What does this research mean for the field?

Combinations of mental disorders are generally associated with higher mortality in a large middle-aged and elderly cohort in the UK, particularly combinations involving alcohol and substance use disorders. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

The aim is to examine the association between combinations of mental disorders and mortality using UK Biobank data.

February 26, 2026Open Access

Combinations of mental disorders and their association with mortality in the UK Biobank

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Probable lifetime mental disorders identified via Mental Health Questionnaire (n=157314). Intervention: Combinations of probable lifetime mental disorders vs. Questionnaire completers without the specific mental disorder combination. Primary outcome: Time from Mental Health Questionnaire completion to all-cause mortality (MRR 4.94, 95% CI 2.57-9.5).

Resultado clave

Combinations of probable lifetime mental disorders, especially including alcohol use disorder, substance use disorder, and psychotic experience, were associated with up to a 4.94-fold increase in mortality compared to others in a large UK cohort.

Puntos clave

The aim is to examine the association between combinations of mental disorders and mortality using UK Biobank data.
Analyzed data from approximately 160,000 UK Biobank participants
Completed a Mental Health Questionnaire
Utilized association rule mining to identify disorder combinations
Estimated age and sex-adjusted mortality rate ratios for each disorder and combination.
30% of respondents had at least one probable lifetime mental disorder
Combinations typically included depression and/or anxiety
Higher mortality rates linked to combinations, especially with alcohol and substance use disorders
Highest mortality rate ratio was 4.94 for alcohol use disorder plus substance use disorder plus psychotic experience.

Diseño del estudio

Tipo

Observational (n=157,314)

Multicéntrico

Sí

PICO estructurado

Are combinations of probable lifetime mental disorders associated with increased all-cause mortality in a middle-aged and elderly cohort?

Población

157,314 middle-aged and elderly adults (median age 58, 54% women) from the UK Biobank who completed the Mental Health Questionnaire.

Intervención

Combinations of probable lifetime mental disorders (depression, generalized anxiety disorder, psychotic experience, bipolar disorder, substance use disorder, alcohol use disorder) identified via the Mental Health Questionnaire.

Comparador

Participants who did not meet criteria for the specific probable mental disorder or combination being evaluated.

Resultado

Time from completing the Mental Health Questionnaire to all-cause death.hard clinical

Combinations of mental disorders, particularly those involving substance and alcohol use, are associated with significantly higher all-cause mortality than single disorders.

Resultado numérico

Estimación del efecto: MRR 4.94 (95% CI 2.57-9.5)

Limitaciones

Mental disorders identified via self-reported questionnaire, not confirmed clinical diagnoses, possibly causing misclassification bias.
Lack of data on age at onset of disorders, introducing potential immortal time bias.
Healthy volunteer bias in UK Biobank limiting generalizability and likely underestimating mortality risk.
No adjustment for socioeconomic or health-related confounders, which may act as mediators.
Small numbers of deaths in some mental disorder combinations limited statistical power.
Did not formally test multiplicative interactions between mental disorders.

Resumen

To explore patterns of combinations of mental disorders and their association with mortality using data from the UK Biobank, a large middle-aged and elderly cohort. This longitudinal cohort study analyzed data from approximately 160,000 UK Biobank participants who completed a Mental Health Questionnaire. We identified six probable lifetime mental disorders, examined their combinations using association rule mining, and estimated age and sex-adjusted mortality rate ratios (MRRs) for each disorder and combination. Combinations of mental disorders were found in approximately 30% of questionnaire completers identified with at least one probable lifetime mental disorder. Most combinations involved depression and/or anxiety. Combinations of mental disorders were generally associated with higher mortality, especially those including alcohol and substance use disorders. The highest MRR was observed for alcohol use disorder plus substance use disorder plus psychotic experience (MRR = 4.94, 95% CI 2.57–9.5). In a large middle-aged and elderly cohort in the UK, combinations of probable lifetime mental disorders identified via an online questionnaire were common and generally associated with higher mortality. Not applicable.

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Cite This Study

Barros et al. (Tue,) conducted a observational in Probable lifetime mental disorders identified via Mental Health Questionnaire (n=157,314). Combinations of probable lifetime mental disorders vs. Questionnaire completers without the specific mental disorder combination was evaluated on Time from Mental Health Questionnaire completion to all-cause mortality (MRR 4.94, 95% CI 2.57-9.5). Combinations of probable lifetime mental disorders, especially including alcohol use disorder, substance use disorder, and psychotic experience, were associated with up to a 4.94-fold increase in mortality compared to others in a large UK cohort.

synapsesocial.com/papers/699fe39d95ddcd3a253e792f https://doi.org/https://doi.org/10.1186/s12888-026-07865-w

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