Abstract
ObjectiveTo review and complete meta‐analysis of studies estimating standardised mortality ratios (SMRs) in bipolar affective disorder (BPAD) for all‐cause and cause‐specific mortalities.MethodCause‐specific mortality was grouped into natural and unnatural causes. These subgroups were further divided into circulatory, respiratory, neoplastic and infectious causes, and suicide and other violent deaths. Summary SMRs were calculated using random‐effects meta‐analysis. Heterogeneity was examined via subgroup analysis and meta‐regression.ResultsSystematic searching found 31 studies meeting inclusion criteria. Summary SMR for all‐cause mortality = 2.05 (95% CI 1.89–2.23), but heterogeneity was high (I 2 = 96.2%). This heterogeneity could not be accounted for by date of publication, cohort size, mid‐decade of data collection, population type or geographical region. Unnatural death summary SMR = 7.42 (95% CI 6.43–8.55) and natural death = 1.64 (95% CI 1.47–1.83). Specifically, suicide SMR = 14.44 (95% CI 12.43–16.78), other violent death SMR = 3.68 (95% CI 2.77–4.90), deaths from circulatory disease = 1.73 (95% CI 1.54–1.94), respiratory disease = 2.92 (95% CI 2.00–4.23), infection = 2.25 (95% CI 1.70–3.00) and neoplasm = 1.14 (95% CI 1.10–1.21).ConclusionDespite considerable heterogeneity, all summary SMR estimates and a large majority of individual studies showed elevated mortality in BPAD compared to the general population. This was true for all causes of mortality studied.
Highlights
An increasing body of research has shown that bipolar affective disorder (BPAD) is associated with premature mortality
Where previously it was believed this was mostly attributable to unnatural causes such as suicide, homicide and accidents, it has been shown that patients with BPAD are at risk of premature death from a range of medical illnesses [1]
The reported standardised mortality ratios (SMRs) for all-cause mortality in patients with BPAD ranged from 1.24 to 4.65
Summary
An increasing body of research has shown that bipolar affective disorder (BPAD) is associated with premature mortality. Where previously it was believed this was mostly attributable to unnatural causes such as suicide, homicide and accidents, it has been shown that patients with BPAD are at risk of premature death from a range of medical illnesses [1]. This review only searched one database and included patients without a clear diagnosis of BPAD (such as mixed unipolar/ bipolar groups). Since these publications, a number of large database studies have derived standardised mortality ratio (SMR) estimates. The SMR is an indirect method of standardisation calculated by the ratio of observed deaths in the study group to expected deaths in the general population
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