REVIEW OF: Wertz J et al, JAMA Psychiatry 2021;78(5):530–539

TYPE OF STUDY: Prospective cohort study

We’ve known for years that patients with severe mental illness have a shortened life expectancy. The World Health Organization estimates that these patients have a 10- to 25-year reduction in lifespan, which is primarily thought to be due to poorly controlled chronic diseases such as diabetes and cardiac/pulmonary disease. Patients with mental illness have inconsistent follow-up with primary and specialty care, live less healthy lifestyles, and are frequently prescribed medications that can worsen physical health (such as antipsychotics causing metabolic syndrome). However, some researchers hypothesize that psychopathology might directly accelerate the aging process, independent of lifestyle factors. A recent study tested this.

Researchers conducted a prospective cohort study based on the Dunedin Multidisciplinary Health and Development Study. The Dunedin study is a population-representative birth cohort of 1,037 individuals born in 1972 or 1973 in Dunedin, New Zealand, who were followed until age 45 years. Subjects were primarily White (93%). Researchers conducted six structured diagnostic interviews between the ages of 18 and 45 years. Of the 997 patients still alive at 45 years, 938 participated in the assessments (94%). To measure psychopathology, researchers measured DSM-defined symptoms of 14 disorders, including externalizing disorders (eg, ADHD or substance use), internalizing disorders (eg, anxiety or mood disorders), and thought disorders (eg, OCD or schizophrenia). Researchers also collected data on BMI, smoking history, antipsychotic exposure, and medical disease.

The observational design of this study cannot rule out all confounders. However, after controlling for childhood health indicators, maltreatment (defined as maternal rejection, harsh discipline, multiple changes in primary caregivers, and abuse), and socioeconomic status; and taking into account BMI, smoking, antipsychotic exposure, and medical disease; individuals with more psychopathology reported feeling older and showed accelerated biological aging as measured by biomarkers. This association amounted to approximately 5.3 more years of biological aging for individuals with the highest psychopathology scores. Additionally, they exhibited more difficulties with hearing, vision, motor functioning, and cognition, and they were rated as looking older by independent observers. These results generalized across all psychiatric disorders.

Carlat Take

This study suggests that psychopathology is an independent risk factor for accelerated biological aging. It reminds us to be vigilant in our monitoring of age-related processes such as hearing loss, motor problems, and cognitive decline, which may appear earlier in our psychiatric patients. Finally, we should liaise with primary care providers, be strong advocates for our patients to receive preventive medical care, and think about referrals for ancillary services as appropriate.