Lifetime manic spectrum episodes and all-cause mortality: 26-year follow-up of the NIMH epidemiologic catchment area study

BackgroundWhile evidence suggests that depression is associated with medical morbidity and mortality, the potential role of mania has received less attention. This analysis evaluated the association between manic spectrum episodes and risk of all-cause mortality over a 26-year follow-up in a population-based study.MethodsParticipants included 14,870 adults (mean age 48.2±20.3; 58.2% female; 31.1% non-white) from four sites of the Epidemiologic Catchment Area Study who completed the Diagnostic Interview Schedule (DIS) mania assessment between 1980 and 1983 and had vital status data available through 2007. Participants were grouped into four mutually exclusive categories based on DIS mania assessment: (1) manic episode (n=46); (2) hypomanic episode (n=195); (3) sub-threshold manic symptoms (n=1041); and (4) no manic spectrum episodes (n=13,588). To determine vital status, participants were matched with the National Death Index. Participants with manic spectrum episodes were compared to those without such episodes with regard to mortality after 26 years.ResultsAfter adjusting for major depressive symptoms and demographic differences, odds of mortality at follow-up for participants with lifetime manic spectrum episodes in the 30-44 and 45-64 year age cohorts at baseline were higher than those with no lifetime manic spectrum episodes in the same age cohorts (OR=1.39, 95% CI=[1.00, 1.93] and OR=1.41, 95% CI=[1.02, 1.95] respectively).ConclusionsHistory of lifetime manic spectrum episodes in early to mid adulthood is associated with increased risk of all-cause mortality in mid to late life.LimitationsFuture studies of mania and mortality should evaluate specific causes of mortality.