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Mortality in people with depressive, anxiety and alcohol use disorders in Finland

  • Niina Markkula (a1), Tommi Härkänen (a2), Jonna Perälä (a1), Krista Partti (a1), Sebastián Peña (a2), Seppo Koskinen (a2), Jouko Lönnqvist (a3), Jaana Suvisaari (a1) and Samuli I. Saarni (a4)...
Abstract
Background

Mental disorders are associated with increased mortality, but population-based surveys with reliable diagnostic procedures controlling for somatic health status are scarce.

Aims

To assess excess mortality associated with depressive, anxiety and alcohol use disorders and the principal causes of death.

Method

In a nationally representative sample of Finns aged 30–70 years, psychiatric disorders were diagnosed with the Composite International Diagnostic Interview. After an 8-year follow-up period, vital status and cause of death of each participant was obtained from national registers.

Results

After adjusting for sociodemographic factors, health status and smoking, depressive (hazard ratio (HR) = 1.97) and alcohol use disorders (HR = 1.72) were statistically significantly associated with mortality. Risk of unnatural death was increased among individuals diagnosed with anxiety disorders or alcohol dependence.

Conclusions

Individuals with depressive and alcohol use disorders have an increased mortality risk comparable with many chronic somatic conditions, that is only partly attributable to differences in sociodemographic, somatic health status and hazardous health behaviour.

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Copyright
Corresponding author
Niina Markkula, National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, P.O. Box 30, 00271 Helsinki, Finland. Email: niina.markkula@helsinki.fi
Footnotes
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Declaration of interest

J.S. has received speakers bureau honoraria from AstraZeneca and served as a consultant to Janssen-Cilag, but they had no role in this study.

Footnotes
References
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Mortality in people with depressive, anxiety and alcohol use disorders in Finland

  • Niina Markkula (a1), Tommi Härkänen (a2), Jonna Perälä (a1), Krista Partti (a1), Sebastián Peña (a2), Seppo Koskinen (a2), Jouko Lönnqvist (a3), Jaana Suvisaari (a1) and Samuli I. Saarni (a4)...
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eLetters

Mortality in people with depressive, anxiety and alcohol disorders

Danica Ralevic, ST5 Psychiatry
16 February 2012

Mortality in people with depressive, anxiety and alcohol disorders

Markkula and colleagues1 found that individuals with depressive and alcohol use disorders have an increased mortality risk from natural causes, accidents and suicide.

Reliably interviewing only 5104 (63.6%) of the original sample of 8028 would have affected the power of the study. Even though, the numbers at each step of the study is explicitly stated and weights were used to adjust for the missing data, the number of individuals with missing information is considerable.

There was a change in the sample population during the study. Initially there was no age restriction and there was an oversampling of individuals aged 80 or over. However, since a large proportion of the oldest subjects were unable to participate in the CIDI, the analysis had to be limited to those under age 70 years.

The assessment of somatic health status was self reported, albeit based on a diagnosis ever made by a physician, raising the possibility of those with anxiety over-reporting somatic illness.

This study highlights the positive association between physical and psychiatric disorders, and consequently, the fallacy of the current policyof managing them completely separately.

The study does suggest that alcohol related deaths may be a group distinct from those related to depression and anxiety. From a public health impact perspective, there has been a 45% increase in alcohol consumption since 19802 and the full impact of this may not yet have made itself felt. Hence, research and policy efforts should be directed to the prevention and management of this explosion.

This study also raises a wider issue about the different approach to mortality by general health services and mental health services. In the UKirrespective of previous contact with general practitioners or physicians,patient deaths would not necessarily be considered as treatment failures. However, if a patient who committed suicide had been in contact with the mental health services, a series of inquiries would start which one way orother would end up identifying scapegoats. We wonder whether it is time for the profession and the professional bodies to acknowledge that the increased mortality through natural causes, accidents and suicides is an inevitable outcome for many individuals with depression and substance misuse problems. The right to search for truth implies also a duty; one must not conceal any part of what one has recognized to be true (Albert Einstein).

1. Markkula N, Harkanen T, Perala J, Partti K, Pena S, Koskinen S etal Mortality in people with depressive, anxiety and alcohol disorders in Finland. BJP 2012, 200:143-149.

2.Sheron N, Olsen N, Gilmore I. An evidence-based alcohol policy. Gut 2008: 57: 1341-1344

Danica Ralevic, ST5 in General Adult Psychiatry, Norfolk & Suffolk Foundation Trust, Wedgwood House, West Suffolk Hospital, Bury St. Edmunds IP33 2QZ, email: danica.ralevic@nsft.nhs.uk; Fax: 01284 719734Lorna Donnelly, ST6 in General Adult Psychiatry, Norfolk & Suffolk Foundation TrustSantvana Pandey, LAT ST4 General Adult Psychiatry, Norfolk & Suffolk Foundation TrustAlbert Michael, Consultant Psychiatrist, Norfolk & Suffolk Foundation Trust

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Conflict of interest: None declared

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