- South African men who use drugs shorten their lives by about 12 years, a new study says.
- For women, alcoholism carries a higher cost in terms of years of life.
- Scientists have looked at data from more than a million medical care patients and say excess mortality in the public sector may be worse.
- They call for steps to improve the prevention, early detection and treatment of physical comorbidities in people with mental illness.
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South Africans with alcoholism are paying the price in the loss of more than 10 years of their lives, according to a new study of excess mortality.
For men, that’s significantly more than the cost in life expectancy of people with a mental health diagnosis, which is nearly four years shorter compared to men who are not mentally ill, researchers found.
But for women, alcohol abuse carries a higher price than drug abuse.
The findings, reported on the preprint server medRxiv and not yet peer-reviewed, are based on medical aid claims from more than one million people between 2011 and the start of the Covid pandemic in March 2020.
Because people who rely on the public health sector are “at greater risk of poor mental health outcomes than workers and insured people who have access to private services,” say the paper’s authors, the toll of mental illness on the life expectancy is even higher higher.
Mental disorders are among the top 10 leading causes of disease in South Africa, according to the 2019 Global Burden of Disease report, and about 30% of people receive a mental health diagnosis at some point.
However, until now, the only research on excess mortality related to mental illness has been among people living with HIV, say 14 authors led by Yann Ruffieux and Anja Wettstein of the University of Bern in Switzerland.
“While most mental health disorders do not directly lead to death, they increase the risk of suicide, accidental death and premature death from physical illness,” they say.
Deaths from natural causes, which constituted the majority of the 282,926 patients with a mental health diagnosis in the study, “may be attributed to a higher incidence of physical comorbidities in people with mental illness and poorer access to or involvement in the healthcare”.
Of the 1,070,183 medical providers they looked at, 30.5% of women and 22.1% of men received a mental health diagnosis. The most common were related to anxiety, including generalized anxiety, post-traumatic stress, depression, and bipolar disorder.
“Life expectancy after diagnosis of a mental disorder was 3.8 years shorter for men and 2.2 years shorter for women compared to undiagnosed age and sex beneficiaries,” say the authors, half of whom are from Southern Africa is coming.
For men, drug use disorders emerge as the most serious threat to life expectancy, costing them 12.32 years (7.89 years for women); for women, the greatest threat to longevity is alcoholism at 10.24 years (11.5 years for men).
Men also lose more than 10 years if they are diagnosed with a mental disorder related to brain dysfunction (also called organic disorders) or a psychotic disorder; women lose more than 10 years for organic disorders; and for both sexes, eating disorders and developmental disabilities such as autism are linked to losses between the ages of seven and 10.
In general, men with mental illness lose more years of life than women, and the researchers said at least part of the reason was the higher accidental and suicide deaths among men with bipolar and substance use disorders.
“For other conditions, lower health care utilization rates among men, arising from the gendered nature of health services creating health care barriers for men, may contribute harmful masculine norms, self-stigmatizing beliefs or differences in coping strategies,” they say.
For both sexes, higher rates of physical disease in people with mental disorders and poorer health care contribute to premature death.
“Experts are recommending interventions to reduce the burden of physical illness in people with mental illness to close the mortality gap.
“These may focus on lifestyle and behavior to prevent physical disease, or early detection and appropriate treatment of common physical comorbidities. In addition, interventions should be considered to reduce stigma of mental illness among caregivers.”
The study, funded by the Swiss National Science Foundation and the US National Institutes of Health, was approved by the ethics committee for human research of the University of Cape Town and the ethics committee of the canton of Bern in Switzerland.