Mortality in affective disorders

Background: To investigate the mortality rates in affective disorders due t o unnatural and natural causes with respect to illness subtype and social-d emographic features. Methods: Mortality data were determined from a prospec tive study of 354 outpatients with affective disorders during a follow-up p eriod of 5 years. Death from natural and unnatural causes was compared to s ex- and age-specific expectations in the general population. Standardized m ortality rates (SMR) in diagnostic subgroups and the influence of social-de mographic features were investigated. Results: The observed 30 deaths repre sented nearly three times (SMR, 2.9) the number expected on the basis of ag e- and sex- standardized reference population rates. Death from natural cau ses occurred with the same rate as expected (SMR, 1.0), death from unnatura l causes was 28.8 times higher than expected. Women with affective disorder s had a considerable high risk to die from unnatural causes (SMR, 47.1). si gnificant excess of unnatural death was found in all subtypes of affective disorders, particularly in recurrent major depressive episodes (SMR, 46.7). Limitations: The sample was restricted in size. Therefore subgroup differe nces and multiple relationships of risk factors could not be analyzed with high statistical power. Conclusions: The results corroborate earlier findin gs of excess mortality in major affective disorders and strengthen the view that suffering from recurrent major depression confers per se an important biological risk for suicide. Natural causes of death in affective disorder s are comparable to expectations from reference populations. Social-demogra phic characteristics may contribute to an additional risk of premature deat h by suicide, particularly in women. (C) 2001 Elsevier Science BY All right s reserved.