- Bipolar disorder has been linked to accelerated biological aging, which increases the risk of mortality from all causes and suicide.
- A retrospective study from Taiwan showed that bipolar II disorder was associated with an increased risk of premature death, including both natural and unnatural causes.
- The researchers said the study’s findings highlight the need for integrated psychiatric and medical care.
According to a Taiwanese population-based retrospective cohort study, bipolar II disorder was associated with an increased risk of premature death, including from both natural and unnatural causes.
When comparing more than 11,000 patients with bipolar II disorder with more than 45,000 matched controls, 1,089 patients and 1,879 controls died (aHR 1.62, 95% CI 1.47-1.78), reported Brian Chen, MD, and co-author Yang-Chieh of the University of Texas Health Science Center in Houston. jama network open.
Compared with people without bipolar disorder, people with bipolar II had increased mortality from natural causes, including mental and behavioral disorders, as well as circulatory, respiratory, digestive, and skin or subcutaneous diseases (adjusted HR 1.37, 95% CI 1.23–1.52), and mortality from unnatural causes, including unintentional injury, suicide, and assault or murder (adjusted HR 4.46, 95% CI) was included. 3.53-5.64).
In analyzes comparing people with bipolar II with unaffected biological siblings, bipolar II remained associated with higher all-cause mortality (aHR 1.31, 95% CI 1.00–1.72) and unnatural-cause mortality (aHR 2.05, 95% CI 1.43–2.95), but not with natural-cause mortality.
Meanwhile, in an analysis comparing people with bipolar II and bipolar I disorder, bipolar II was associated with higher all-cause mortality (aHR 1.24, 95% CI 1.01-1.53) and natural-cause mortality (aHR 1.45, 95% CI 1.14-1.86), but not unnatural-cause mortality.
Bipolar II is often viewed as the “mild” form of bipolar disorders, as patients experience less intense manic symptoms than patients with bipolar I disorder. However, patients with bipolar II typically have more frequent and longer lasting depressive episodes, resulting in significant functional impairment, Chen pointed out. Medpage Today.
The increased risk of natural deaths in patients with bipolar II suggests that they may struggle more to manage their personal health care, even compared to patients with bipolar I, Chen said.
The authors noted that bipolar II should not be considered only a mild form of the disorder, and that the higher risk of natural death may reflect Bipolar II’s “more frequent delays in identification and treatment”, which “may reduce engagement with physical health care and allow greater accumulation of medical risk.”
He pointed out that studies have shown that bipolar disorder is associated with accelerated biological aging. decreased telomere length Compared to people without the disorder.
“Additionally, atypical depressive symptoms (bipolar II) are common in hyperphagia“Marked fatigue, and the resulting reduced physical activity, may increase the risk of obesity and outcomes, such as metabolic dysfunction-related fatty liver disease, cardiovascular disease, and diabetes,” they wrote.
Previous studies including A. meta-analysis It has been suggested that all-cause mortality nearly doubles in people with bipolar disorder, while the relative risk of suicide increases 12-fold, and the risk of deaths from other unnatural causes increases seven-fold. However, most studies have not distinguished bipolar II from bipolar I.
“Overall, our findings align with contemporary models that conceptualize[bipolar disorder]as a somatoprogressive disease,” the authors wrote, “with physical comorbidities parallel to worsening neuropsychiatric disorders, and reinforce the need for integrated psychiatric and medical care.”
Chen added that “Future studies should examine the relationship of specific factors to increased risks of death in bipolar II disorder, including, but not limited to, lifestyle habits such as smoking, diet, and occupational exposures.”
This study is the first to examine mortality risk with bipolar II disorder alone, Chen said. The authors relied on data from Taiwan’s National Health Insurance Research Database from January 2000 to December 2022 for patients aged 12 years and older with two or more bipolar II diagnoses confirmed by psychiatrists. Patients were matched to four controls without bipolar II disorder on gender and date of birth.
Overall, the study included 11,427 patients with bipolar II and 45,708 matched controls. The mean age was 39.6, and 61.9% were female. The mean follow-up was 7.3 years.
In their analysis, the authors controlled for age, sex, income, urbanization, health care utilization, and co-morbidities.
