Deep dive
The mental health conditions that cost the most years, ranked
Updated 2026-08-30
Mental health, by the numbers
of life, at the median, for people with mental disorders versus the general population, and about two-thirds of their deaths are from physical illness, not suicide (JAMA Psychiatry 2015).
Years of life lost, most severe to least
Estimated years of life lost versus the general population
The short version
- •Mental disorders are a longevity issue, not just a quality-of-life issue: across 1.7 million patients, people with mental disorders died at more than twice the rate of the general population, losing about 10 years of life at the median (Walker, JAMA Psychiatry 2015).
- •Ranked by years lost, the severe end is substance use disorders (9 to 24 years), schizophrenia (about 14.5), and bipolar disorder (9 to 20). Anorexia carries the highest per-person death rate of any eating disorder (Chesney, World Psychiatry 2014; Hjorthøj, Lancet Psychiatry 2017).
- •Depression appears twice on the list on purpose: untreated, it costs an estimated 7 to 11 years. Actively treated, the excess mortality largely disappears — a 24% lower death risk over 8 years, landing near people without depression (Gallo, BMJ 2013).
- •The surprise is what kills: about two-thirds of deaths among people with mental disorders are from natural causes, mostly heart, metabolic, and lung disease, not suicide. The mortality gap is largely a physical-health-neglect gap, which means it is attackable.
- •The levers are familiar: staying on treatment that works (Tiihonen, Lancet 2009), quitting smoking (Taylor, BMJ 2014), and exercise, which treats depression with effects comparable to first-line therapies (Noetel, BMJ 2024).
Mental health rarely shows up in longevity lists, which is strange, because the numbers are enormous: a mental disorder shortens life more than obesity does, and severe mental illness rivals heavy smoking. Here is each major condition ranked by its best-measured cost in years, from most severe to least. Two things stand out. First, most of the lost years do not come from the disorder itself or from suicide; they come from untreated physical disease, smoking, and a health system that stops looking at your body once it has labeled your mind. Second, treatment moves a condition down this list — depression sits near the top untreated and near the bottom treated. Every one of those levers is movable.
Substance use disorders: 9 to 24 years lost
In the largest meta-review of mortality across mental disorders, substance use disorders carried the highest all-cause death risks of any category, translating into life-expectancy reductions of roughly 9 to 24 years, larger than heavy smoking (Chesney, World Psychiatry 2014). Alcohol and opioids dominate, through overdose, liver disease, cancer, and accidents.
Do this
Run an honest audit: if drinking or drug use has ever felt like something you manage rather than choose, that is the signal. Treatment works and is not all-or-nothing; even cutting alcohol to low-risk levels moves the curve.
Schizophrenia and psychotic disorders: about 14.5 years
People with schizophrenia die about 14.5 years earlier than the general population, with life expectancy around 60 for men and 68 for women (Hjorthøj, Lancet Psychiatry 2017, meta-analysis of 11 studies across four continents). The drivers are mostly cardiovascular and metabolic: very high smoking rates, weight gain from illness and medication, and physical care that arrives late or not at all.
Do this
Cardiometabolic monitoring should start on day one of antipsychotic treatment, not after the first weight gain: baseline weight, glucose, and lipids, rechecked within months. Blood pressure, lipids, HbA1c, and weight belong in the treatment plan yearly — ask for them explicitly; it is the part of care most often skipped.
Bipolar disorder: 9 to 20 years
Bipolar disorder shortens life by an estimated 9 to 20 years (Chesney, World Psychiatry 2014), through suicide risk at the extremes of mood and, over the long run, the same cardiometabolic disease that drives the rest of the gap. Treatment moves the number: lithium roughly halves the risk of suicide in mood disorders (Cipriani, BMJ 2013 meta-analysis of 48 trials).
Do this
Mood stability and physical numbers are the two dials that matter: stay with maintenance treatment through the good stretches, and get weight, glucose, and lipids checked yearly, since mood stabilizers and antipsychotics can shift them.
Anorexia: the deadliest disorder per person
Anorexia nervosa has a death rate around 5.9 times the matched general population, the highest of any eating disorder and, alongside substance use disorders, at the top tier of mortality across all mental disorders, with about one in five of those deaths from suicide (Arcelus, Archives of General Psychiatry 2011; Chesney, World Psychiatry 2014). Because it strikes young, each death costs decades.
Do this
Take rapid weight loss, food rituals, and exercise-as-punishment seriously at any age and any body size, in yourself or anyone you love. Early specialist treatment changes the trajectory; waiting for it to pass is the dangerous move.
Depression, untreated: 7 to 11 years
Recurrent depression costs an estimated 7 to 11 years of life (Chesney, World Psychiatry 2014). Per person that is smaller than psychosis, but depression is so common that mood disorders account for the largest share of deaths attributable to mental illness overall (Walker, JAMA Psychiatry 2015). It also roughly doubles the risk of developing heart disease, through stress physiology, inflammation, and abandoned health habits.
Do this
Two weeks or more of low mood, flat interest, or broken sleep is a screening moment, not a character phase. A PHQ-9 takes two minutes online; therapy and medication each work, and combined they work better.
ADHD: roughly 5 to 11 years
The first life-expectancy study of adults with diagnosed ADHD found men lose an estimated 4.5 to 9 years and women 6.5 to 11 versus the general population (O'Nions, British Journal of Psychiatry 2025). The drivers are downstream and largely preventable: higher smoking rates, accidents, untreated depression and substance use, and routine health care that ADHD makes harder to keep up with.
Do this
Treat the downstream risks as part of the condition: real help with quitting smoking, honest screening for mood and substance problems, and systems — reminders, standing appointments — that make routine health care actually happen.
Anxiety and PTSD: the smallest direct hit
Anxiety disorders roughly double death rates in national registry data, but most of that excess is explained by comorbid depression and substance use rather than the anxiety itself (Meier, British Journal of Psychiatry 2016). On its own, anxiety carries the smallest direct mortality cost on this list; its danger is what it travels with, plus years of chronic stress physiology.
Do this
Treat persistent anxiety instead of enduring it — CBT and SSRIs both work — and screen honestly for the companions that carry most of the risk: low mood that has settled in, and drinking that has crept up.
Depression, treated: the gap mostly closes
Treatment moves depression from near the top of this list toward the bottom. In the IMPACT trial, older adults whose depression was actively managed had a 24% lower risk of death over 8 years than those left in usual care, ending with mortality similar to people without depression (Gallo, BMJ 2013). The direction holds in severe illness too: long-term antipsychotic use predicted lower mortality than no treatment in a 66,881-patient Finnish cohort (Tiihonen, Lancet 2009).
Do this
Staying on treatment that works is a longevity behavior. If side effects are pushing you to quit, bring that to your prescriber as a problem to solve together; there is almost always an adjustment short of stopping.
The levers are ordinary: smoking, movement, connection
About two-thirds of the deaths behind these numbers are from natural causes — heart, metabolic, and lung disease — not suicide (Walker, JAMA Psychiatry 2015), so the gap is attackable with ordinary tools. Quitting smoking improves mental health about as much as antidepressants treat depression (Taylor, BMJ 2014), exercise treats depression with effects comparable to first-line therapies (Noetel, BMJ 2024), and strong social ties predict about 50% higher survival odds (Holt-Lunstad, PLoS Medicine 2010).
Do this
Whatever the diagnosis, the same three moves shrink the gap: get medication plus support to quit smoking (it roughly doubles quit rates), treat 150 minutes a week of movement as a prescription, and keep one standing weekly commitment with other people.
How to tell if yours is good
Signals you can read yourself, starting today, and what a good reading looks like.
Mood
Low days pass within days; interest and energy come back on their own
Physical screening
If you have a diagnosis: blood pressure, lipids, and HbA1c checked within the last year
Treatment
Any psychiatric medication is taken as prescribed, and changes go through your prescriber
Substances
Alcohol and drugs feel like a choice, not a management project
Movement
150+ minutes a week of heart-rate-raising activity, even on hard weeks
Connection
At least one standing weekly commitment with other people
Check your own risk
6 quick questions about you, not the article. You get a personal readout of where your risks sit.
Pick an answer to reveal the numbers: life-model years where an answer maps to one (+0y = measured, no effect on its own), check points otherwise (+2 pts working for you, +1 pt worth tightening, 0 pts elevated risk).
1. How often do you feel down, flat, or depressed?
2. If you have a mental health diagnosis: were your blood pressure, lipids, and HbA1c checked in the last year?
3. Have you been diagnosed with a mental health condition — and is it in treatment?
4. Do you smoke?
5. Heart-rate-raising movement: how many days a week do you get 30+ minutes?
6. A standing commitment with other people — a club, team, faith group, or volunteering?
Now score your own
These two-minute checks turn this research into your numbers, and the years they are worth.
Sources
- Walker, McGee & Druss, JAMA Psychiatry 2015 — mortality in mental disorders meta-analysis
- Hjorthøj et al., Lancet Psychiatry 2017 — years of life lost in schizophrenia
- Chesney, Goodwin & Fazel, World Psychiatry 2014 — all-cause and suicide mortality meta-review
- Plana-Ripoll et al., Lancet 2019 — Danish nationwide mortality metrics for mental disorders
- Tiihonen et al., Lancet 2009 — antipsychotic use and mortality, Finnish national cohort
- Cipriani et al., BMJ 2013 — lithium and suicide risk meta-analysis
- Arcelus et al., Arch Gen Psychiatry 2011 — mortality in eating disorders meta-analysis
- Taylor et al., BMJ 2014 — smoking cessation and mental health meta-analysis
- Noetel et al., BMJ 2024 — exercise for depression network meta-analysis
- Holt-Lunstad et al., PLoS Medicine 2010 — social relationships and mortality meta-analysis
- Gallo et al., BMJ 2013 — depression care management and 8-year mortality (IMPACT trial)
- O'Nions et al., Br J Psychiatry 2025 — life expectancy in adults with diagnosed ADHD
- Meier et al., Br J Psychiatry 2016 — anxiety disorders and mortality, Danish national cohort
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YapSpan estimates are for reflection and entertainment only. They are not medical advice, a diagnosis, or a prediction of any individual outcome.