3 questions to… Magali Coldefy and Coralie Gandré, following the publication of Issues in Health Economics (237), September 2018: "Persons with Severe Mental Disorders: Life expectancy is Greatly Reduced and Premature Mortality has Quadrupled".
Our study shows that women and men with mental disorders live on average 13 and 16 years less than the general population. This significant difference is not only due to the high proportion of deaths by suicide. Violent deaths, suicides, transport accidents and falls are actually only the third leading cause of death among these individuals, behind cancers and cardiovascular diseases. Persons with mental disorders have mortality rates 2 to 5 times higher than the French population, whatever the cause of death considered (cardiovascular diseases, diseases of the digestive or respiratory system, tumours...).
The excess mortality of persons with severe mental disorders has long been underestimated, due to the non-directly lethal nature of these disorders. While this excess mortality, compared to the general population, has been widely documented abroad, large-scale French studies remain limited so far. The recent availability of data on medical causes of death that can be linked with health care consumption data in the National Health Data System (SNDS, Système national des données de santé) allows us to objectify this excess mortality at the national level. This gap in life expectancy questions the identification and access to somatic care of these persons and the effectiveness of the health system in reducing these inequalities...
The literature highlights several factors that could explain these health inequalities: first, increased risk factors for poor general health such as adverse socio-economic conditions or behavioural factors (high tobacco consumption, addictive behaviours, unbalanced diet, high sedentary lifestyle or lower adherence to treatment); secondly, withdrawal and social isolation will also be obstacles to appropriate medical care.
The side effects of psychotropic drugs could also play a significant role, especially in the long term. Finally, factors related to the health care system are probably involved, such as reduced access to prevention, care and screening, and sub-optimal quality of somatic care for persons with mental disorders. Stigmatization associated with mental illness will have a particular impact on screening and health services utilization. These populations less often report a referring physician, and coordination between general practitioners and psychiatrists is often pointed out as difficult in France.
These first French data currently provide the most comprehensive results on the mortality of individuals with mental disorders at the national level, and objectify the health inequalities they face. Nevertheless, the assumptions on their causes need to be confirmed. This study represents a preliminary - but essential - step in the development of complementary research to assess the impact of the care received by people with mental disorders on their mortality. Thus, individual data on the paths, consumptions and discontinuities of care of persons with mental disorders will now have to be compared with their causes of death in long-term longitudinal studies considering many adjustment factors - both individual and contextual.
Interview by Anna Marek