Bipolar disorder, a mental illness with both manic and depressed moods, is often resulting in earlier death than others, by up to 15 years. In two groups, people with bipolar disorder were four to six times more likely as people without the condition to die prematurely, while people who had ever smoked were about twice as likely to die prematurely than those who had never smoked – whether or not they had bipolar disorder.

When it comes to bipolar disorder, the differences in health and lifestyle change mortality a lot.

“Bipolar disorder has long been seen as a risk factor for mortality, but always through a lens of other common causes of death,” said Anastasia Yocum, Ph.D. of the University of Michigan, lead author of the study. “We wanted to look at it by itself in comparison with conditions and lifestyle behaviors that are also linked to higher rates of premature death.”

The authors looked at deaths and related factors among 1,128 people who had volunteered for the program’s longterm study of people with and without bipolar disorder. They found that all but 2 of the 56 deaths since the study began in 2006 were from the group of 847 people in the study who had bipolar disorder.

Statistical analysis led them to conclude that having a diagnosis of bipolar disorder made someone six times more likely to die during a 10-year period than people taking part in the same study who did not have bipolar disorder. By comparison, study participants who had ever smoked or were over age 60 were more than twice as likely to die in that same time as people who never smoked or were under 60, regardless of bipolar status.

Then they analyzed years’ worth of anonymous patient records from more than 18,000 people who get their primary care through Michigan Medicine. Among this group, people with bipolar disorder were four times as likely to die during the study period than those with no record of bipolar disorder. The team studied records from more than 10,700 people with bipolar disorder and a comparison group of just over 7,800 people without any psychiatric disorder.

The only factor associated with an even higher chance of dying during the study period in this pool of people was high blood pressure. Those who had hypertension were five times more likely to die than those with normal blood pressure, no matter whether they had bipolar disorder or not.

By contrast, smokers were twice as likely to die as never-smokers in this sample, and those over age 60 were three times as likely to die, both regardless of bipolar status.

“To our major surprise, in both samples we found that having bipolar disorder is far more of a risk for premature death than smoking,” said Melvin McInnis, M.D., a professor of psychiatry at the University of Michigan.

About 4% of Americans live with bipolar disorder while about 11.5% of Americans smoke. People with bipolar disorder in both groups were much more likely than the people without bipolar disorder to have ever smoked, consistent with past studies. Nearly half (47%) of the pool with bipolar disorder had a history of smoking, as did 31% of the study participants with bipolar disorder. By comparison, smoking among those without bipolar disorder stood at 29% of the U-M patients and 8% of theparticipants. 

People with bipolar disorder in both groups were also much more likely to be female, and female gender was associated with a slightly lower risk of early death.