Researchers have discovered that men with a combination of mental disorders and social disconnection have a markedly higher risk of premature death. The study is based on data from more than 160,000 people and is the largest of its type. Men with mental disorders who are also lonely or have low social support have especially high mortality.
At a time when society is increasingly concerned about mental disorders and social factors such as loneliness and social isolation, researchers in Denmark conducted a comprehensive study that sheds new light on how a combination of these factors predicts mortality. The study shows that men with a combination of mental disorders and social disconnection have a markedly higher risk of premature death.
“Our study indicates that the interplay between mental disorders and socially disconnection could be of importance for the risk of premature death since mortality was considerably higher than expected among men. This reinforces the relevance of integrating social aspects when treating vulnerable people with mental disorders,” explains a researcher behind the study, Lisbeth Mølgaard Laustsen, PhD student, Department of Clinical Epidemiology, Aarhus University and affiliated with DEFACTUM, Central Denmark Region.
Inconsistencies in previous studies
People with mental disorders have a higher risk of premature death than the general population, resulting in reduced life expectancy of on average 7.1 years for women and 10.1 years for men. In addition, people with mental disorders more often have diminished social connections, which also predicts life expectancy.
“Previous studies led by Professor Mathias Lasgaard that clearly associated loneliness and poor health were one inspiration for the new study. This made us wonder how social relationships and mental disorders interact and how they affect health and lifestyle,” says Lisbeth Mølgaard Laustsen.
Most people intuitively associate mental disorders and social relationships. People with a mental disorder may tend to become more isolated socially, and people who experience loneliness have an increased risk of developing depression and anxiety. Understanding the interaction between mental disorders and social relationships can be crucial for identifying people with a higher risk and informing targeted prevention efforts.
“These previous studies have shown that people with mental disorders and social disconnection have an increased risk of an adverse illness trajectory, including more severe symptom, a poorer recovery rate and diminished social functioning. Although a few of the studies have examined how social disconnection predicts mortality among people with mental disorders, the results have been unclear and inconsistent,” notes Lisbeth Mølgaard Laustsen.
The ultimate consequence
Most previous studies have focused on people with depression and are limited by small study populations of 4,000 or fewer.
“Extensive studies with larger samples are needed to identify trends and document correlations,” says Lisbeth Mølgaard Laustsen.
The researchers therefore used data from the Danish National Health Survey in one of Denmark’s five administrative regions from 2013 and four of the regions from 2017, totalling 162,497 people. These data were linked with registry data on mental disorders and mortality.
“We investigated mortality, since it is the ultimate consequence. In addition, we have good-quality mortality statistics in Denmark, whereas illness is more difficult to evaluate, since undiagnosed illness is not registered,” explains Lisbeth Mølgaard Laustsen.
To investigate the interaction between mental disorders and social connections, the researchers carried out interaction analyses.
“We investigated whether the combination of A and B turns out to be more than just A plus B,” explains Lisbeth Mølgaard Laustsen, adding that “the combination of mental disorders and social disconnection among men was associated with higher excess mortality than expected, indicating that the two factors mutually reinforce each other.”
Women may cope better
The researchers followed the 162,497 individuals over 886,614 person-years, and 9,047 people (5.6%) died during follow-up. As expected, there was considerable excess mortality among people with a mental disorder and social disconnection. In addition, the researchers investigated the mortality associated with a combination of the two factors.
No clear trends were identified in relation to age or several characteristics of the mental disorder, but strong sex differences were found.
“For men, the interaction between mental disorders and loneliness, social isolation and low social support explained 47%, 24% and 61% of the excess mortality, respectively. For women, excess mortality could not be attributed to this interaction,” says Lisbeth Mølgaard Laustsen, noting that “one small previous study found sex differences, but this could have just been coincidental. However, our study clearly indicates that men are more vulnerable than women to the interaction between mental disorders and social disconnection.”
“Women with a mental disorder may cope better, despite social challenges. Although we also found increased mortality among women with mental disorders and socially disconnection, men seem to be considerably more vulnerable,” explains Lisbeth Mølgaard Laustsen.
Causes and solutions not yet investigated
Nevertheless, the study cannot determine whether the mental disorder, social disconnection or other factors specifically affect mortality.
“Our results have many possible explanations. The health behaviour of men with mental disorders and social disconnection may entail a higher risk of becoming ill. Alternatively, these men may not receive optimal treatment for early-stage or existing illnesses. A third explanation could be that external causes, including suicide, homicide and accidents, may drive these differences,” says Lisbeth Mølgaard Laustsen.
Regardless of the explanation, the results suggest that men with mental disorders and social disconnection are at higher risk. This reinforces the relevance of integrating social aspects when treating vulnerable people with mental disorders. This could potentially improve prognosis and increase the life expectancy of vulnerable groups.
The researchers plan to continue their work by further examining how the interaction between mental disorders and social disconnection predict the development of chronic disease and economic costs.
