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

TL;DR

This study finds that combinations of mental disorders are common and linked to higher mortality, especially when alcohol and substance use disorders are involved.

Contribution

The study introduces a novel approach to analyzing combinations of mental disorders and their mortality risks using association rule mining.

Findings

Combinations of mental disorders were found in 30% of participants with at least one disorder.

Combinations involving alcohol and substance use disorders showed the highest mortality risk.

The highest mortality rate ratio was observed for alcohol use disorder plus substance use disorder plus psychotic experience.

Abstract

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.

The online version contains supplementary material available at 10.1186/s12888-026-07865-w.

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