.58-4.10）。与没有精神健康诊断的女性相比，患有精神健康诊断的女性失去了 2.19 年的寿命（1.97-2.41）。超额死亡率因性别和诊断而异，从男性酒精使用障碍的 11.50 LYL（95%CI 9.79-13.07）到女性广泛性焦虑症的 0.87 LYL（0.40-1.43）不等。大多数 LYL 归因于自然原因（男性：3.42，女性：1.94）。在男性双相情感障碍（1.52）或物质使用障碍（2.45）患者中，相当一部分 LYL 归因于非自然原因。
精神科诊断是基于报销索赔。
南非患有精神障碍的个体过早死亡的比例很高。我们的研究结果支持针对该人群进行预防、早期发现和治疗躯体共病的干预措施。针对男性的自杀预防和物质使用治疗的针对性计划可以帮助减少非自然原因导致的超额死亡率。
