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Coming to grips with early death

January 29, 2016
by Ron Manderscheid, PhD
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Early death is a very existential, yet often unstated fear of persons who receive public mental healthcare. For more than a decade, we have known that public mental health clients die, on average, 25 years prematurely, yet from the same causes as do other people.1 This totally unacceptable situation has generated considerable effort, particularly by peers and by SAMHSA, to develop and implement programs that promote and maintain personal wellness.

Evolution of research on early death

The decade-old research left many essential questions unanswered. For example, what causes early death in public mental health clients? Also, how do public mental health clients compare with other people who have the same demographics, but who do not have mental illnesses? And what happens to those with mental illness who receive no care? Without further information to begin answering these questions, progress in addressing early mortality tragically will be stymied.

In the intervening decade, additional research has been done to begin unraveling the answers to each of these important questions.2 This more-refined work has helped guide some important current research just reported in General Hospital Psychiatry.3 Here, I would like to review the key findings from this latest research.

First, a little background is necessary. The work reported 10 years ago examined the population of persons receiving care through state-operated mental health systems. Persons receiving inpatient and ambulatory care were included. No contrast group of community residents was available, either for those with or without mental illness. Further, in the original research, all persons served by public mental health systems were included. Although two levels of disability were considered, no effort was made to differentiate people according to their specific diagnoses. Finally, some important key variables that could influence age of early death, such as lifestyle factors, e.g. smoking, were not available.

The new study addresses most of these issues: The sample examined was nationally representative of the community household population. It included people with and without mental illnesses, as well as people receiving and not receiving mental healthcare. Specific diagnoses were obtained for persons with major depressive episode, generalized anxiety disorder, panic attack, and any of these (hereafter collectively called depression/anxiety). Data also were obtained on sociodemographic factors, mediators between mental illness and death (i.e., socioeconomic factors, behaviors, and comorbid chronic diseases), and use of mental health services. Initial data were collected in 1999, and follow-up data to assess age of death were collected in 2011.

Key findings from the new study

The new study offers several very significant findings:

> First, and most important, receipt of mental health services reduces the risk of early death. Persons in the community with depression/anxiety die on average almost 8 years younger than persons without these conditions. However, receipt of mental health services by those with depression/anxiety eliminates this disparity in age of death.



Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid



Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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