Mental health disorders reduce life expectancy by up to 20 years

Heart disease, not suicide or overdose, is the leading killer of people living with serious mental health conditions. This is the conclusion of a sweeping review led by Viola Vaccarino of Emory University.

The experts report that adults with depression, schizophrenia, bipolar disorder, post-traumatic stress disorder (PTSD), and anxiety die, on average, 10 to 20 years earlier than their peers – largely because of cardiovascular disease. 

Mental health and life expectancy

The cardiovascular penalty attached to common psychiatric diagnoses is substantial. Depression raises the risk of heart disease by roughly 72 percent. 

For schizophrenia, the risk nearly doubles – up to about 95 percent. Bipolar disorder increases cardiovascular risk by 57 percent, PTSD boosts coronary heart disease risk by 61 percent, and anxiety disorders are associated with a 41 percent higher risk of dying from cardiovascular causes.

These numbers help explain why life expectancy shrinks so dramatically for this population.

Despite the elevated risks, people with mental health conditions routinely receive worse heart care than the general public. Screenings are missed and risk factors go unmanaged. Evidence-based treatments are offered less often and followed up less reliably. 

The result is a widening survival gap affecting a vast swath of society: roughly one in four people will experience a mental health disorder during their lifetime.

Mental illness and heart disease

Mood and thought disorders don’t just coincide with heart disease; they help cause it – and cardiovascular events can in turn trigger new psychiatric illness. That feedback loop runs through behavior and biology. 

Higher rates of smoking, physical inactivity, and poor diet are part of the story. So are the physiological effects of chronic stress: systemic inflammation, elevated blood pressure, arrhythmias, and insulin resistance all nudge the cardiovascular system toward failure.

The relationship is equally visible in reverse. About 18 percent of people with cardiovascular disease live with depression; after an acute event such as a heart attack, that figure climbs to roughly 28 percent. 

Nearly one in four stroke survivors develops depression in the aftermath, and around 12 percent of heart attack survivors go on to meet criteria for PTSD. Treating either condition in isolation misses the way each amplifies the other.

Existing systems miss what matters

The review highlights a pattern of structural neglect. Mental health and cardiology are typically staffed, funded and measured as separate domains, with little coordination between them. 

Many cardiology clinics don’t routinely screen for depression, PTSD, or anxiety. Many psychiatric services don’t monitor blood pressure, lipids, or glucose as systematically as cardiovascular teams would.

Access gaps compound the problem. In a 2023 U.S. survey cited by the authors, 54 percent of people who met criteria for a mental health disorder received no treatment at all.

Even in countries with universal coverage, patients with serious mental illness are less likely to receive recommended medications, procedures and follow-up for heart disease.

Poverty, unstable housing, and social isolation make adherence and clinic attendance harder, turning health inequities into entrenched mortality.

Mental and physical health gains

The good news is that several familiar tools carry cardiovascular benefits alongside mental health gains. 

Exercise is one of the most effective treatments for depression and also directly improves blood pressure, insulin sensitivity, and endothelial function. The review argues it should sit alongside psychotherapy and antidepressants as core treatment – not an optional add-on.

Mind-body practices such as yoga, tai chi, and meditation can reduce symptoms of anxiety and depression and improve some risk factors (for example, heart rate variability and stress biomarkers). Evidence that they prevent heart attacks or strokes remains limited, but early signals are encouraging and warrant larger trials.

Integrated care models – where mental health and cardiovascular teams coordinate around the same patient – consistently improve psychiatric outcomes in clinical studies. The next step is proving that these collaborative approaches also cut hard cardiac endpoints like myocardial infarction and cardiovascular mortality. 

To do that, researchers will need to stop excluding people with mental health disorders from cardiovascular trials, a longstanding practice that has left clinicians without robust, disorder-specific guidelines for high-risk patients.

Improving life expectancy outcomes

The authors call for changes that are as practical as they are profound. Medical schools and residency programs should train clinicians to recognize and manage the bidirectional links between mental and physical illness. 

Health systems and payers need to expand mental health coverage while embedding routine cardiovascular screening and risk management into psychiatric care – and, conversely, embedding mental health screening into cardiology.

Community-level solutions matter, too. Making exercise accessible and safe, addressing tobacco use with tailored support, improving food access and tackling social isolation are public-health interventions that serve both the heart and the mind. 

And because the burden is unequally distributed, equity must be a design principle: culturally competent care, outreach in underserved neighborhoods and policies that reduce financial and logistical barriers will save the most lives.

Treat the whole person

Taken together, the evidence reframes a familiar crisis. Mental health disorders are common. Cardiovascular disease is common. When they collide, lives are cut short – not by inevitability, but by gaps we can close. 

If roughly a quarter of us will face a mental health condition in our lifetime, preventing the downstream heart damage is not a niche priority; it’s a population-wide imperative.

The path forward is clear enough: measure risk where it’s highest, treat depression and anxiety as cardiac risk factors, deploy exercise and integrated care as first-line tools, and build research and reimbursement structures that reflect how tightly the mind and heart are tied.

Stop treating mental and cardiovascular health separately, and that 10- to 20-year life-expectancy penalty starts to look less like fate – and more like a fixable failure.

The research is published in the journal The Lancet Regional Health – Europe.

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