Living with bipolar disorder often poses several challenges, including social stigma, isolation and strained relationships in personal and work space. A new study says bipolar disorder is associated with a four to six-fold risk of premature death.

Bipolar disorder is a mental health condition that causes extreme mood swings with emotional highs, called mania, and lows, characterized by depressive moods. Around 4% of Americans live with bipolar disorder.

A team of researchers from the University of Michigan (U-M) found that people with bipolar disorder have a much higher risk of dying prematurely compared to smokers. The findings of the study were published in the journal Psychiatry Research.

The risk of premature death in people who smoke is about two times more than in those who have never smoked. However, people with bipolar disorder face a much greater risk; they are four to six times more likely to die prematurely compared to those without the condition. The findings were made after evaluating two different databases.

"Bipolar disorder has long been seen as a risk factor for mortality, but always through a lens of other common causes of death. We wanted to look at it by itself in comparison with conditions and lifestyle behaviors that are also linked to higher rates of premature death," said Anastasia Yocum, lead author of the study, in a news release.

Researchers first studied a group of 1,128 volunteers who were part of a long-term study of people with and without bipolar disorder. Of the 56 deaths, all but two were from the group that had bipolar disorder (847 participants).

"With statistical adjustments, their analysis shows that having a diagnosis of bipolar disorder made someone six times more likely to die during a 10-year period than people taking part in the same study who did not have bipolar disorder. By comparison, study participants who had ever smoked or were over age 60 were more than twice as likely to die in that same time as people who never smoked or were under 60, regardless of bipolar status," the news release said.

Researchers wanted to evaluate if the results would be the same when tested in a different database. The team then looked into a group of around 18,000 participants, of which 10,700 people had bipolar disorder and just over 7,800 people were without any psychiatric disorder. The participants had received their primary care through Michigan Medicine, U-M's academic medical center.

Participants with bipolar disorder were four times more likely to die than those with no record of bipolar disorder. In contrast, smokers were twice as likely to die as never-smokers, and the risk was three times in those above the age of 60, regardless of bipolar status.

Researchers noted that the only factor that puts individuals at higher risk of premature death is hypertension. The risk of premature death was five times higher in people with hypertension when compared to those with normal blood pressure, irrespective of whether they have bipolar or not.

"To our major surprise, in both samples, we found that having bipolar disorder is far more of a risk for premature death than smoking," said co-researcher Melvin McInnis, a professor of psychiatry at the U-M Medical School.

McInnis hopes the findings will prompt more action to address the many factors that contribute to the risk of premature death in people with bipolar disorder.

"Over the years there have been all kinds of programs that have been implemented for smoking prevention and cardiovascular disease awareness, but never a campaign on that scale for mental health," he said.