Do People With Bipolar Die Earlier? - A Look at Three Studies

Patient Expert

Last week, in a post on aging, I reported:

According to a 2011 study in PLOS, males with bipolar can expect to lose 10 years of life compared to the general population, females 11 years.

This prompted a comment from Crystal, who wondered what things people with bipolar die of. This will be the topic of a future post. But first we need to understand what this lost years business is all about. A little background:

My post on aging was based on a lecture I attended about ten days ago in San Diego, delivered by Colin Depp of UCSD. In his lecture, Dr Depp referred to the study in PLOS.

This was hardly my first encounter with expert evidence of bipolar's lethal effects. In 2001, at the Fourth International Conference on Bipolar Disorder in Pittsburgh, I heard one of the presenters (sorry, the name eludes me) mention that people with bipolar lose seven years of life due to the illness, irrespective of suicide.

That certainly got my attention.

Now let's examine the study evidence:

At the 2002 NAMI annual convention, Ken Duckworth, then deputy commissioner of the Massachusetts Department of Mental Health, recounted how he woke up to the high kill rate of mental illness. "Ken," a doctor told him, "you guys are getting fabulous at doing memorial services."

Years later, Dr Duckworth was in a position to launch a study, which was published in 1999. A look at the data found that clients in the Massachusetts mental health system lost nine years of life compared to other people living in Massachusetts.

Respiratory diseases were four to six times higher and diabetes twice as high. Said Dr Duckworth to the MDs in the audience: "You need to think of your patients as if they already had a heart attack."

Next study ...

In her comment, Crystal wrote:

I read something a while back that said people with bipolar live on average 25 years shorter.

There actually is a study (from 2006) that sort of came to that conclusion. The source is the Center for Mental Health Statistics, which did not crunch out a definitive number, as such. Instead, the Center compiled yearly data on mental health clients in eight states and tabulated these separately. Thus, in Oklahoma in 1999, mental health clients could expect to lose 26 years of life compared to the general population.

Close enough to 25.

Here is the money quote from the study:

Most public mental health clients in all of the states died of natural causes and at younger ages than the general populations of their states. Leading causes of death for most public mental health clients were similar to those of individuals throughout the United States and in state general populations, especially heart disease, cancer, and cerebrovascular, respiratory, and lung diseases. People with mental illness have medical problems that lead to death, especially if they have inadequate medical treatment.

Neither the Massachusetts study nor the Mental Health Statistics study separated out bipolar from other serious mental illnesses. The PLOS study mentioned at the beginning of this piece (another data-mining exercise, this time involving a mental health registry in London) did a basic breakdown. Thus, in addition to its findings on bipolar, the study came up with the following:

Depression (seven years lost in males, 11 in females), schizophrenia (15 years lost M, 10 years F), schizoaffective (8 years lost M, 18 years F), and substance use (14 years lost M, 15 W). For serious mental illness in general - 13 lost years.

According to the authors of the study, the impact of serious mental illness on life expectancy is higher than for smoking, diabetes and obesity.

There is no accounting for the wide discrepancy in these study results. I would certainly not feel safe citing 25 lost years for bipolar patients. Ten or so lost years sounds closer, but even then I would issue some strong qualifications:

These studies do not take into account patients who do well and leave the mental health system. In all likelihood, these are individuals who practice healthy lifestyles, find meaning in their lives, are socially connected, stable financially, and have a handle on managing their illness. From my support group experience, these are the people who do not stick around. Once they get better, they are gone. We need to find them and study them.

So, why don't we knock ten lost years down to six or seven?

Now let's get personal. Let's assume, for one, we're not helpless bystanders. That there are things we can do to lead long and healthy lives. So let's knock six or seven lost years down to three or four. If you live in the US, that means you get to live until age 75 or 76 rather than age 79. There, almost normal.

But hold on. Aging is not linear. The longer we live, the longer we can expect to live. Thus, if you are a female who has made it to age 50, you can expect to live another 32 years to age 82. If you are a male age 64 (that's me), you can expect to live another 17 years to age 81. If you make it to age 81, you get another seven bonus years.

This has to do with actuarial science, which is Greek (actually math) to me. But the bottom line is clear. In my case, I have two ways of looking at my life: I can assume that I should be dead by now. Or I can look forward to my grandkids growing up.

On my bad days, to be honest, I see a lot of merit in a quick and unspectacular exit off this planet. But then, unaccountably, I have my good days. Can I actually imagine myself living to a ripe old age? Can you?

More to come ...