Associations of lung function abnormalities with the onset and progression of mental disorders in the UK Biobank

To examine the associations of lung function abnormalities with the onset and progression of mental disorders (MD).

This prospective cohort study included 314,115 participants from the UK Biobank. Spirometric patterns were classified as normal, airflow obstruction (AO), restrictive spirometry pattern (RSP), preserved ratio impaired spirometry (PRISm), and PRISm+RSP based on FEV₁, FVC, and FEV₁/FVC. MDs was defined based on ICD-10 codes, including depression, anxiety disorders, schizophrenia and bipolar disorder. Cox regression and multistate models were applied.

During a median follow-up of 13.68 years, 22,196 participants developed first mental disorder (FMD), 4133 progressed to psychiatric comorbidity (PsyC), and 25,057 died. Compared with normal lung function, abnormal spirometric patterns were associated with increased risks of FMD, PsyC, and mortality. In multistate analyses, impaired lung function was associated with elevated transition risks across the disease trajectory, particularly from baseline to death, with the highest risk observed in the PRISm + RSP group (HR = 1.45, 95% CI: 1.39, 1.51). Among individuals with FMD, mortality risk was significantly increased in the AO (HR = 1.44, 95% CI: 1.31-1.48) and PRISm + RSP (HR = 1.34, 95% CI: 1.19-1.51) groups. The transition from FMD to PsyC was modestly elevated in the AO group (HR = 1.10, 95% CI: 1.01-1.20). These associations were generally stronger among older adults, men, smokers, alcohol drinkers, and those with low physical activity.

Abnormal lung function is associated with increased risk of adverse psychiatric trajectories, highlighting the need for integrated respiratory and mental healthcare.