The Untold Story of Bipolar Disorder: Understanding Excess Mortality

Bipolar disorder (BD), also known as ‘bipolar affective disorder,’ is a mental health condition associated with extreme changes in mood between depression and mania, with stable periods in between. It affects approximately 1.2% of the global population (Merikangas, 2009). The severe mood fluctuations experienced by individuals with bipolar disorder can significantly impact their daily functioning.

Studies have shown that individuals with bipolar disorder face a higher risk of mortality compared to the general population. The leading causes of death among people with BD are suicide and physical illnesses such as cardiovascular and metabolic diseases (Carvalho et al., 2024; Hayes et al., 2017). However, the specific factors contributing to increased mortality in individuals with bipolar disorder are not fully understood.

The Research Study

A recent study conducted by Paljärvi and colleagues (2023) aimed to investigate the excess mortality rates among individuals with bipolar disorder aged 15-64 compared to the general population. The study focused on identifying both external (unnatural) and somatic (natural) causes of death in this population.

Bipolar disorder has been linked with increased mortality, but the causes for excess death compared to the general population remain less known.

Key Findings

The study revealed that individuals with bipolar disorder had significantly higher mortality rates compared to the general population. External causes such as accidents and suicides contributed notably to this excess mortality, particularly in younger age groups. Older individuals with BD (45-64 years) were at a higher risk of death from somatic causes.

On average, individuals with BD lost around 10 years of life compared to those without the disorder. The overall mortality rate was three times higher in individuals with BD, with deaths from external causes being as much as six times higher, with suicide being the leading cause of excess deaths in this population.

The mortality gap between people with bipolar disorder and the general population can be attributed to external causes of death, such as suicide or accidents.

Implications and Recommendations

• Interventions focused on preventing substance abuse are crucial in reducing excess mortality, especially among older individuals with bipolar disorder.
• Clinicians should carefully consider the long-term effects of medications on physical health when managing symptoms of bipolar disorder.
• Priority should be given to suicide prevention efforts, as it is the primary cause of death among individuals with BD. Qualitative research can provide further insights into suicidal behavior and protective factors.

Suicidal ideation and behavior needs to be better understood in people with bipolar disorder to identify more prevention strategies.

In Summary

The study sheds light on the significant mortality gap between individuals with bipolar disorder and the general population, emphasizing the need for tailored interventions to address different causes of death across various age groups. By understanding and addressing the factors contributing to excess mortality, we can strive to improve outcomes and quality of life for individuals living with BD.

References

Primary Paper

Paljärvi T, et al. (2023). Cause-specific excess mortality after first diagnosis of bipolar disorder: population-based cohort study. BMJ Ment Health.

Additional References

Biazus, T., et al. (2023). All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis. Mol Psychiatry, 28, 2508–2524.

Carvalho, A., et al. (2024). Mortality and Lithium-Protective Effects after First-Episode Mania Diagnosis in Bipolar Disorder: A Nationwide Retrospective Cohort Study in Taiwan. Psychother Psychosom.

Hayes, J. F., et al. (2017). Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000-2014. The British journal of psychiatry.

Merikangas, K. R., & Pato, M. (2009). Recent developments in the epidemiology of bipolar disorder in adults and children. Clinical Psychology: Science and Practice.