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Mental disorders are associated with elevated mortality rates and reduced life expectancy. However, it is unclear whether these associations differ by socioeconomic position (SEP). The aim of this study was to explore comprehensively the role of individual-level SEP in the associations between specific types of mental disorders and mortality (due to all causes, and to natural or external causes), presenting both relative and absolute measures. This was a cohort study including all residents in Denmark on January 1, 2000, following them up until December 31, 2020. Information on mental disorders, SEP (income percentile, categorized into low, <20%; medium, 20-79%; and high, ≥80%), and mortality was obtained from nationwide registers. We computed the average reduction in life expectancy for those with mental disorders, relative and absolute differences in mortality rates, and proportional attributable fractions. Subgroup analyses by sex and age groups were performed. Overall, 5,316,626 individuals (2,689,749 females and 2,626,877 males) were followed up for 95.2 million person-years. People with mental disorders had a shorter average life expectancy than the general population regardless of SEP (70.9-77.0 vs. 77.2-85.1 years, depending on income percentile). Among individuals with a mental disorder, the subgroup in the top 3% of the income distribution had the longest average life expectancy (77.0 years), and this estimate was lower than the shortest life expectancy in the general Danish population (77.2 years for individuals in the bottom 6% income distribution). The mortality rate differences were larger in the low-income than the high-income group (19.6 vs. 13.3 per 1,000 person-years). For natural causes of death, a socioeconomic gradient for differences in life expectancy and mortality rates was observed across most diagnoses, both sexes, and all age groups. For external causes, no such gradient was observed. In the low-SEP group, 10.1% of all deaths and 23.7% of those related to external causes were attributable to mental disorders, compared with 3.5% and 8.7% in the high-SEP group. Thus, our data indicate that people with mental disorders have a shorter life expectancy even than people with the lowest SEP in the general population. The socioeconomic gradients in mortality rates due to natural causes highlight a greater need for coordinated care of physical diseases in people with mental disorders and low SEP., (© 2025 World Psychiatric Association.)

Aims: Individuals with diminished social connections are at higher risk of mental disorders, dementia, circulatory conditions and musculoskeletal conditions. However, evidence is limited by a disease-specific focus and no systematic examination of sex differences or the role of pre-existing mental disorders., Methods: We conducted a cohort study using data on social disconnectedness (loneliness, social isolation, low social support and a composite measure) from the 2013 and 2017 Danish National Health Survey linked with register data on 11 broad categories of medical conditions through 2021. Poisson regression was applied to estimate incidence rate ratios (IRRs), incidence rate differences (IRDs), and explore sex differences and interaction with pre-existing mental disorders., Results: Among 162,497 survey participants, 7.6%, 3.5% and 14.8% were classified as lonely, socially isolated and with low social support, respectively. Individuals who were lonely and with low social support had a higher incidence rate in all 11 categories of medical conditions (interquartile range [IQR] of IRRs, respectively 1.26-1.49 and 1.10-1.14), whereas this was the case in nine categories among individuals who were socially isolated (IQR of IRRs, 1.01-1.31). Applying the composite measure, the highest IRR was 2.63 for a mental disorder (95% confidence interval [CI], 2.38-2.91), corresponding to an IRD of 54 (95% CI, 47-61) cases per 10,000 person-years. We found sex and age differences in some relative and absolute estimates, but no substantial deviations from additive interaction with pre-existing mental disorders., Conclusions: This study advances our knowledge of the risk of medical conditions faced by individuals who are socially disconnected. In addition to the existing evidence, we found higher incidence rates for a broad range of medical condition categories. Contrary to previous evidence, our findings suggest that loneliness is a stronger determinant for subsequent medical conditions than social isolation and low social support.A preregistered analysis plan and statistical code are available at Open Science Framework (https://osf.io/pycrq).

Background: Despite the recognised importance of mental disorders and social disconnectedness for mortality, few studies have examined their co-occurrence., Aims: To examine the interaction between mental disorders and three distinct aspects of social disconnectedness on mortality, while taking into account sex, age and characteristics of the mental disorder., Method: This cohort study included participants from the Danish National Health Survey in 2013 and 2017 who were followed until 2021. Survey data on social disconnectedness (loneliness, social isolation and low social support) were linked with register data on hospital-diagnosed mental disorders and mortality. Poisson regression was applied to estimate independent and joint associations with mortality, interaction contrasts and attributable proportions., Results: A total of 162 497 individuals were followed for 886 614 person-years, and 9047 individuals (5.6%) died during follow-up. Among men, interaction between mental disorders and loneliness, social isolation and low social support, respectively, accounted for 47% (95% CI: 21-74%), 24% (95% CI: -15 to 63%) and 61% (95% CI: 35-86%) of the excess mortality after adjustment for demographics, country of birth, somatic morbidity, educational level, income and wealth. In contrast, among women, no excess mortality could be attributed to interaction. No clear trends were identified according to age or characteristics of the mental disorder., Conclusions: Mortality among men, but not women, with a co-occurring mental disorder and social disconnectedness was substantially elevated compared with what was expected. Awareness of elevated mortality rates among socially disconnected men with mental disorders could be of importance to qualify and guide prevention efforts in psychiatric services.

Competing Interests: OP-R has received funding from Lundbeck Foundation (Fellowship number R345-2020-1588) and Independent Research Fund Denmark (grant numbers 1030-00085B and 2066-00009B). All other authors report no competing interests.

Aims: Prolonged loneliness and severe stress are increasingly recognised as public health concerns and considered risk factors for mental disorders, somatic illnesses and mortality. Loneliness and perceived stress also often co-occur; however, their longitudinal relation remains unclear. To the best of our knowledge, this is the first study aiming to investigate the longitudinal relation between loneliness and perceived stress independently of cross-sectional associations and time effects., Methods: Designed as a population-based cohort study with repeated measurements, the present study included individuals aged 16-80 years at baseline who participated in the Danish National Health Survey ('How are you?') in 2013 and 2017 ( N = 10,159; response rate = 50%). Structural equation modelling was used to examine associations between loneliness and perceived stress in the total sample and across age groups (i.e., 16-29, 30-64 and 65-80 years)., Results: The models indicated bidirectional relations between loneliness and perceived stress. The standardized cross-lagged path from loneliness to perceived stress (β: 0.12, 95% confidence interval (CI) (0.08, 0.16), p < 0.001) and from perceived stress to loneliness (β: 0.12, 95% CI (0.07, 0.16), p < 0.001) both corresponded to small effect sizes in the total sample. Additionally, the results indicated strong cross-sectional associations, especially among adolescents and young adults (16-29 years), and high temporal stability, especially among the elderly (65-80 years)., Conclusions: Loneliness and perceived stress mutually predict each other over time. The finding of both substantial bidirectional and cross-sectional associations demonstrates an interdependence between loneliness and perceived stress that may be relevant to consider in future interventions., Competing Interests: Conflict of interestThe authors declared no potential conflicts of interest with respect to the research, authorship and publication of this article.

Importance: Studies are lacking summarizing how the association between mental disorders and mortality varies by socioeconomic position (SEP), particularly considering different aspects of SEP, specific types of mental disorders, and causes of death., Objective: To investigate the role of SEP in the association between mental disorders and mortality and the association between SEP and mortality among people with mental disorders., Data Sources: MEDLINE, Embase, PsycINFO, and Web of Science were searched from January 1, 1980, through April 3, 2023, and a snowball search of reference and citation lists was conducted., Study Selection: Inclusion criteria were observational studies estimating the associations between different types of mental disorders and mortality, stratified by SEP and between SEP and mortality in people with mental disorders., Data Extraction and Synthesis: Pairs of reviewers independently extracted data using a predefined data extraction form and assessed the risk of bias using the adapted Newcastle-Ottawa scale. Graphical analyses of the dose-response associations and random-effects meta-analyses were performed. Heterogeneity was explored through meta-regressions and sensitivity analyses., Main Outcomes and Measures: All-cause and cause-specific mortality., Results: Of 28 274 articles screened, 71 including more than 4 million people with mental disorders met the inclusion criteria (most of which were conducted in high-income countries). The relative associations between mental disorders and mortality were similar across SEP levels. Among people with mental disorders, belonging to the highest rather than the lowest SEP group was associated with lower all-cause mortality (pooled relative risk [RR], 0.79; 95% CI, 0.73-0.86) and mortality from natural causes (RR, 0.73; 95% CI, 0.62-0.85) and higher mortality from external causes (RR, 1.18; 95% CI, 0.99-1.41). Heterogeneity was high (I2 = 83% to 99%). Results from subgroup, sensitivity, and meta-regression analyses were consistent with those from the main analyses. Evidence on absolute scales, specific diagnoses, and specific causes of death was scarce., Conclusion and Relevance: This study did not find a sufficient body of evidence that SEP moderated the relative association between mental disorders and mortality, but the underlying mortality rates may differ by SEP group, despite having scarcely been reported. This information gap, together with our findings related to SEP and a possible differential risk between natural and external causes of death in individuals with specific types of mental disorders, warrants further research.

Background: The prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts., Methods: We studied 49 334 participants from 14 population-based cohorts in different age groups (≤10, >10-15, >15-20, >20-25 years, and overall, 5-25 years). The obstructive phenotype was defined as forced expiratory volume in 1 s (FEV 1 )/forced vital capacity (FVC) z-score less than the lower limit of normal (LLN), whereas the restrictive phenotype was defined as FEV 1 /FVC z-score ≥LLN, and FVC z-score -2 increase in BMI, respectively). Current smoking was associated with the obstructive phenotype in participants older than 10 years (aOR=1.24, 95% CI 1.05-1.46)., Conclusion: Obstructive and restrictive phenotypes were found to be relatively prevalent during childhood, which supports the early origins concept. Several well-known respiratory risk factors were associated with the obstructive phenotype, whereas only low BMI was associated with the restrictive phenotype, suggesting different underlying pathobiology of these two phenotypes., Competing Interests: Conflict of interest: G. Wang has nothing to disclose. Conflict of interest: J. Hallberg reports receiving payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from AstraZeneca AB, outside the submitted work. Conflict of interest: D. Charalampopoulos has nothing to disclose. Conflict of interest: M. Casas Sanahuja has nothing to disclose. Conflict of interest: R. Breyer-Kohansal has nothing to disclose. Conflict of interest: A. Langhammer has nothing to disclose. Conflict of interest: R. Granell has nothing to disclose. Conflict of interest: J.M. Vonk has nothing to disclose. Conflict of interest: A. Mian reports that this study was funded by the Erasmus Medical Centre, Rotterdam; the Erasmus University Rotterdam; and the Netherlands Organization for Health Research and Development. The project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement number 733206, 2016; EUCAN-Connect grant agreement number 824989; and ATHLETE, grant agreement number 874583). The researchers are independent from the funders. The study sponsors had no role in the study design, data analysis, interpretation of data, or writing of this report. Consulting fees received for an opponent PhD defence committee at Copenhagen University, outside the submitted work. Conflict of interest: N. Olvera reports funding for salary payment for the current manuscript from Centro de Investigación Biomédica en Red (Instituto de Salud Carlos III). Conflict of interest: L.M. Laustsen has nothing to disclose. Conflict of interest: E. Rönmark has nothing to disclose. Conflict of interest: A. Abellan has nothing to disclose. Conflict of interest: A. Agusti has nothing to disclose. Conflict of interest: S.H. Arshad has nothing to disclose. Conflict of interest: A. Bergström has nothing to disclose. Conflict of interest: H.M. Boezen has nothing to disclose. Conflict of interest: M-K. Breyer has nothing to disclose. Conflict of interest: O. Burghuber has nothing to disclose. Conflict of interest: A.C. Bolund has nothing to disclose. Conflict of interest: A. Custovic reports grants or contracts from the Medical Research Council and Wellcome Trust, outside the submitted work; personal consulting fees from Philips and Stallergenes Greer, outside the submitted work; speaker's fees from Thermo Fisher Scientific, Sanofi, Stallergenes Greer, AstraZeneca and GSK, outside the submitted work; and is on the Board of Directors of the WAO and BSACI council, outside the submitted work. Conflict of interest: G. Devereux has nothing to disclose. Conflict of interest: G.C. Donaldson reports payment or honoraria for serving as a statistical editor for the American Journal of Respiratory and Critical Care Medicine from the American Thoracic Society), for reviewing grants for FWO and EOS (Belgium); and for participation on data safety monitoring or advisory boards for Novartis and AstraZeneca, outside the submitted work. Conflict of interest: L. Duijts reports this study was funded by The Erasmus Medical Centre, Rotterdam; the Erasmus University Rotterdam; and the Netherlands Organization for Health Research and Development. The project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement number 733206, 2016; EUCAN-Connect grant agreement number 824989; and ATHLETE, grant agreement number 874583. The researchers are independent from the funders. The study sponsors had no role in the study design, data analysis, interpretation of data, or writing of this report. She also reports consulting fees for an opponent PhD defence committee at Copenhagen University, outside the submitted work. Conflict of interest: A. Esplugues has nothing to disclose. Conflict of interest: R. Faner reports that during the planning of this work, she was supported by the Spanish National Health System Research Contrat Miguel Sevet (CP16/00039); grants from Menarini, GSK and AZ, outside this work; and consulting fees as well as payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from GSK and Chiesi, outside the submitted work. Conflict of interest: F. Ballester has nothing to disclose. Conflict of interest: J. Garcia-Aymerich has nothing to disclose. Conflict of interest: U. Gehring has nothing to disclose. Conflict of interest: S. Haider has nothing to disclose. Conflict of interest: S. Hartl reports grants from GSK, Böhringer, Menarini, Chiesi, AstraZeneca, MSD, Novartis, Air Liquide, Vivisol, Pfizer and TEVA; and personal fees from GSK, Böhringer, Menarini, Chiesi, AstraZeneca, MSD, Novartis, Roche, Abbvie, TEVA and Takeda, outside the submitted work. Conflict of interest: H. Backman has nothing to disclose. Conflict of interest: J.W. Holloway has nothing to disclose. Conflict of interest: G.H. Koppelman reports support for the current manuscript from the Lung Foundation of the Netherlands, payment made to his institution; grants or contracts paid to institution from H2020, Vertex, the Ubbo Emmius Foundation, TEVA the Netherlands and GSK, outside the submitted work; consulting fees paid to his institution from PURE IMS and GSK, outside the submitted work; and unpaid membership of the board of the Stichting Astma Bestrijding, outside the submitted work. Conflict of interest: A. Lertxundi has nothing to disclose. Conflict of interest: T.L. Holmen has nothing to disclose. Conflict of interest: L. Lowe has nothing to disclose. Conflict of interest: S.M. Mensink-Bout reports that this study was funded by The Erasmus Medical Centre, Rotterdam; the Erasmus University Rotterdam; and the Netherlands Organization for Health Research and Development. The project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement number 733206, 2016; EUCAN-Connect grant agreement number 824989; ATHLETE, grant agreement number 874583). The researchers are independent from the funders. The study sponsors had no role in the study design, data analysis, interpretation of data, or writing of this report. She also reports consulting fees received for an opponent PhD defence committee at Copenhagen University, outside the submitted work. Conflict of interest: C.S. Murray reports grants or contracts from Asthma UK, MRC, the Moulton Charitable Foundation and the NIHR, outside the submitted work; payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from GlaxoSmithKline, Novartis, AstraZeneca and ThermoFisher, outside the submitted work; and participation on a data safety monitoring or advisory board for Boehringer Ingelheim, outside the submitted work. Conflict of interest: G. Roberts has nothing to disclose. Conflict of interest: L. Hedman has nothing to disclose. Conflict of interest: V. Schlünssen has nothing to disclose. Conflict of interest: T. Sigsgaard has nothing to disclose. Conflict of interest: A. Simpson reports a grant from UK Medical Research Council, outside the submitted work. Conflict of interest: J. Sunyer has nothing to disclose. Conflict of interest: M. Torrent has nothing to disclose. Conflict of interest: S. Turner has nothing to disclose. Conflict of interest: M. van den Berge reports grants from GlaxoSmithKline, AstraZeneca, Sanofi and Novartis, outside the submitted work. Conflict of interest: R.C.H. Vermeulen has nothing to disclose. Conflict of interest: S.A.A. Vikjord reports payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from AstraZeneca and Boehringer Ingelheim, outside the submitted work. Conflict of interest: J.A Wedzicha reports grants or contracts from GSK, AstraZeneca, Boehringer, Chiesi, Novartis and Greentech, outside the submitted work. Conflict of interest: A.H. Maitland-van der Zee reports grants or contracts from Vertex, Boehringer Ingelheim and Health Holland, outside the submitted work; consulting fees paid to her institution received from AstraZeneca and Boehringer Ingelheim, outside the submitted work; payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from GSK, outside the submitted work; and leadership or fiduciary roles in FIGON and EASYM, outside the submitted work. Conflict of interest: E. Melén has nothing to disclose., (Copyright ©The authors 2021.)