• Posted July 19, 2023

Bipolar Disorder Ups Early Death Risk by Sixfold

People who have bipolar disorder may have a higher risk of dying early, according to new research.

Finnish investigators say this is due to a combination of external causes -- such as suicide, accidents and violence -- and physical health issues, with alcohol a big contributor.

Targeting interventions to substance abuse will likely reduce premature deaths owing to both external and physical causes, according to the study, published July 18 in BMJ Mental Health.

"Suicide prevention remains a priority, and better awareness of the risk of overdose and other poisonings is warranted," researchers led by Tapio Paljärvi of Niuvanniemi Hospital in Kuopio, Finland, said in a journal news release.

The study involved more than 47,000 Finns between 15 and 64 years of age with bipolar disorder.

Bipolar disorder was linked to sixfold increase in risk of early death from external causes, the researchers found. It doubled the risk of death due to physical illness.

In all, about 7%, or 3,300, of those in the study died during the follow-up, which spanned 2004 to 2018.

The average age at death was 50. About 65% of these deaths were among men, although women made up 57% of the study population. Physical illness caused 61% of the deaths and external causes were responsible for 39%.

For those whose deaths were attributed to physical illness, 29% were caused by alcohol; 27% to heart disease and stroke; 22% to cancer; 4% to respiratory disease; 2% to diabetes, and 1% to behavioral disorders associated with other substance misuse. The remaining 15% were from other causes.

Among the 595 alcohol-related deaths, liver disease was responsible for 48%; accidental alcohol poisoning for 28%, and alcohol dependence for 10%, researchers found.

Most of the external cause deaths (58%) were suicides and nearly half of those (48%) were caused by overdosing on prescribed mental health medications.

About 64% of deaths from any cause were considered excess, above the number expected for the population. Alcohol, heart disease and cancer were responsible for most of the excess deaths from illness.

The researchers excluded people diagnosed with schizophrenia and other psychotic illnesses from the study, which may have led to underestimating excess deaths from bipolar disorder. A history of persistent symptoms of psychosis, delusions and hallucinations is associated with a greatly increased risk of death, they explained.

A current focus on preventing excess death due to physical illness should be reconsidered, the authors said, because external causes appear to have a greater role.

They said a balanced consideration between therapeutic response, potential long-term side effects of different medicines and risk of premature death by specific cause is needed, especially in younger people.

More information

The American Psychiatric Association has more on bipolar disorders.

SOURCE: BMJ Mental Health, news release, July 18, 2023