Is There a Link Between Bipolar Disorder and Early Death?

Discussions of mental illnesses such as bipolar disorder often focus on how the symptoms of these disorders can negatively impact the substance and quality of a person’s life, but what most people don’t talk about is how certain mental health disorders can also shorten their life expectancy, or to put it less elegantly, lead to an early death.

The link between mental illness and premature mortality received renewed attention in recent months, following the December 2023 publication of a study on bipolar disorder and premature mortality.

That study, conducted by a team of researchers from the University of Michigan (UM), found  the impact of bipolar disorder on a risk of early death is more significant than smoking, high blood pressure, or old age.

Anastasia Yocum, Ph.D., lead study author, offered this insight in a UM article about her team’s research:

“Bipolar disorder is never going to be listed on the death certificate as the main cause of death, but it can be an immediate or secondary contributor to a death, including in suicides.”

Who’s at Risk?

We’ll refer back to the UM team’s study later in this post. First, though, let’s take a look at how many people are at risk of early death due to bipolar disorder.

According to the World Health Organization (WHO) about 40 million people across the globe have bipolar disorder.

The National Institute of Mental Health (NIMH) provides the following information about the scope of bipolar disorder in the U.S.

Bipolar Disorder: Prevalence Statitics

• About 2.8% of U.S. adults reported symptoms of bipolar disorder in the past year. That’s about 7.2 million people 18+.
• The past-year prevalence of bipolar disorder is slightly higher among men (2.9%) than among women (2.8%).
• Among adults, bipolar disorder is most common among individuals aged 19-29, with a past-year prevalence of 4.7%.
• The past-year prevalence of bipolar disorder among adolescents aged 13-17 is 2.9%.
• Bipolar disorder is more common among adolescent girls (3.3%) than adolescent boys (2.6%).

Risk for developing bipolar disorder is influenced by a variety of internal (genetic) and external (environmental) factors.

A September 2018 meta-analysis in the journal Therapeutic Advances in Psychopharmacology reported the following risk factors for bipolar disorder.

Bipolar Disorder: Risk Factors

• When one twin has bipolar disorder, the other twin has a 40%-70% risk of also developing this condition.
• Among individuals with a first-degree relative (parent or sibling) with bipolar disorder, the lifetime risk is 5%-10%, significantly higher than the 2.8% risk among the general public.
• Studies suggest a shared genetic risk among bipolar disorder, autism spectrum disorder, and schizophrenia.
• Prenatal infection with the Toxoplasma gondii (T. gondii) parasite may be associated with higher rates of bipolar disorder.
• Researchers report inconsistent support for a link between maternal tobacco smoking or exposure to severe psychological stressors and higher rates of bipolar disorder among their children.
• Abuse, neglect, and other adverse childhood experiences (ACEs) correlate with an increased likelihood of bipolar disorder later in life. One study found reported prevalence four times higher among adults with a history of emotional abuse during childhood compared to adults without a history of childhood trauma.
• Various stressors later in life – including disability, divorce, unemployment, and the death of a first-degree relative by suicide – may be linked with the onset of bipolar disorder, especially first-time hospitalization for manic episodes.

Also, substance use disorders (addictions) and certain mental health disorders frequently co-occur with bipolar disorder. However, researchers have not identified a definitive cause-effect relationship between these disorders and bipolar disorder.

Bipolar Disorder and Elevated Death Rates

As UM researcher Anastasia Yocum noted, bipolar disorder will never appear as an official, primary cause of death on a death certificate. And thought correlation does not equal causation, the considerable body of evidence makes it safe to say that bipolar disorder may have a considerable adverse impact on life expectancy.

After reviewing two sets of data, the UM team concluded:

• One data set showed a death rate for people with bipolar disorder six times higher than for people with no mental illness.
• The other data set showed a death rate within the bipolar disorder group four times higher than within the control group.
• When researchers analyzed one set of participants by tobacco smoking/non-smoking status, they found a death right twice as high among smokers.
• When grouped by age, they reported a death rate three times higher in the over-60 group compared to the under-60 group.
• Only high blood pressure (which caused a fivefold increase in risk of death) came close to the elevated likelihood of early death among people with bipolar disorder.

Here’s how UM researcher Melvin McInnis, MD, characterized these results in the January 2024 article:

“Over the years there have been all kinds of programs that have been implemented for smoking prevention and cardiovascular disease awareness, but never a campaign on that scale for mental health.”

That begs the question: should there be similar campaigns for mental health? At this point, the primary reason no such campaigns exist is the lack of causal, as opposed to correlative, data.

Why Does Bipolar Disorder Impact Life Expectancy?

The UM researchers aren’t the first experts to identify the association between bipolar disorder and increased risk of early death:

• An August 2015 study in the journal Bipolar Disorder found bipolar disorder patients aged 25-45 were likely to die 3-12 years earlier than peers of the same age without bipolar disorder.
• A September 2022 meta-analysis in the British Journal of Psychiatry – based on a review of 13 studies involving more than 96,000 subjects – determined people with bipolar disorder live an average of 9 fewer years than people without bipolar disorder.

Though the numbers vary from one study to the next, many mental health experts agree that bipolar disorder can shorten life expectancy. But there’s no consensus about why. Therefore, this question is the question the experts want answered:

What is it about bipolar disorder that causes people to die so earlier than people without bipolar disorder?

Efforts to answer this question focus on a variety of behaviors characteristic of bipolar disorder.

It’s important to remember different forms of bipolar disorder affect people in different ways. Bipolar disorder can cause a person to experience manic, hypomanic, and/or depressive symptoms:

• During times of mania or hypomania, a person may engage in unhealthy behaviors such as overeating, driving dangerously, misuse of alcohol or other drugs, and unsafe sex.
• During periods of depression, a person may not follow a healthy diet, exercise, or get an appropriate amount of sleep. Depression also increases risk of self-harm and suicide.

Several studies document problematic behavior patterns among people with bipolar disorder:

• About 60%-70% of people with bipolar disorder smoke cigarettes. This is more than two twice the smoking rate among the general public.
• At least one large study reports obesity rates among people with bipolar disorder twice as high as people without a mental health disorder.
• Adolescents and young adults with bipolar disorder scored significantly lower than members of a control group on an assessment of dietary habits.
• An analysis of data collected for the National Epidemiologic Survey on Alcoholism and Related Conditions (NESARC) found 56% of people with bipolar disorder report a co-occurring substance use disorder (SUD), compared to a 32.3% SUD rate among the general public.

On their own, any of the behaviors listed above can be extremely detrimental to health and well-being. Their combined impact can be devastating, especially when added to the myriad other personal, financial, and societal challenges that people with bipolar disorder and other severe mental illnesses often face.

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