Mental health: an overlooked longevity factor

According to recent data from U.S. News' Healthiest Communities 2019 rankings, untreated mental illness can have a long-term impact on physical health, and poor self-reported mental health can reduce life expectancy just as much as diabetes, smoking, and lack of exercise. According to the World Health Organization, those with serious mental health illnesses have a 10-to-25-year decrease in life expectancy, which is similar to or worse than heavy smoking.

Putting this into the context of macro trends is even scarier. We know that the world is aging rapidly, the phenomenon is sometimes called the “silver tsunami”. We also know that most of the progress in the recent decades was more about lifespan and life expectancy and not necessarily healthspan, which means that the final stages of life often aren't pleasant due to chronic morbidities, which then leads to more age-associated mental health decline. When we add to that the recent COVID-19 pandemic and related societal changes, which heavily amplified the already existing mental health pandemic, we have almost a perfect storm on our hands that has the potential to have a significantly negative effect on mental health and therefore also lifespan and healthspan globally.

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The mechanisms by which mental health conditions reduce a person's life expectancy are complex, but we can identify at least several factors that are linked to mental illness and known to reduce life expectancy, such as chronic health conditions, infectious disease, poor self-care, poverty, or suicide.

Most people with moderate or severe mental health conditions experience some relief from their symptoms with professional therapies, and many experience tremendous improvements. After symptoms recede and new coping abilities are mastered, people tend to gravitate toward better lifestyle choices and ways of thinking. These modifications can significantly enhance physical health and reduce the risk of suicide.

Achieving positive mental health, like eating well, attending to the doctor, and taking medicine, should therefore be considered a pillar of total well-being and longevity strategy. Maintaining a healthy and positive mentality can be as easy as taking the time to practice mindfulness for some, while for others, it may necessitate more concentrated work with a professional. In any case, improving mental health is a proven method to live longer. It has been demonstrated that people who practice positive thinking live an average of 8 to 13 years longer. 

It has been shown that an excess of stress hormones, including cortisol and adrenaline, can speed up aging by impairing immune function, lowering it, and causing hormonal imbalances. As a result of these hormones' stimulation of metabolic processes, more free radicals are produced. Our DNA then experiences oxidative stress from free radicals, which ends up shortening our telomeres and accelerating cellular aging.

And this all has another consequence that’s been largely overlooked until recently, as researchers from the University of Michigan in Ann Arbor, Duke University in Durham, NC, and the University of Auckland in New Zealand have shown in a recently published long-term study of 1.7 million people from New Zealand aged 21–60 years.

The consequence being that mental health conditions are strongly associated with dementia later in life. The study found that mental health conditions were associated with subsequent Alzheimer’s and non-Alzheimer’s dementias, as well as other early- and late-onset dementias. Just over 6% of people with mental health conditions developed dementia during the observation period. Among those without mental health conditions, only 1.8% developed dementia. The association persisted across all genders and age groups, and also determined that socioeconomic deprivation or previous chronic physical diseases were not significant factors.

“We were surprised to find that mental health conditions were a much stronger predictor of dementia than chronic physical diseases,” said Dr. Richmond-Rakerd, Assistant Professor of Psychology at the University of Michigan.

“This reinforces the need,” said Dr. Richmond-Rakerd, “to think about dementia prevention earlier in the life course because mental health conditions tend to peak in young adulthood, while chronic physical diseases do not typically emerge until later in life. Supporting young people’s mental health could be a window of opportunity to help reduce the burden of dementia in older adults.”

One possible reason for all this comes back to biological aging. In the past ten years, researchers and practitioners have discovered a strong correlation between typical mental health issues and accelerated brain aging, or the changes to the brain's structure, physiology, and function that are thought to precede later cognitive impairment

For instance, there is a direct correlation between anxiety and depressive disorders and later-life dementias like Alzheimer's disease. The specific symptoms that may contribute to age-related cognitive impairment are the focus of intense research by neuroscientists and gerontologists worldwide. Excessive worry and rumination may affect the rate of neurodegeneration and the memory and attention problems that accompany it, according to new research from the University of Pittsburgh that uses a machine learning model to predict a person's "brain age". This only underscores the need for a more comprehensive insight into the brain and the aging of our brain, so focused brain age diagnostics will be needed in the future. One example of such an endeavor is our portfolio company Brainkey.

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All in all, preventing and addressing mental conditions in young people might reduce or delay the burden of dementia later in older people. With the current mental health crisis, supercharged by the COVID-19 situation, this should be a priority, otherwise, we might as well see large aftermath in the future.

Given that mental disorders are the leading cause of disability compared to any other disease category already, perhaps the most impactful thing we could do for average life expectancy and longevity overall around the world would be to heavily focus on mental health. After all, the same distinction between lifespan and healthspan works for mental health as well - people don’t want to live longer if they are not healthy, and the same applies to mental wellness as well.