{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:02:26Z","timestamp":1791669746986,"version":"4.3.4"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Whether bipolar II disorder (BD-II) is associated with increased long-term mortality remains uncertain because most studies have not distinguished BD-II from bipolar I disorder (BD-I).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine whether BD-II is associated with elevated all-cause and cause-specific mortality compared with population controls, unaffected siblings, and those with BD-I.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This population-based, retrospective cohort study used data from Taiwan\u2019s National Health Insurance Database from January 1, 2000, to December 31, 2022. Individuals 12 years or older with 2 or more psychiatrist-assigned BD-II diagnoses were individually matched to 4 controls without BD-II by sex and birthdate. Additional comparisons included unaffected biological siblings and a BD-I cohort. Follow-up was from the index date to death or December 31, 2022. Data were analyzed from June to August 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Clinical diagnosis of BD-II.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcome was all-cause mortality; secondary outcomes were natural-cause and unnatural-cause mortality. Cox proportional hazards regression models estimated adjusted hazard ratios (AHRs) with 95% CIs, controlling for age, sex, income, urbanization, health care use, and comorbidity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The study included 11\u202f427 individuals with BD-II (mean [SD] age, 39.6 [16.6] years; 7073 [61.9%] female) and 45\u202f708 matched controls (mean [SD], 39.6 [16.7] years; 28\u202f292 [61.9%] female). During a mean (SD) follow-up of 7.3 (5.1) years, 1089 patients with BD-II and 1879 controls died (AHR, 1.62; 95% CI, 1.47-1.78). Excess mortality in BD-II was observed for natural causes (AHR, 1.37; 95% CI, 1.23-1.52) and for unnatural causes (AHR, 4.46; 95% CI, 3.53-5.64). Natural-cause deaths included mental and behavioral disorders; circulatory, respiratory, digestive, and skin or subcutaneous diseases; and symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified. Unnatural-cause deaths were predominantly unintentional injuries, suicide, and assault or homicide. Findings were consistent across sex, age, and psychiatric comorbidities. In within-family analyses, BD-II remained associated with higher all-cause (AHR, 1.31; 95% CI, 1.00-1.72) and unnatural-cause mortality (AHR, 2.05; 95% CI, 1.43-2.95) but not natural-cause mortality. Compared with BD-I, BD-II had higher all-cause (AHR, 1.24; 95% CI, 1.01-1.53) and natural-cause mortality (AHR, 1.45; 95% CI, 1.14-1.86) but not unnatural-cause mortality.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, BD-II was associated with a significant risk of premature mortality across multiple causes; even after accounting for shared familial factors and relative to BD-I, all-cause mortality remained elevated. These findings underscore the importance of comprehensive psychiatric care for individuals with BD-II.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.5535","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T15:00:26Z","timestamp":1775574026000},"page":"e265535","source":"Crossref","is-referenced-by-count":1,"title":["All-Cause and Cause-Specific Mortality in Patients With Bipolar II Disorder"],"prefix":"10.1001","volume":"9","author":[{"given":"Chih-Wei","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang-Chieh Brian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan"},{"name":"Department of 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