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January 14, 2021
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Mental disorders in early life may predict risk for physical disease, early mortality

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Mental disorders appeared to begin and peak during young adulthood, and they were linked to subsequent physical diseases and early mortality, according to study results published in JAMA Network Open.

Leah S. Richmond-Rakerd

“Prior research had suggested that people who experience mental health problems when they are young also experience age-related physical diseases when they are older, but this work had not accounted for the possibility of reverse causation, in which having a physical health problem leads to a mental health problem,” Leah S. Richmond-Rakerd, PhD, of the department of psychology at the University of Michigan, told Healio Psychiatry. “We found that individuals with mental disorders were at increased risk for subsequent physical diseases, even after accounting for pre-existing physical health problems. We also tracked the association between mental disorders and physical diseases over a 30-year span, which is a long follow-up relative to many prior studies.”

In the current population-based cohort study, Richmond-Rakerd and colleagues analyzed data of 2,349,897 individuals aged 10 to 60 years who were included in the New Zealand Integrated Data Infrastructure, which collected nationwide administrative data sources linked at the individual level. Specifically, they sought to identify mental disorders, physical diseases and deaths recorded between July 1988 and June 2018 among New Zealand’s population. The analysis included all individuals born in the country between 1928 and 1978 who resided there at any point during the 30 years of observation. Mental disorder diagnoses made in public hospitals and available in nationwide administrative records served as the exposures. Main outcomes and measures included chronic physical disease diagnoses made in public hospitals, deaths and health care use.

Results showed those with a mental disorder developed subsequent physical diseases at younger ages (HR = 2.33; 95% CI, 2.3-2.36) and died at younger ages (HR = 3.8; 95% CI, 3.72-3.89) vs. those without a mental disorder. After accounting for preexisting physical diseases and across sex and age, these associations remained. Further, the researchers observed associations across various types of mental disorder and self-harm behavior. They noted a link between mental disorders and onset of physical diseases and the accumulation of physical disease diagnoses (incidence rate ratio [IRR] = 2; 95% CI, 1.98-2.03), a higher number of hospitalizations (IRR = 2.43; 95% CI, 2.39-2.48), longer hospital stays for treatment (IRR = 2.7; 95% CI, 2.62-2.79) and higher associated health care costs.

“Mental health providers are positioned to help prevent not only mental health problems in young people, but also physical health problems in older adults,” Richmond-Rakerd said. “Treating mental disorders in early life could be a window of opportunity to help reduce the societal burden of age-related physical diseases. Importantly, we found that the association between mental disorders and physical diseases was not specific to any one disorder, since individuals diagnosed with different types of mental disorders all developed excess physical diseases as they grew older. This suggests that targeting any mental disorder in early life might benefit later-life health.”