Background While risk of premature death is most pronounced among persons with severe mental illness, also milder conditions are associated with increased all-cause mortality. We examined non-psychotic mental (NPM) disorders and specific causes of natural death in a cohort of late adolescent men followed for up to 46 years.
Methods Prospective cohort study of Swedish males (n=1 784 626) who took part in structured conscription interviews 1968–2005. 74 525 men were diagnosed with NPM disorders at or prior to conscription. Median follow-up time was 26 years. HRs for cause-specific mortality were calculated using Cox proportional hazards models.
Results Risks in fully adjusted models were particularly elevated for death by infectious diseases (depressive and neurotic/adjustment disorders (HR 2.07; 95% CI 1.60 to 2.67), personality disorders (HR 2.90; 95% CI 1.96 to 4.28) and alcohol-related and other substance use disorders (HR 9.02; 95% CI 6.63 to 12.27)) as well as by gastrointestinal causes (depressive and neurotic/adjustment disorders (HR 1.64; 95% CI 1.42 to 1.89), personality disorders (HR 2.77; 95% CI 2.27 to 3.38) and alcohol-related/substance use disorders (HR 4.41; 95% CI 3.59 to 5.42)).
Conclusion Young men diagnosed with NPM disorders had a long-term increased mortality risk, in particular due to infectious and gastrointestinal conditions. These findings highlight the importance of early preventive actions for adolescents with mental illness.
- adolescents CG
- cohort studies
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MW and MÅ contributed equally.
Contributors MW, MÅ and JN designed the study. All authors have been involved in data analysis and interpretations. MH, JN, MW and MÅ have written the manuscript and MÅ is corresponding author. All coauthors had substantial contribution into writing and revising the manuscript.
Funding This study was supported by grants from the Swedish state under an agreement between the Swedish government and the county councils concerning economic support of research and education of doctors (ALFGBG-427301, ALFGBG-715841) and the Swedish Research Council 2013-2699, 2013-5187, 2013-4236 and the Swedish Council for Health, Working Life and Welfare (FORTE) (2007-2280, 2013-0325) and Stiftelsen Peter Erikssons minnesfond för hjärnforskning. Financial support was also provided by the Gothenburg Medical Society.
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval The Ethics Committee of the University of Gothenburg and Confidentiality Clearance at Statistics Sweden approved the study (Dnr: 462-14).
Provenance and peer review Not commissioned; externally peer reviewed.