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Additionally, mental health disorders can adversely affect antiretroviral therapy (ART) adherence, leading to increased HIV\u2010related mortality. This study aims to quantify the difference in mortality between PWH who have a mental health disorder and PWH without mental health disorders in South Africa (SA) and North America (NA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cohort study includes PWH aged 18 years or older who initiated ART between 2000 and 2021 at a national private\u2010sector HIV programme in SA and 13 programmes in the United States and Canada. Mental health disorders were diagnosed according to ICD\u201010 codes F10\u2010F99, which include psychotic disorders, bipolar disorders, depression, anxiety and substance use disorders. We estimated life\u2010years lost (LYL) associated with mental health disorders, quantifying the average difference in remaining life expectancy between individuals diagnosed with a mental health disorder and those without such diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 119,785 participants from SA (57.4% female, median age 39 years) and 142,044 from NA (85.0% male, median age 43 years). In SA, 57,999 (48.4%) were diagnosed with a mental health disorder, compared with 93,518 (65.8%) in NA. In SA, the LYL associated with any mental health disorder were 3.42 years (95% CI 2.42\u22124.28) in males and 2.95 years (0.67\u22125.95) in females. Corresponding figures for NA were 4.16 years (3.71\u22124.59) in males and 4.64 years (2.93\u22126.05) in females. In both regions, LYL were higher for psychotic and substance use disorders than for depression and anxiety. Losses were primarily due to natural deaths at CD4 counts \u2265200 cells\/\u00b5l, with considerable contributions at CD4 counts &lt;200 cells\/\u00b5l. Unnatural causes also contributed to the loss of life\u2010years in males from SA and males and females from NA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PWH affected by mental health disorders experience higher mortality, primarily from natural causes. LYL were associated with both immunosuppression and higher CD4 levels. Improved management of HIV and physical comorbidities among PWH affected by mental health disorders may enhance their prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70023","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T05:20:31Z","timestamp":1755580831000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Life\u2010years lost associated with mental disorders in people with HIV: a cohort study in South Africa, Canada and the United States"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0891-2448","authenticated-orcid":false,"given":"Yann","family":"Ruffieux","sequence":"first","affiliation":[{"name":"Institute of Social and Preventive Medicine University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Joska","sequence":"additional","affiliation":[{"name":"HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health Neuroscience Institute, University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raynell","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunyan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2667-0956","authenticated-orcid":false,"given":"Naomi","family":"Folb","sequence":"additional","affiliation":[{"name":"Medscheme  Cape Town South Africa"},{"name":"Division of Clinical Pharmacology, Department of Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Kirk","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4321-125X","authenticated-orcid":false,"given":"Angela M.","family":"Parcesepe","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Silverberg","sequence":"additional","affiliation":[{"name":"Division of Research Kaiser Permanente Northern California Pleasanton California USA"},{"name":"Department of Health Systems Science Kaiser Permanente Bernard J. 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