Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark; and Department of Psychology, University of Southern Denmark, Odense, Denmark.
Br J Psychiatry. 2024 Jul;225(1):282-289. doi: 10.1192/bjp.2024.68.
Despite the recognised importance of mental disorders and social disconnectedness for mortality, few studies have examined their co-occurrence.
To examine the interaction between mental disorders and three distinct aspects of social disconnectedness on mortality, while taking into account sex, age and characteristics of the mental disorder.
This cohort study included participants from the Danish National Health Survey in 2013 and 2017 who were followed until 2021. Survey data on social disconnectedness (loneliness, social isolation and low social support) were linked with register data on hospital-diagnosed mental disorders and mortality. Poisson regression was applied to estimate independent and joint associations with mortality, interaction contrasts and attributable proportions.
A total of 162 497 individuals were followed for 886 614 person-years, and 9047 individuals (5.6%) died during follow-up. Among men, interaction between mental disorders and loneliness, social isolation and low social support, respectively, accounted for 47% (95% CI: 21-74%), 24% (95% CI: -15 to 63%) and 61% (95% CI: 35-86%) of the excess mortality after adjustment for demographics, country of birth, somatic morbidity, educational level, income and wealth. In contrast, among women, no excess mortality could be attributed to interaction. No clear trends were identified according to age or characteristics of the mental disorder.
Mortality among men, but not women, with a co-occurring mental disorder and social disconnectedness was substantially elevated compared with what was expected. Awareness of elevated mortality rates among socially disconnected men with mental disorders could be of importance to qualify and guide prevention efforts in psychiatric services.
尽管精神障碍和社会脱节对死亡率的重要性已得到公认，但很少有研究探讨它们的同时存在。
在考虑到性别、年龄和精神障碍特征的情况下，研究精神障碍与社会脱节的三个不同方面之间的相互作用对死亡率的影响。
本队列研究纳入了 2013 年和 2017 年参加丹麦全国健康调查的参与者，并随访至 2021 年。关于社会脱节（孤独、社会隔离和社会支持度低）的调查数据与医院诊断的精神障碍和死亡率的登记数据相链接。应用泊松回归来估计与死亡率的独立和联合关联、交互作用对比和归因比例。
共有 162497 人随访 886614 人年，随访期间有 9047 人（5.6%）死亡。在男性中，精神障碍与孤独、社会隔离和社会支持度低之间的交互作用分别占调整人口统计学、出生地、躯体发病率、教育程度、收入和财富后超额死亡率的 47%（95%CI：21-74%）、24%（95%CI：-15 至 63%）和 61%（95%CI：35-86%）。相比之下，在女性中，没有超额死亡率可以归因于交互作用。根据年龄或精神障碍特征，没有明确的趋势。
与预期相比，患有精神障碍和社会脱节的男性的死亡率明显升高，而女性则不然。对于社会隔离且患有精神障碍的男性中升高的死亡率，提高认识可能对精神卫生服务中的资格认证和预防工作具有重要意义。
