Mental health and years

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 [2]. Alcohol and opioids dominate, through overdose, liver disease, cancer, and accidents.

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 et al. [3], 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.

Bipolar disorder shortens life by an estimated 9 to 20 years [2], 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 et al. [9] meta-analysis of 48 trials).

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 [10, 2]. Because it strikes young, each death costs decades.

Recurrent depression costs an estimated 7 to 11 years of life [2]. 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 [1]. It also roughly doubles the risk of developing heart disease, through stress physiology, inflammation, and abandoned health habits.

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 [4]. 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.

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 [11]. 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.

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 [5]. The direction holds in severe illness too: long-term antipsychotic use predicted lower mortality than no treatment in a 66,881-patient Finnish cohort [6].

About two-thirds of the deaths behind these numbers are from natural causes — heart, metabolic, and lung disease — not suicide [1], so the gap is attackable with ordinary tools. Quitting smoking improves mental health about as much as antidepressants treat depression [7], exercise treats depression with effects comparable to first-line therapies [8], and strong social ties predict about 50% higher survival odds [12].