Risks of all-cause and suicide mortality in mental disorders: a meta-review

TLDR

A meta‑review was conducted to explore the risks of all‑cause and suicide mortality in major mental disorders. The authors systematically searched 407 reviews, selecting 20 that reported mortality risks across 20 mental disorders, encompassing over 1.7 million patients and more than a quarter‑million deaths. All mental disorders showed elevated all‑cause mortality—often comparable to heavy smoking—with substance use disorders and anorexia nervosa having the highest ratios, leading to 10–20‑year life‑expectancy reductions, while borderline personality disorder, anorexia nervosa, depression, and bipolar disorder had the greatest suicide risks; the findings highlight substantial mortality gaps and the need for prioritized research, prevention, and treatment.

Abstract

A meta-review, or review of systematic reviews, was conducted to explore the risks of all-cause and suicide mortality in major mental disorders. A systematic search generated 407 relevant reviews, of which 20 reported mortality risks in 20 different mental disorders and included over 1.7 million patients and over a quarter of a million deaths. All disorders had an increased risk of all-cause mortality compared with the general population, and many had mortality risks larger than or comparable to heavy smoking. Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa. These higher mortality risks translate into substantial (10-20 years) reductions in life expectancy. Borderline personality disorder, anorexia nervosa, depression and bipolar disorder had the highest suicide risks. Notable gaps were identified in the review literature, and the quality of the included reviews was typically low. The excess risks of mortality and suicide in all mental disorders justify a higher priority for the research, prevention, and treatment of the determinants of premature death in psychiatric patients.