The Disturbing Link Between Psychiatric Illness and Accelerated Aging

People with mental illness have decreased life expectancy. This often results from chronic illnesses associated with aging, such as cardiovascular disease, diabetes, and cancer. Is there a relationship between psychiatric illnesses and the aging process? In an important and provocative paper recently published online in JAMA Psychiatry, Jasmin Wertz, Avshalom Caspi, Terrie Moffitt, and colleagues address this question. Their research suggests that the answer is a resounding “yes.”

These investigators studied individuals participating in the Dunedin Multidisciplinary Health and Development Study (Dunedin Study). Participants in this study were born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand. They have been followed prospectively at regular intervals since birth. In the recent paper, the group report data collected through April 2019, when the participants were 45 years old. Of the 997 members still alive, an amazing 94 percent were still participating in the study. This type of longitudinal study allowed the investigators to examine the relationship between a history of psychiatric symptoms and the rate of age-related changes.

The researchers used a variety of measures to monitor the aging process, including laboratory tests, self-reports by participants, and relationship to function during childhood. For example, a “pace of aging” measure included a laboratory battery of 19 biological markers assessing age-related changes in cardiovascular, metabolic, pulmonary, kidney, immune, and dental systems between ages 26 and 45 years, physical health during childhood between birth and 11 years, and the participant’s self-perceived age at 45 (“What age do you feel most of the time?”). In a similar fashion, measures of hearing, vision, balance, motor function, and cognitive function were documented.

Healthcare professionals assessed participants at regular intervals (ages 18, 21, 26, 32, 38, and 45 years) for the presence of psychiatric symptoms using a structured standardized psychiatric interview, the Diagnostic Interview Schedule. Those administering this assessment were blind to a participant’s prior results.

Psychiatric symptoms were categorized into three broad dimensions: externalizing disorders, internalizing disorders, and thought disorders. Externalizing disorders include symptoms related to attention-deficit/hyperactivity disorder (ADHD), conduct disorder, and substance use disorders. Internalizing disorders include generalized anxiety disorder, depressive disorders, fear-related disorders such as social phobias and panic disorder, posttraumatic stress disorder, and eating disorders. Thought disorders include illnesses such as schizophrenias, mania, and obsessive-compulsive disorder. In addition, an overall measure of psychopathology known as the “p-factor” was calculated. (We discussed the p-factor in an earlier post.)

The results of this study demonstrate a clear relationship between psychopathology and rate of aging. Remarkably, this relationship was obvious by the age of 45. By that time, those with the upper 10 percent of psychopathology factor (p-factor) scores had aged approximately 5.3 more years than those with the lowest 10 percent of p-factor scores. This relationship between accelerated aging and psychiatric symptoms was evident for all categories utilized to assess aging and persisted after controlling for a host of factors including sex, childhood health indicators, maltreatment, smoking, and socioeconomic status.

Interestingly, this relationship occurred equally for those with externalizing, internalizing, or thought disorder symptoms. Psychiatric factors that contributed to accelerated aging included having early onset of disorders (particularly in childhood) and having psychiatric symptoms across the three dimensions. There is something about the presence of a broad range of psychiatric symptoms that correlates with more rapid aging.

There are many possible explanations for this relationship, and further research is needed to tease out various biological, genetic, and psychosocial contributors. Does prevention or successful treatment of psychiatric symptoms prevent or reverse this association? This is another question that we will have to wait for research to answer.

The paper discussed here further highlights the impact of psychiatric illnesses on public health and underscores the importance of careful longitudinal studies in understanding the complexity of these illnesses.

This post was written by Eugene Rubin M.D., Ph.D., and Charles Zorumski M.D.

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