Association of Psychiatric Illness and All-Cause Mortality in the National Department of Veterans Affairs Health Care System

OBJECTIVE: To assess the independent association of seven psychiatric illnesses with all-cause mortality in a representative national sample of veterans, after adjustment for demographic factors, psychiatric and medical comorbidity, obesity, tobacco use, and exercise frequency. METHODS: Analyses were conducted using data from the 1999 Large Health Survey of Veteran Enrollees (n = 559,985). Cox proportional hazards models were used to examine the relationship of seven psychiatric diagnoses with mortality. Date of all-cause mortality was determined from the Department of Veterans Affairs' Beneficiary Identification and Records Locator System. All-cause mortality rates were calculated as the total number of deaths in each group divided by the person-years of follow-up time in each group. RESULTS: During the 9-year study period, 27% of the subjects (n = 131,396) died. Each of the psychiatric diagnoses was associated with significantly increased HR for all-cause mortality after adjusting for age, race, and gender. Hazard ratios ranged from 1.02 (95% confidence interval, 1.01, 1.04) for posttraumatic stress disorder to 1.97 (95% confidence interval, 1.89, 2.04) for alcohol use disorders. After adjustment for psychiatric and medical comorbidity, obesity, current smoking and exercise frequency, alcohol and drug abuse and dependence, and schizophrenia were statistically significantly associated with an increased risk of mortality. CONCLUSIONS: In this study of a large representative national sample of veterans, schizophrenia and alcohol and drug use disorders were independently associated with an increased risk of all-cause mortality over a 9-year period.