Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas

Prevalence of Severe Mental Illness and Its Associations With Health Outcomes in Patients With CKD: A Swedish Nationwide Study

RATIONALE & OBJECTIVE

Patients with chronic kidney disease (CKD) often face mental health problems, but the burden of severe mental illness (SMI) in this population is unclear. We estimated the prevalence of SMIs among people with CKD and their associations with health outcomes.

STUDY DESIGN

Nationwide cross-sectional and cohort study.

SETTING & PARTICIPANTS

Using the Swedish Renal Registry, we identified 32,943 patients with incident CKD G3b-5 or kidney replacement therapy (KRT) between 2008 and 2020 for estimation of the prevalence of SMIs. Data about the 30,103 patients not receiving KRT were used to examine associations between SMIs and subsequent health outcomes.

EXPOSURE

Occurrence of SMIs (ie, schizophrenia, bipolar disorder, and major depressive disorder) before the date of first registration into the registry (index date), using diagnoses from inpatient or specialist outpatient care.

OUTCOME

30% decline in eGFR, initiation of KRT, and all-cause mortality.

ANALYTICAL APPROACH

Prevalence of SMIs was estimated in patients with CKD and compared with the general population using standardization with ratios adjusted for age, sex, and calendar year. Associations between SMIs and health outcomes were examined using Cox proportional hazards models.

RESULTS

The overall prevalence of SMI was 7.3% in patients with CKD, which was 56% higher than the general population. The prevalences for schizophrenia, bipolar disorder, and major depressive disorder were 0.5%, 2.1%, and 5.6%, respectively. All 3 SMIs were associated with a higher mortality rate. Schizophrenia was not associated with 30% decline in eGFR (HR, 0.92 [95% CI, 0.65-1.29]), but it was associated with a lower rate of initiating KRT (HR, 0.56 [95% CI, 0.39-0.80]). Bipolar disorder was associated with a higher rate of 30% decline in eGFR (HR, 1.47 [95% CI, 1.29-1.67]) but a lower rate of initiating KRT (HR, 0.79 [95% CI, 0.67-0.94]). Major depressive disorder was not associated with 30% decline in eGFR or initiation of KRT.

LIMITATIONS

Lack of primary care data and exclusion of individuals with CKD G1-3a.

CONCLUSIONS

Patients with CKD had a higher prevalence of SMI compared with the general population. In patients with CKD, each SMI was associated with higher mortality, and bipolar disorder was associated with a faster eGFR decline. Patients with CKD and pre-existing schizophrenia or bipolar disorder experienced a lower rate of initiating KRT.

PLAIN-LANGUAGE SUMMARY

Patients with chronic kidney disease (CKD) frequently experience mental health problems, yet the prevalence and impact of severe mental illness (SMI) in this population remain uncertain. This Swedish nationwide study revealed that the prevalence of any SMI was 7.3% among patients with CKD (0.5% for schizophrenia, 2.1% for bipolar disorder, and 5.6% for major depressive disorder), representing a 56% higher prevalence than experienced by the Swedish general population. All 3 SMIs were associated with a higher mortality rate in patients with CKD, and bipolar disorder was also associated with a faster eGFR decline. Moreover, patients with CKD and schizophrenia or bipolar disorder exhibited a lower rate of initiating kidney replacement therapy. These findings highlight the need for improved recognition and management of SMI among people with kidney disease.

Average lifespan variation among people with mental disorders in Denmark: a nationwide, register-based cohort study

AIMS

Mortality associated with mental disorders has been estimated using metrics such as mortality rate ratios and life expectancy. However, the variation around the average life expectancy has never been quantified. The main aim of this study was to measure life disparity for people with mental disorders as a measure of inequality at the time of death.

METHODS

Using data from Danish registries, average life disparity was introduced and calculated to measure the lifespan variation associated with major types of mental disorders. Average life expectancy is also reported for completeness.

RESULTS

Compared with the general population, people with mental disorders not only had shorter average life expectancy, but experienced larger average life disparity. For those diagnosed with a mental disorder, average life expectancy increased between 1995 and 2021; however, average life disparity declined in women only, and did not change for men. In addition, the differences in both metrics between those with mental disorders and the general population were largest for substance use disorders and schizophrenia spectrum disorders. For these disorders, the differences even increased during the study period.

CONCLUSIONS

Mortality rates for individuals with mental disorders have been declining in recent decades in Denmark; however, the increase in the average life disparity emphasizes the increasing heterogeneity and inequality in lifespans within this group, which requires measures to promote a longer and more equal life for those with mental disorders.

Physical Health and Health Behaviours of Australians with Psychosis

People living with psychosis live up to 20 years less compared to the general population. Cardiometabolic ill-health and barriers to health-related behaviour are significant contributors. This is a cross-sectional descriptive study of cardiometabolic health and health behaviours of consumers attending a public community mental health service in an Australian city. One hundred and fourteen consumers currently living with psychosis participated. Standard measures of cardiometabolic health, quality of life and, health-related behaviours were utilised. Data were analysed using descriptive statistics. The cohort reported higher fruit intake and physical activity, and lower excess alcohol use compared to previous studies. Health-related behaviours including smoking and vegetable intake were poorer than previously reported. Participants had low levels of cardiometabolic health (e.g. abnormal lipids). Physical and mental quality of life was also lower than for general populations. Improved efforts to address physical health for people with mental health conditions are urgently needed.

Five-year survival following a non-small-cell lung cancer diagnosis among Veterans Health Administration patients with schizophrenia and bipolar disorder

OBJECTIVE

Veterans with schizophrenia or bipolar disorder (SZ/BP) experience excess mortality due to several reasons, including cancer. We evaluated whether disparities exist in stage of non-small-cell lung cancer (NSCLC) diagnosis and survival between Veterans Health Administration (VHA) patients with and without SZ/BP.

METHOD

This retrospective evaluation used VHA data to identify patients newly diagnosed with NSCLC from 2005 to 2014. Bivariate analyses compared NSCLC stage at diagnosis by SZ/BP status. Kaplan-Meier and adjusted Cox proportional hazards regression analyses examined differences in survival by SZ/BP status. Meaningful differences were assessed using statistical significance, p < .01, and effect sizes of least 0.2 less/greater than 1.

RESULTS

The cohort included 64,269 VHA patients with newly diagnosed NSCLC. These included 1605 (2.5 %) patients with schizophrenia and 1099 (1.7 %) with bipolar disorder. Stage at diagnosis did not meaningfully differ between patients with and without SZ/BP. After adjusting for stage of diagnosis and other factors, schizophrenia, but not bipolar disorder, was associated with an increased risk of five-year all-cause mortality compared to no SZ/BP (schizophrenia: HR 1.22, 95 % CI 1.14-1.30; bipolar: HR 1.01, 95 % CI 0.94-1.10).

CONCLUSIONS

VHA patients diagnosed with NSCLC who had schizophrenia experienced greater mortality compared to those without SZ/BP, despite no meaningful differences between the two groups in stage of NSCLC at diagnosis. Further work to understand drivers of this difference (e.g., access to NSCLC treatment) and subsequent interventions are needed.

Trends and disparities in schizophrenia related mortality in the United States: An analysis of CDC WONDER database, 1999-2020

BACKGROUND

Schizophrenia is a mental health condition that typically begins between ages 18 and 25, significantly impairs daily functioning, ranks among the leading causes of disability worldwide, and is associated with a shortened lifespan. Mortality in schizophrenia is often linked to cardiovascular disease, driven by poor lifestyle choices, limited access to physical healthcare, frequent comorbidities, and non-compliance with antipsychotic medications. This article analyzes mortality trends among U.S. adults aged 35-85 + years with schizophrenia from 1999 to 2020 using CDC Wonder data, contributing valuable insights to the existing literature on this topic.

METHOD

Data from death certificates between 1999 and 2020 were obtained from the CDC WONDER database using ICD-10 code F20 to identify deaths where schizophrenia was listed as a primary or contributing cause, covering all 50 states and the District of Columbia. Demographic data, including race/ethnicity, age, and gender, and information on the place, year, and setting of death-residences, hospices, nursing homes/long-term care facilities, and medical institutions-were collected. We analyzed schizophrenia-related mortality trends in the U.S. from 1999 to 2020. We used the Joinpoint Regression Program (Version 5.1.0, National Cancer Institute) to calculate the annual percent change (APC) and Average Annual Percentage Change (AAPC) in AAMR, along with their 95 % CIs, to identify significant trends over time. Statistical significance was set at P < 0.05.

RESULTS

We identified 80,836 schizophrenia-related deaths, with the highest proportion occurring in nursing homes and long-term care facilities. The overall age-adjusted mortality rate (AAMR) rose from 23.9 in 1999-27.2 in 2020. Notably, the AAMR decreased between 1999 and 2015, with a significant increase from 2015 to 2020.

CONCLUSIONS

This study reveals an increase in the age-adjusted mortality rate (AAMR) for schizophrenia-related deaths among adults from 1999 to 2020, which highlights critical insights for healthcare professionals and policymakers. Further research is needed to identify modifiable factors to reduce morbidity and mortality, potentially easing the burden on healthcare resources and improving the quality of life for those with schizophrenia. Understanding these trends is essential for addressing gaps in the healthcare system and directing resources to areas of greatest need.

Diagnostic pathways and mortality across psychotic disorders: Evidence from Catalonia integrated health records

INTRODUCTION

Although psychotic disorders are associated with significant morbidity and mortality, the diagnostic trajectories and mortality risks across the spectrum of these disorders remain poorly understood. This study aimed to characterize diagnostic pathways and compare mortality outcomes across psychotic disorders in Catalonia.

METHODS

We conducted a retrospective cohort study using electronic health records of 357,007 adults accessing mental health services in Catalonia from 2015 through 2019. Diagnostic categories included schizophrenia, bipolar disorder, schizoaffective disorder, delusional disorder, other non-organic psychoses, unipolar psychotic depression, and other mental health diagnoses. Cox proportional hazards models assessed mortality risk, adjusting for sociodemographic factors and comorbidities.

RESULTS

About one-third of the sample received their first psychotic disorder diagnosis in specialized care. All psychotic disorders showed elevated mortality risk vs other mental health conditions. Schizophrenia had the highest risk (HR, 2.63; 95%CI, 2.46-2.81, p<0.001 followed by schizoaffective (HR, 1.99; 95%CI, 1.77-2.24, p<0.001) and delusional disorders (HR, 1.92; 95%CI, 1.66-2.21, p<0.001). Low socioeconomic status (HR, 3.69; 95%CI, 3.48-3.92, p<0.001) and comorbidities (HR, 1.82 per comorbidity; 95%CI, 1.81-1.83, p<0.001) were significant predictors of mortality across diagnoses. Gradient boosting machine modeling identified comorbidities (56.07%) and diagnostic category (24.51%) as top predictors of mortality risk.

CONCLUSIONS

This study demonstrates significantly elevated mortality risk across the spectrum of psychotic disorders in a Southern European context, with socioeconomic factors and medical comorbidities emerging as critical determinants. These findings underscore the need for integrated care approaches addressing both mental and physical health needs in psychotic disorders.

Transmural collaborative care model for cardiovascular risk management and medication review in patients using antipsychotics in primary care (TACTIC): A study protocol of an incomplete stepped wedge cluster randomized trial

Background

It is well established that patients with severe mental illness and those treated with atypical antipsychotics (AAPs) are at an increased risk of cardiovascular disease. However, primary care currently lacks adequate monitoring of AAP usage, its effects, and the associated cardiovascular risk. We have developed TACTIC, a transmural collaborative care model for patients using AAPs prescribed by the general practitioner (GP) to address the issues of potential overtreatment with AAPs and undertreatment for cardiovascular risk. TACTIC comprises three steps: an informative video for patients, a multidisciplinary meeting, and a shared decision-making consultation with the GP.

Objectives

To evaluate TACTIC's effectiveness on cardiovascular risk and mental health and its cost-effectiveness.

Methods

We will conduct an incomplete stepped wedge cluster randomized trial in the Netherlands.40 GP-nurse clusters are randomized into four waves. Each cluster recruits adult patients (25-85 years), without prior diagnoses of dementia, delirium, or cardiovascular disease, for whom the GP prescribes AAPs. Every five months, a new wave starts with TACTIC. Measurements are taken before the intervention starts and every 5 months until the study concludes. Primary outcomes are cardiovascular risk and mental health as measured with the QRISK3 score and MHI5, respectively. The economic evaluation consists of two cost-utility analyses, one on the data collected alongside the trial and one based on a model extrapolating the trial data to a 10-year horizon. We will also evaluate the process of delivering TACTIC.

Conclusion

This study will assess TACTIC's (cost)effectiveness and provide insights for successful delivery in general practice.

Clinical trials registration

clinicaltrials.gov NCT05647980.

Exposure to Adverse Childhood Experiences and Mental Health Issues in a Young-Adult Sample of University Students in Bangladesh: A Cross-Sectional Study

Background and Aims

The prevalence of adverse childhood experiences (ACEs) is remarkably high in Bangladesh, and there is well-documented evidence establishing a relationship between ACEs and mental disorders in children and adults. However, little is known about how ACE exposure affects young adults' mental health. Therefore, this study aims to estimate the prevalence of ACEs and assess the relationship between ACE exposure and developing anxiety and depression symptoms in a young adult sample of university students.

Methods

A cross-sectional survey comprising 858 young adult students aged 18-29 years, enrolled in an undergraduate or graduate level of study at a large university in Bangladesh, was conducted between October and December 2023. ACE exposure was measured using ten items from the CDC-developed ACE tool. Self-reported anxiety and depression symptoms were assessed using the Generalized Anxiety Disorder 7-item Scale and the Patient Health Questionnaire-9. The associations between the variables of interest were assessed using multivariable logistic regression.

Results

More than half (54.1%) of the students reported experiencing ACEs. The prevalence of developing moderate-to-severe anxiety and depression symptoms was 34.4% and 71.6%, respectively. One item increase in the ACE score increased the odds of experiencing moderate-to-severe anxiety symptoms by 27% (adjusted odds ratio [AOR]: 1.27; 95% confidence interval [CI]: 1.16-1.38) and moderate-to-severe depression symptoms by 19% (AOR: 1.19; 95% CI: 1.08-1.31).

Conclusion

ACE exposure is prevalent in this sample of university students and is associated with developing anxiety and depression symptoms. Exposure to ACEs should be considered in developing intervention strategies for improving young adult students' mental health.

Do Green Spaces Mitigate Mental Health Disorders in Tehran? Evidence from 358 Neighborhoods

BackgroundWith a prevalence of mental disorders affecting 18 out of every 100 Iranians and a rising urban population, it is crucial to examine the impact of built environments on people's well-being.ObjectiveWhile some studies have conducted individual-level surveys in Iran, this research aims to investigate the potential impact of green spaces on mental health at the neighborhood level in Tehran.MethodUsing secondary data from 358 neighborhoods in Tehran in 2011, a linear regression analysis was conducted to investigate the correlation between four green space indicators and three mental health metrics.ResultsThe results indicate that green space indicators have the potential to mitigate mental disorders in Tehran, with accessibility to green spaces emerging as the most impactful factor among those studied on mental disorders and anxiety. However, no significant association was found with depression when considering intervening variables. The study also found that other green space indicators, such as the ratio of green space in neighborhoods and satisfaction with green spaces, did not show significant effects, underscoring the importance of accessibility over size or quantity of green spaces per person. Additionally, our findings suggest that higher levels of unemployment in neighborhoods have a more pronounced impact on mental disorders among sociodemographic factors.ConclusionUrban planners and designers should prioritize equitable access to green spaces within neighborhoods, rather than focusing solely on size or per capita availability. Additionally, policymakers should recognize that addressing both environmental and socioeconomic factors-rather than just one-can effectively alleviate residents' mental health issues.

Strengthening the Delivery of Physical Healthcare for Adults Living With Serious Mental Illness - A Qualitative Description of Patient and Family Member Perspectives

BACKGROUND

Individuals with serious mental illness (SMI) have higher rates of comorbid physical health conditions, poorer associated health outcomes, and die on average 10-20 years earlier than the general population. This qualitative study aimed to explore the perspectives and experiences of adults living with SMI and family members with accessing physical healthcare within primary and mental health settings in Canada.

METHODS

We conducted a qualitative descriptive study using semi-structured interviews with 20 adults living with SMI and five focus groups with 18 family members between July 2023 and April 2024. After coding by two authors, thematic analysis was completed with the support of a data analysis team to identify overarching themes capturing participant experiences with accessing physical healthcare, care needs and preferences.

RESULTS

Four main themes emerged from participant narratives: (1) The centrality of mental health problems in the lives of people with SMI; (2) Challenges in accessing physical healthcare; (3) The role of families in supporting access to care; (4) Perceived health priorities and preferences. There was a high degree of congruence between the perspectives of individuals living with SMI and family members. Both participant groups described challenges accessing primary care settings, fragmented health services, and a desire for person-centred, whole-person health within mental health settings, with family member support where available.

CONCLUSIONS

Findings from this study highlight the need for advancing the integration of physical healthcare within mental health settings for adults living with SMI, who are less likely to engage with community-based primary care services. Enhanced access to physical healthcare could leverage multidisciplinary resources in these settings and partnerships with families. These findings can inform efforts to provide whole-person healthcare for individuals experiencing SMI.

PATIENT OR PUBLIC CONTRIBUTION

The study team collaborated closely with community organizations and individuals with lived experience at every stage of this research. This included contributions to the funding proposal, the study protocol, participant recruitment, study materials, data analysis and preparing the manuscript. Individuals with lived experience and family members actively participated in management and project meetings for the duration of the study.

End-of-life care for people with severe and persistent mental illness and a life-limiting disease: An umbrella review

BACKGROUND

It is widely known that people with a severe and persistent mental illness (SPMI) are more at risk of poor physical health outcomes because of disparities in healthcare access and provision. Less is known about the quality of end-of-life (EoL) care in people with SPMI who have a life-limiting disease.

METHODS

A comprehensive and systematic literature search in PubMed, Embase, Web of Science, Scopus, and CINAHL electronic databases (from inception to November 2023) was conducted, without language restriction, for reviews on EoL care and/or palliative sedation for people with SPMI and a life-limiting disease. A critical appraisal of the selected reviews was performed. Data were analyzed according to the four principles of biomedical ethics.

RESULTS

Ten reviews were included. These show that people with SPMI are at risk of suboptimal EoL care. Stigma among healthcare professionals, lack of integrated care policies, absence of advanced care planning, and insufficient expertise and training in palliative care of psychiatrists have been identified as key challenges to the provision of adequate EoL care for people with SPMI. No data were found about palliative sedation.

CONCLUSIONS

To optimize palliative and EoL care for SPMI patients with a life-limiting disease, a policy of coordinated and integrated mental and physical healthcare is needed. Moreover, education and training initiatives to reduce stigma and discrimination among all healthcare workers and to enhance palliative care skills in psychiatrists should be offered. Finally, more research is needed on EoL particularly on palliative sedation for people with SPMI and a life-limiting disease.

Association of Polygenic Risk for Psychiatric Disorders with Cardiometabolic Disease

IMPORTANCE

Clinical diagnoses of psychiatric disorders are associated with cardiometabolic diseases (CMDs) such as type 2 diabetes and ischemic heart diseases. Studying how genetic liability for psychiatric disorders relate to CMD risk will offer novel insight into the relationship between psychiatric disorders and CMDs.

OBJECTIVE

To evaluate the associations between psychiatric polygenic risk scores (PRSs) and clinically diagnosed CMDs while accounting for cross-disorder pleiotropy.

DESIGN SETTING AND PARTICIPANTS

This study computed PRSs for attention deficit-hyperactivity disorder (ADHD), major depressive disorder (MDD), anxiety disorder, post-traumatic stress disorder (PTSD), bipolar disorder, and schizophrenia. The analysis was conducted in three population-based Northern European cohorts: the Swedish Twin Registry (STR, N=17,378 genotyped samples), the Estonian Biobank (EstBB, N=208,383), and the Norwegian Mother, Father and Child Cohort Study (MoBa, N=129,398). Associations between psychiatric PRSs and clinical diagnoses of 10 major CMDs (including metabolic diseases such as hyperlipidemia, obesity, and type 2 diabetes, and cardiovascular diseases such as hypertensive disease, arteriosclerosis, ischemic heart disease, heart failure, thromboembolic disease, cerebrovascular disease, and arrhythmias) were estimated using models that mutually adjusted for all psychiatric PRSs. Supplementary analyses were performed by additionally controlling for self-reported body mass index (BMI). A discordant twin-pair analysis was conducted in the STR (N=70,619) to assess the association between self-reported lifetime MDD and subsequent CMD risk while adjusting for familial factors shared between monozygotic and dizygotic co-twins.

MAIN OUTCOMES AND MEASURES

Psychiatric PRSs were constructed based on both all available genetic risk variants and genome-wide significant risk variants from large-scale GWASs. Clinical diagnoses of psychiatric disorders and CMDs were ascertained through electronic health records (with primary care records used exclusively in the EstBB). Lifetime self-reported MDD in the STR was assessed via the Composite International Diagnostic Interview Short Form.

RESULTS

PRSs for ADHD and MDD were associated with increased risk of all CMDs. The ADHD PRS showed stronger associations with metabolic disease, whereas the MDD PRS showed stronger associations with cardiovascular diseases. PRSs for anxiety disorder, PTSD, and bipolar disorder showed only limited associations with CMDs, while increased levels of schizophrenia PRSs were associated with decreased risk of CMDs. These associations remained after adjustment for BMI. Finally, twins endorsing lifetime MDD were found to have an increased risk of subsequent CMD diagnoses compared to their unexposed co-twins.

CONCLUSIONS AND RELEVANCE

PRSs for ADHD and MDD showed robust associations with risk of CMDs and self-reported MDD was associated with subsequent CMD risk even after adjusting for familial factors shared between co-twins. These findings provide robust evidence for genetic overlap between ADHD and MDD with CMDs.

Metabolic Monitoring for Adults Living with a Serious Mental Illness on a Second-Generation Antipsychotic Agent: A Scoping Review

Premature mortality in people living with a severe mental illness (SMI) is often attributed to multiple factors including the use of medicines such as antipsychotics. Second-generation antipsychotics (SGAs) are known to cause metabolic syndrome which can increase the risk of cardiovascular disease. Practice guidelines have recommended regular physical health monitoring, particularly of metabolic parameters, however, metabolic monitoring for people living with SMI using antipsychotics remains suboptimal. Therefore, highlighting the need for ongoing research. This scoping review aimed to provide an overview of current metabolic monitoring practices. We anticipate that this information will assist clinicians and policymakers and inform future research. The following databases were searched: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), the Cochrane Database of Systemic Reviews (Wiley), APA PsycInfo (Ovid) and Scopus (Elsevier Science Publishers). The target group was adults (aged ≥ 18) diagnosed with SMI (including bipolar disorder, major depressive disorder and psychotic disorders) and taking SGAs. In total, 44 studies from 14 countries were retrieved. Our findings highlighted that most studies conducted in hospitals did not report on metabolic monitoring practices. Additionally, the roles and responsibilities of healthcare professionals in metabolic monitoring for SMI were infrequently described and parameters such as waist circumference and BMI were often poorly monitored. The scoping review highlights that no streamlined approach towards metabolic monitoring currently exists. There is a need to stipulate and define the roles and responsibilities of all health professionals involved in metabolic monitoring in SMI to optimise care for these individuals. Moreover, there is a need for ongoing research, particularly in the community setting, to promote increased accessibility to metabolic monitoring for SMI.

Investigation of bidirectional causal association between temporomandibular disorders and five mental disorders

OBJECTIVE

This study utilized two-sample Mendelian randomization (TSMR) to investigate the bidirectional causal associations between temporomandibular disorders (TMD) and five mental disorders.

METHODS

Single-nucleotide polymorphisms (SNPs) linked to TMD were extracted from the Genome-Wide Association Studies (GWAS) database. The SNPs selected as instrumental variables (IVs) were required to have strong associations with the exposure phenotype and to meet the assumptions of Mendelian randomization (MR) analysis. The primary method employed for TSMR analysis was the Inverse Variance-Weighted (IVW) method. Additionally, the Weighted Median, Weighted Mode, and MR Egger methods were used as secondary approaches to ensure the reliability and credibility of the results. Furthermore, heterogeneity, pleiotropy, and sensitivity tests were conducted to ensure the accuracy and robustness of the findings. After MR analysis, we performed reverse analysis to explore the bidirectional association between TMD and five mental disorders.

RESULTS

Our study provided evidence of a positive correlation between TMD and both anxiety (P = 5.94 × 10-15, OR = 1.5253, 95 % CI = 1.3719-1.6959) and depression (P = 3.79 × 10-12, OR = 1.4243, 95 % CI = 1.2890-1.5738). In the reverse TSMR analysis, a positive association was found between anxiety and TMD (P = 0.0126, OR = 1.0664, 95 % CI = 1.0139-1.1217). However, no causal relationship was found between TMD and depression, insomnia, bipolar disorder, or schizophrenia (P > 0.05).

CONCLUSION

These evidences indicated a bidirectional relationship between TMD and anxiety, and TMD may also contribute to the development of depression.

A systematic review of occupation- and activity-based health management interventions for adult patients with severe mental disorders

BACKGROUND

Considering the negative effects of severe mental disorders (SMDs) on the patient's social and occupational functioning and general health, besides accumulating evidence on the effectiveness of occupation- and activity-based health management interventions for these patients and the novelty of research on this topic, it is important to review, evaluate, and categorize relevant studies. The present study aimed to systematically review occupation- and activity-based health management interventions for adult patients with SMDs.

MATERIALS AND METHODS

The present study is a systematic review. We conducted a literature search in Medline, OTseeker, Cochrane Library, Embase, CINAHL, PubMed, PsycINFO, ISI Web of Science, MagIran, ISC, and SID databases from 2000 until October 2021. The study population consisted of patients clinically diagnosed with SMDs (e.g., schizophrenia, bipolar disorder, and major depression). After the literature search, we investigated the screening, quality, and inclusion and exclusion criteria of the articles. In the primary search, we extracted 238 relevant articles, and after appraising their titles and abstracts, we identified 55 relevant articles. After reviewing the full text of the articles and removing duplicates, 17 articles met the inclusion criteria of this study, while we excluded two articles from the quality assessment. Finally, we reviewed 15 studies. The outcomes included all positive and negative treatment effects and outcomes of the interventions.

RESULTS

According to the results, there were multiple occupation- and activity-based interventions for patients with SMDs, which could directly or indirectly improve their general functioning and health management.

CONCLUSION

The reviewed studies had numerous blind spots and limitations, such as common shortcomings of randomized clinical trials, lack of long follow-ups, and ambiguity or dispersion of intervention protocols. Besides addressing these limitations, we also discussed research proposals in this study.

Twenty-four-hour movement guidelines and depressive symptoms: association, temporal trends and moderators over a ten-year period among 45,297 US adolescents

The aims of the present study were: (1) to examine the association between meeting the 24-h movement guidelines and depressive symptoms among U.S. adolescents; (2) to analyze the temporal trends of this association; and (3) to test whether sex, age, or race/ethnicity moderate these associations. This is a cross-sectional study using repeated data collection from the high school Youth Risk Behavior Surveys (YRBS), involving 45,297 adolescents in the US (49.7% females). Data were collected bi-annually between 2011 and 2021. These surveys represent cross-sectional snapshots rather than a longitudinal study, capturing data at distinct points in time across multiple years. The three 24-h movement guidelines, including guidelines for physical activity, screen time, and sleep duration were assessed by self-reported questions. Depressive symptoms were assessed by the question "During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing your usual activities?" with yes/no answer options. A generalized linear mixed model (GLMM) was employed to gauge the association between adherence to the 24-h movement guidelines (exposure) and the likelihood of having depressive symptoms (outcome). The year of data collection was included as a random intercept in the mixed-effects model to account for potential variations in depressive symptoms across different time points. The model was further adjusted for covariates, including sex, age, race/ethnicity, alcohol and tobacco consumption, school bullying, cyberbullying, and excess weight. Adolescents meeting all three 24-h movement guidelines (physical activity, screen time, and sleep) had the lowest probability of depressive symptoms (21.3%, 95% CI 17.3-25.3%) compared to those meeting none (37.6%, 95% CI 33.4-41.8%). Significant protective effects were observed across all adherence levels (p < 0.05). Over the 2011-2021 period, adherence remained consistently associated with reduced depressive symptoms, with the strongest effects seen in 2019 and 2021. Younger adolescents, males, and White individuals showed the greatest benefits, while females, older adolescents, Black, Hispanic/Latino, and individuals from other racial/ethnic groups exhibited weaker protective effects despite adherence. Findings from the present study highlight the importance of encouraging adherence to 24-h movement guidelines as a potential strategy to reduce depressive symptoms in adolescents. Notably, the protective effects of adherence varied across sociodemographic groups, with younger adolescents, females, and White individuals experiencing the greatest benefits.

Effectiveness of referral to a population-level telephone coaching service for improving health risk behaviours in people with a mental health condition: a randomised controlled trial

BACKGROUND

Telephone support services are a viable means of providing population-level support to reduce health risk behaviours. While research exists on the effectiveness of Quitlines to reduce smoking, there is limited other research investigating whether telephone services can provide effective behaviour change support for people with a mental health condition for behaviours including physical activity, healthy eating, and weight management. The aims of this trial were to evaluate the effectiveness of referral of people with a mental health condition to a population-level telephone coaching service to improve health risk behaviours and increase attempts to do so.

METHODS

A parallel-group randomised controlled trial was conducted. Participants with a mental health condition (N = 681) were assigned to a control (health information pack) or intervention group (information pack and referral by the research team to a coaching program). Data were collected via telephone surveys at baseline and six months post-recruitment. Primary outcomes were: (1) weekly minutes of moderate-to-vigorous physical activity, (2) daily fruit serves, (3) daily vegetable serves, and (4) attempted behaviour change/weight loss (yes/no; composite measure). Secondary outcomes included weight, Body Mass Index (BMI), and attempts to change each health behaviour individually.

RESULTS

Intention-to-treat analyses found no significant differential change between groups from baseline to six months for primary or secondary outcomes. By follow-up, 242/549 (44%) of intervention participants had enrolled in coaching and completed at least one call, with 16/242 having completed the program, 79 ongoing, and 147 withdrawn. Per-protocol analyses found attempting to improve at least one health behaviour/lose weight was significantly greater in enrolees (OR = 3.7, 95% CI 1.03-13.23) than the control group.

CONCLUSIONS

Referral to the program did not improve risk behaviours or weight/BMI but did support behaviour change attempts. Contributing factors may include low program completion by follow-up and impact of COVID-19. Further research is required to better understand participation in and benefits of telephone coaching services for people with a mental health condition.

TRIAL REGISTRATION

Registered retrospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12620000351910).

Strengthening the delivery of integrated care for individuals experiencing serious mental illness within mental health settings: a qualitative description of health provider perspectives

BACKGROUND

Individuals experiencing serious mental illness (SMI) have higher rates of comorbid physical health conditions, poorer associated health outcomes, and die on average 10-20 years earlier than the general population. They encounter multiple barriers to accessing appropriate physical health care in many countries, including Canada, where policies and practices to promote integrated care delivery to this population remain scant. This qualitative study aimed to explore health provider perspectives and experiences with integrated physical and mental health care within mental health settings in Canada, in efforts to address the health needs of this population.

METHODS

This qualitative descriptive study involved conducting individual semi-structured interviews with 13 health administrators and four focus groups with 15 clinicians between July 2023 and April 2024. The data analysis team, inclusive of individuals with SMI, used thematic analysis to identify overarching themes that capture participants' perspectives on and experiences with delivering integrated physical and mental health care within mental health settings in Canada, including their clinical practices and organizational contexts.

RESULTS

We identified four themes in participant narratives: (1) the need for integrated care delivery within mental health settings; (2) organizational readiness for integrated care; (3) moving integration forward: addressing challenges; and (4) leveraging opportunities to advance integrated care. Both participant groups highlighted challenges with fragmented healthcare services, emphasized the urgent need for policies, practices and guidelines that support person-centered, comprehensive care within mental health settings, and called for engaging people with living/lived experience and family members in service redesign.

CONCLUSION

Findings underscore the importance of accelerating efforts to promote integrated health care delivery for adults with SMI within mental health settings, and of implementing policies that address health disparities for this population in the Canadian context.

CLINICAL TRIAL NUMBER

Not Applicable.

Relationship between quality of life of patients with severe mental illnesses and family burden of disease: the mediating effect of caregivers' social support

BACKGROUND

Severe mental illnesses (SMIs) have become one of the public health problems of great concern in society, which not only bring physical and mental pain to patients but also heavy burden to families. It is known that the health-related quality of life (HRQoL) of patients and caregivers' social support are correlated with caregivers' family burden of disease, but the interaction mechanism among them is not clear. The purpose of this study was to investigate the association between HRQoL in patients with SMIs and the family burden of disease and to examine the mediating role of caregivers' social support.

METHODS

From January to July 2022, this cross-sectional study was conducted in 23 community health service centers in Nanjing, China. We recruited 924 patients with SMIs and their caregivers, using a random sampling method. Hayes' PROCESS macro was used to test the mediation effect of caregivers' social support in the relationship between patients' HRQoL and family burden of disease. Indirect effects were tested using bootstrapped confidence intervals (CI).

RESULTS

The SF-36 score of patients with SMIs was 57.85 (49.59, 63.64), while the caregivers' social support was measured at 32.00 (27.00, 35.00), and the family burden of disease scored 16.00 (8.00, 24.00). Spearman correlation analysis revealed a negative correlation between the patients' HRQoL and the family burden of disease (r = -0.54, p < 0.01). Furthermore, caregivers' social support was negatively correlated with the family burden of disease (r = -0.19, p < 0.01). The mediating role of caregivers' social support between the patients' HRQoL and the family burden of disease was confirmed by the Bootstrap test (p < 0.01), with a mediating effect of 2.75% (β = -0.016, 95% CI = -0.031, -0.002).

CONCLUSIONS

This study highlights that caregivers experience a heavy family burden of disease. The patients' HRQoL not only directly affects the family burden of disease but also indirectly influences it through the caregivers' social support. Therefore, relevant departments need to prioritize improving patients' HRQoL and expanding caregivers' social support networks when developing targeted intervention programs to reduce the family burden of SMIs.

Conceptual competence in medicine: promoting psychosomatic awareness in clinics, research and education

Introduction

In recent decades, psychosomatic medicine has developed into a distinct specialty, bringing specific clinical concepts to bear seeking to acknowledge the unity (not the identity) of the mind and body in clinical care. Such concepts form the identity of the psychosomatic field as a distinct discipline and its epistemological status between somatic medicine and psychiatry. Despite the importance of these concepts from an educational and a research perspective, too little attention has been paid to their clinical impact.

Methods

This paper investigated the general nature of concepts and their role and significance in structuring the clinical encounter and care, including consideration of their relevance for the hidden curriculum.

Results

Conceptual competence is defined as a transformative awareness of the multilayered, fallible, and plural nature of human concepts, which have both descriptive and evaluative and action-guiding properties having both an explicit and an implicit meaning. Conceptual competence in psychosomatic medicine entails dealing competently with the mind-body-distinction and the biopsychosocial model (and criticism of it) with respect to the clinical situation.

Discussion

Conceptual research is presented as an autonomous research area and the complement of empirical research, having a descriptive and a normative function: descriptively analyzing the concepts we have and normatively searching for the concepts that we need for the integrated care we strive for.

Premature Mortality and Health Inequality among Adult New Yorkers with Serious Mental Illness

Although numerous studies have documented excess mortality and health inequality among individuals with serious mental illness (SMI), none has been done among individuals in a large, diverse urban setting, such as New York City (NYC). We used referral data for adults aged 18 and older referred to the NYC Department of Health and Mental Hygiene public mental health services between January 2004 and December 2018 and matched it to the NYC death registry. Age at death, leading causes of death, years of potential life lost (YPLL), and standardized mortality ratios (SMRs) were calculated for this population. We found individuals with SMI in NYC died at younger ages and had higher rates of YPLL compared to the total population (147.4 YPLL vs. 66.8 YPLL per 1000 population). Age and gender-adjusted SMRs show these individuals have more than twice the mortality rate of the total NYC adult population (overall SMR 2.2 [95% CI 2.1-2.2]). Cause-specific SMRs show an increased risk of death among SMI from diabetes (SMR 2.8 [95% CI 2.4-3.10]), heart disease (SMR 2.7 [95% CI 2.6-2.9]), psychoactive substance use and accidental overdose (SMR 4.5 [95% CI 4.1-4.9]), and suicide (SMR 6.7 [95% CI 6.0-7.4]). Our results highlight the need to implement effective, preventive, and rehabilitative measures that integrate physical and behavioral healthcare services and address upstream drivers of health to achieve health equity and eliminate health disparities. In order to achieve gains in life expectancy, specific considerations for reducing excess mortality in the SMI population must be accounted for.

The Live Well intervention: Promoting healthy lifestyles during routine older people's mental healthcare

OBJECTIVE

Lifestyle is an important determinant of health. The Live Well intervention allows mental health clinicians to address lifestyle during routine mental health encounters.

METHOD

Clinicians were taught how to encourage consumers to learn more about lifestyle and health; consider their own lifestyle and health using a self-rated health and wellness questionnaire (HAWQ) and helped them decide which out of six health domains (physical, mental and social activity, healthy eating, mental wellbeing and positive thinking) should be improved in small, sustainable steps using a SMART (specific, measurable, achievable, relevant and timed) goal-setting template.

RESULTS

Out of 65 enrolled consumers, 52 completed pre-intervention, 6-week and 12-week post-assessment assessments. There were improvements in all self-rated health domains except for heathy eating. At 12-week, consumers also recorded significant satisfaction with the Live Well program, goal achievement and wellbeing. Clinicians' feedback was positive about using this intervention with their consumers.

CONCLUSIONS

Live Well is a feasible and effective way to engage consumers on positive lifestyle changes in routine mental health care encounters.

Respiratory disease in people with bipolar disorder: a systematic review and meta-analysis

People with bipolar disorder (BD) have an increased risk of premature mortality and the respiratory mortality rate is higher than those of the general population. To date, however, the evidence on respiratory disease in this population has not been meta-analyzed. We systematically review and meta-analyze the frequency of respiratory diseases in patients with BD and to compare prevalence and odds ratio (OR) with the general population. The systematic literature search was conducted in Pubmed, PsycINFO, Scielo and Scopus, with snowball search of reference and citation lists. Inclusion criteria were studies reporting diagnoses of respiratory diseases (asthma, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer and tuberculosis) in people with BD according to operationalized criteria and where possible, control group. Of the 2158 articles screened, 20 including 962,352 people with BD and 37,340,405 control group, met the inclusion criteria. In people with BD, the prevalence of COPD was 9.14% (95%CI: 6.61-12.5%), asthma 6.4% (95%CI: 4.56-8.91%), pneumonia 2.78% (95%CI: 2.51-3.08%) and lung cancer 0.44% (95%CI:0.23-0.84%). Compared to the general population, people with BD had significantly higher rates of COPD (OR: 1.73; 95% CI: 1.40-2.14), showing an increased rate in younger and female patients; asthma (OR: 1.91, 95% CI: 1.25-2.94), with a greater rate in younger patients; and pneumonia (OR: 2.82, 95% CI: 1.33-5.99). In the first meta-analysis on the topic, BD was associated with an increased risk of respiratory illness versus the general population. In COPD and asthma, young people and women are at particular risk. Prevention programs are urgently needed.

Key Aspects of Recovery-Oriented Practice in Caring for People With Mental Ill-Health in General Emergency Departments: A Modified Delphi Study

AIM

To identify key aspects of recovery-oriented practice in caring for people with mental ill-health in general emergency departments.

DESIGN

A modified Delphi study with three rounds.

METHODS

A 24-member expert panel was recruited consisting of people with lived experience of mental ill-health, registered nurses working in emergency care, registered nurses specialised in psychiatric and mental health nursing and mental health recovery researchers. In the initial round, important aspects of recovery-oriented practice were identified through focus group interviews. Thematic analysis generated statements that were then reformulated as a questionnaire for subsequent rounds. The experts rated each statement's perceived importance on a 5-point Likert scale. The consensus level was set at ≥ 80%. Descriptive statistics were used to analyse the data.

RESULTS

Consensus was reached on the importance of 39 of 73 statements, with ≥ 80% deemed 'very important' in recovery-oriented practice in general emergency departments.

CONCLUSION

The study emphasises the delicate balance between the essential elements of recovery-oriented practice, their practical feasibility and the predominant biomedical perspective in general emergency department care. It proposes strategies to empower nursing staff and managers to adopt recovery-oriented practices that enhance the quality of care for people with mental ill-health. Enabling staff by providing the necessary prerequisites and a care environment that supports reflective practices is crucial. The responsibility for facilitating these changes needs to be a shared commitment between nursing staff and managers.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The identified issues can serve as a framework for interventions, education and training to support the integration of recovery-oriented practice in general emergency care. They can also be used to develop tools for evaluating emergency care environments and promoting alignment with recovery-oriented principles.

IMPACT

Problem addressed: People with mental ill-health are at risk of being neglected, judged and dismissed in general emergency department care, creating obstacles to their mental health recovery.

MAIN RESULTS

The Delphi study identified 39 key aspects of recovery-oriented practice in general emergency departments, emphasising person-centred, strength-based, collaborative and reflective care.

IMPACT

The research seeks to establish a foundation for developing training programmes, education and interventions and for the integration of recovery-oriented practices in general emergency care. It thus has the potential to enhance the quality and equality of care for patients with mental ill-health in emergency care. The impact extends to nursing staff and managers as it seeks to empower them to systematically reflect on and reevaluate established emergency department practices to ensure that every person, irrespective of their health condition, is treated with dignity and respect in emergency department settings.

REPORTING METHOD

The CREDES guidance on conducting and reporting Delphi studies.

PATIENT OR PUBLIC CONTRIBUTION

The authors have nothing to report.

Increased mortality risk in people with schizophrenia in Lithuania 2001-2020

The aim of this study was to assess mortality risk in people with schizophrenia in Lithuania from 2001 and 2020. Cause-specific and all-cause mortality risk among patients with schizophrenia was assessed using a retrospective cohort study design. The cohort identified all patients with schizophrenia diagnosis (ICD-10 code F20) who were admitted to the Vilnius Republican Psychiatric Hospital from 1 January, 2001 to December 31, 2020. Dates of death and emigration were obtained from the Central Population Register. The standardized mortality ratios (SMRs) were calculated by dividing the observed number of deaths among patients with schizophrenia by the expected number of deaths, calculated using the national rates. The final cohort included 7883 patients, with 2458 observed deaths. An increased all-cause mortality risk was found for both sexes (SMR = 1.96; 95% CI 1.88-2.04) compared to the general population. The most common cause-specific mortality risk was found for diseases of the circulatory system (SMR = 2.17; 95% CI 2.05-2.30). Other significant increases in cause-specific mortality risk were observed for infectious diseases, mental and behavioural disorders, diseases of the nervous system and respiratory system, diseases of the genitourinary system, as well as external causes. Patients with schizophrenia do not benefit from the health strategies that have led to reduced mortality in the general population. To close the mortality gap, smoking and alcohol cessation interventions, cardiovascular and cancer screening and monitoring, early diagnosis, and interventions for identified physical diseases should be regarded as imperative.

Clubhouse Partnerships with Clinical Services: Current Status and Barriers to Integration

The Clubhouse model of psychosocial rehabilitation has supported the recovery of people with serious mental illness for over 75 years, but many of the roughly 350 Clubhouses are not well-integrated into the larger health care system, limiting their reach. This article examines Clubhouses' and psychiatric providers' interactions and experiences to understand the nature of and barriers to partnerships. The directors of Clubhouses affiliated with Clubhouse International were surveyed, examining their attitudes and practices around collaboration with psychiatric providers. To provide context, psychiatric providers were also surveyed regarding their understanding of and experiences with Clubhouses. Findings reveal broad support among both Clubhouse directors and psychiatrists for enhancing partnerships, despite current barriers, limited interactions, and the need for greater mutual understanding. Key considerations that emerged include the importance of maintaining the Clubhouse model's distinct non-clinical, community-based, and member-directed identity in any integration efforts.

The Challenging Problems of Cancer and Serious Mental Illness

PURPOSE OF REVIEW: Patients with Serious Mental Illness (SMI) are reported to be at higher risk for somatic disorders (e.g. cardiovascular and metabolic diseases) and higher mortality, compared to the general population, because of the consequences of SMI including psychotropic medication side effects, sedentary and unhealthy lifestyle, difficult access to physical health care. The aim of this review was to examine the current evidence regarding oncology, focusing on the problem of cancer among patients with SMI. RECENT FINDINGS: Compared to the general population, individuals with SMI showed a lower rate of screening for cancer, suboptimal standard cancer treatment, delayed treatment, and higher mortality from cancer. Several factors, including those related to the patient, the health-care system, and the social context, are involved in these negative outcomes. It is therefore necessary to raise awareness and alert clinicians in oncology settings to the challenging problem of cancer among patients with SMI, a marginalized and vulnerable segment of the population that can be at risk for not receiving proper cancer prevention and care. Evidence supports the mandatory need for an interdisciplinary approach involving psychiatry and mental health services.

Psychosocial hybrid interventions for weight and sedentary behavior management among patients with severe mental disorders: A systematic review and meta-analysis

BACKGROUND

Severe mental disorders, such as schizophrenia, bipolar disorders, and other psychosis have been associated with risk of premature mortality, predominantly due to cardiovascular diseases and metabolic syndrome. The aim of this systematic review and meta-analysis was to examine the efficacy of hybrid psychosocial interventions combining face-to-face and eHealth components for patients with severe mental disorders on reduction of weight and waist circumference.

METHOD

The electronic search on PubMED, PsycINFO, EMBASE, Web of Science were conducted, and data were extracted twice. A supplementary search was also conducted. Interventions with severe mental disorder patients reporting outcomes related to obesity, metabolism, metabolic syndrome, and inflammation were included. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments to address the risk of bias. A meta-analysis was also conducted.

RESULTS

After following the steps recommended by PRISMA statements, 14 studies were included in the systematic review and four studies were included in meta-analysis. The pooled analysis demonstrated that hybrid interventions were not able to significantly promote waist circumference changes [SMD (cm) = -0.19, 95% CI = -0.60, 0.22; Z = 0.91; p = 0.36; two studies] nor weight reduction [SMD (kg) = -0.21, 95% CI = -0.43, 0.01; Z = 1.90; p = 0.06; four studies] in patients with severe mental disorders.

CONCLUSION

More studies should focus on hybrid mental health psychosocial for weight control and sedentary lifestyle need to be elaborated to verify their effectiveness in improving sedentary lifestyle and promoting weight reduction in people with severe mental disorders.

The Contribution of Noncommunicable and Infectious Diseases to the Effect of Depression on Mortality: A Longitudinal Causal Mediation Analysis

BACKGROUND

The increased prevalence of physical diseases among individuals with mental illness contributes to their increased risk of mortality. However, the mediating role of specific diseases in the effect of mental illness on mortality is not well understood.

METHOD

We conducted a longitudinal causal mediation analysis using data from beneficiaries of a South African medical insurance scheme from 2011 to 2020. We estimated the overall effect of major depressive disorder (MDD) on mortality and evaluated reductions in this overall effect through hypothetical interventions on the risks of mediating physical diseases using an interventional effects approach. Monte Carlo simulation-based g-computation was used for estimation.

RESULTS

Among 981,540 individuals, 143,314 (14.6%) were diagnosed with MDD. Mortality risk after 8 years was 6.5% under MDD, and 5.3% under no MDD (risk ratio 1.23, 95% CI = 1.19, 1.26). Overall, 43.4% of this disparity could be attributed to higher rates of physical comorbidities due to MDD. Cardiovascular diseases accounted for 17.8%, followed by chronic respiratory diseases (8.6%), cancers (7.5%), diabetes and chronic kidney disease (5.8%), tuberculosis (4.3%), and HIV (2.7%).

CONCLUSION

Within the privately insured population of South Africa, MDD is associated with increased mortality. We found that noncommunicable diseases, rather than infectious diseases, are important mediators of the effect of MDD on mortality.

Intuitive eating predictors and outcomes in people with severe mental illness participating in a lifestyle intervention

ISSUE ADDRESSED

People with severe mental illness (SMI) are at higher risk of preventable diseases than the general population; poor diet contributes to heightened risk. Adaptive approaches designed to improve intuitive eating may improve dietary behaviours in people with SMI. Aims of this study were to investigate predictors of, and assess the impact of a nutrition program on, intuitive eating in people with SMI.

METHODS

This was a retrospective analysis of an exercise and nutrition program for people with SMI. The primary outcome was intuitive eating assessed using the Intuitive Eating Scale 2 (IES2); psychological distress was measured using the Kessler-6 scale. Regression analyses were conducted on baseline data; change in intuitive eating was assessed using Wilcoxon tests.

RESULTS

A total of 93 participants had complete data for regression analyses, and 32 completed pre/post-assessments. The most common mental health diagnosis was psychotic disorder (35%); 74% had BMI > 25 kg/m2. The regression model significantly predicted total IES2 score and three intuitive eating domains. Body mass index (BMI) was negatively associated with these outcomes (β = -0.234 to -0.248; p < 0.05). Both BMI and psychological distress were negatively associated with body-food choice congruence (B-FCC), and only B-FCC was improved at post-intervention.

CONCLUSIONS

Higher BMI and psychological distress were associated with lower intuitive eating in people with SMI. Nutrition interventions may improve B-FCC in people with SMI. SO WHAT?: Given the interrelatedness of BMI and psychological distress with psychosocial stressors, nutritional interventions should be implemented alongside holistic approaches to improve health equality.

Elevated mortality risks associated with late diagnosis of cancer in individuals with psychiatric disorders?

INTRODUCTION

Considering the elevated cancer mortality in individuals with psychiatric conditions, possibly associated with late diagnosis, this study investigated cancer screening participation rates among patients under the care of four Trieste community mental health centers (CMHCs).

METHODS

We conducted a retrospective cohort study on 1252 individuals with psychiatric disorders, retrieving their electronic health records up to December 2019. The study assessed participation rates in breast, cervical, and colorectal cancer screening programs. We explored differences in demographic and clinical characteristics of participants versus non-participants in screening programs.

RESULTS

Patients with psychiatric conditions had lower screening participation rates compared to the general population of Trieste. The rates for breast and cervical cancers were approximately one-third lower, whereas the rate for colorectal cancer was halved. Psychiatric diagnosis influenced participation in breast cancer screening, with patients having anxiety disorders more likely to participate than those suffering from schizophrenia or disorders of adult personality and behavior. Age, nationality, marital status, employment status, and living situation all affected adherence to cervical cancer screening. Individuals who participated more frequently were in the 35-54 age range, of Italian nationality, employed, and had a family of their own. Conversely, non-participants were more likely to be widowed or unmarried. Finally, among patients eligible for colorectal cancer screening, those who participated were more likely to have a family of their own and have a diagnosis of affective or anxiety disorders, while those who did not adhere to the programs were more commonly widowed and had a higher frequency of diagnosis of schizophrenia or disorders of adult personality and behavior.

CONCLUSIONS

Mental health services should focus on increasing patients' participation in cancer screening programs in order to improve their physical health and reduce mortality. This intervention could contribute to promoting equitable access to preventative care and to bridging the gap between mental health and general medical services.

The Living Well, Living Longer program: an integrated care strategy to improve the health of people living with severe mental illness

Living Well, Living Longer (The Program) is an integrated care strategy to improve the physical health of people living with severe mental illness within a public mental health service. The significant life expectancy gap experienced by this cohort is largely attributed to higher rates of cardiovascular disease and modifiable risk factors. The Program addresses this by guiding people through the four stages of screening, detection, treatment initiation, and ongoing management of coexisting chronic health conditions. The Program adopted an integrated care approach to ensure the provision of appropriate and coordinated care across hospital and primary care services. Key care pathways include a cardiometabolic health assessment clinic, shared care with general practitioners, oral health services partnership and employment of peer support workers, dietitians, exercise physiologists, and smoking cessation to provide targeted community support and interventions. There has been strong engagement with the care pathways introduced since The Program's inception in 2013 and evaluation is currently underway to consider the impact on cardiometabolic health outcomes for participants. Critical to The Program's effectiveness has been engagement with lived experience expertise, multidisciplinary collaboration, and strong executive support. However, significant challenges persist amid an Australian public health crisis characterised by reducing rates of free primary healthcare access for people living with severe mental illness and enduring communication challenges between primary and secondary health services. With the implementation of MyMedicare and the imminent Single Digital Patient Record across NSW Health, we stand at a critical juncture. It is imperative to establish robust systems to enhance care for this vulnerable population.

Lung function decline in people with serious mental illness: A call to action

This prospective observational study aimed to evaluate the rate of change in forced expiratory volume in the first second (FEV1) and to explore the factors associated with changes in FEV1 in people with serious mental illness (SMI). Sixty subjects diagnosed with schizophrenia or bipolar disorder who were smokers and without history of respiratory illness agreed to participate. The mean (range) follow-up period was 3.54 (3.00-4.98) years. The mean (standard deviation) annual rate of change in FEV1 decreased by 39.1 (105.2) mL/year. Thirty-one (51.7 %) patients experienced a decrease in the FEV1 ≥40 mL/year (i.e. a rapid decline). The factors associated with the absolute change in FEV1 were the baseline International Physical Activity Questionnaire activity score in metabolic equivalents of tasks (β 0.145, 95 % confidence interval [CI] 0.043 to 0.246; p = 0.005), baseline FEV1 (β -0.025, 95 % CI -0.076 to 0.027; p = 0.352), and the interaction term of both variables (β -3.172e-05, 95 % CI -6.025e-05 to -0.319e-05; p = 0.029). The factors associated with rapid FEV1 decline were income (odds ratio [OR] 0.999, 95 % CI 0.995 to 1.003; p = 0.572), the rate of change in abdominal circumference (OR 0.000, 95 % CI 0.000 to 0.890; p = 0.081), and the interaction term of both variables (OR 1.038, 95 % CI 1.010 to 1.082; p = 0.026). In conclusion, a substantial proportion of people with SMI experienced a rapid decrease in FEV1. If our results are confirmed in larger samples, the routine evaluation of lung function in people with SMI would be an opportunity to identify individuals at greater risk of morbidity and mortality.

Co-occurrence between mental disorders and physical diseases: a study of nationwide primary-care medical records

BACKGROUND

Mental disorders and physical-health conditions frequently co-occur, impacting treatment outcomes. While most prior research has focused on single pairs of mental disorders and physical-health conditions, this study explores broader associations between multiple mental disorders and physical-health conditions.

METHODS

Using the Norwegian primary-care register, this population-based cohort study encompassed all 2 203 553 patients born in Norway from January 1945 through December 1984, who were full-time residents from January 2006 until December 2019 (14 years; 363 million person-months). Associations between seven mental disorders (sleep disturbance, anxiety, depression, acute stress reaction, substance-use disorders, phobia/compulsive disorder, psychosis) and 16 physical-health conditions were examined, diagnosed according to the International Classification of Primary Care.

RESULTS

Of 112 mental-disorder/physical-health condition pairs, 96% of associations yielded positive and significant ORs, averaging 1.41 and ranging from 1.05 (99.99% CI 1.00-1.09) to 2.38 (99.99% CI 2.30-2.46). Across 14 years, every mental disorder was associated with multiple different physical-health conditions. Across 363 million person-months, having any mental disorder was associated with increased subsequent risk of all physical-health conditions (HRs:1.40 [99.99% CI 1.35-1.45] to 2.85 [99.99% CI 2.81-2.89]) and vice versa (HRs:1.56 [99.99% CI 1.54-1.59] to 3.56 [99.99% CI 3.54-3.58]). Associations were observed in both sexes, across age groups, and among patients with and without university education.

CONCLUSIONS

The breadth of associations between virtually every mental disorder and physical-health condition among patients treated in primary care underscores a need for integrated mental and physical healthcare policy and practice. This remarkable breadth also calls for research into etiological factors and underlying mechanisms that can explain it.

Prevalence of and factors associated with overweight and obesity in patients with severe mental disorders in Shenzhen: results from the urban Chinese population

OBJECTIVE

To determine the prevalence of overweight and obesity in patients with severe mental disorders (SMD) and the factors associated with their socio-demographic and disease characteristics in a cross-sectional population-based study.

DESIGN

This analysis examined the prevalence of overweight and obesity in 14 868 managed SMD patients in an urban area of Shenzhen city based on data from the health information monitoring system in 2021. Multivariate logistic regression were used to identify the factors associated with the prevalence of overweight and obesity in patients with SMD.

SETTING

China.

PARTICIPANTS

14 868 patients with SMD.

RESULTS

The prevalence of overweight and obesity in patients with SMD in this study was 32·6 % and 16·1 %, respectively. In multivariate analysis, married status, Shenzhen household registration, management durations of 5-10 years and >10 years, participation in family physician services, taking clozapine or aripiprazole, FPG > 6·1 mmol/l, hypertension, TC ≥ 5·2 mmol/l, TG ≥ 1·7 mmol/l, and more frequent follow-ups in the past year were associated with higher odds of overweight and obesity. Compared to their respective reference categories, living with parents, spouse and children, taking risperidone, aripiprazole, amisulpride and perphenazine, FPG > 6·1 mmol/l, hypertension, TC ≥ 5·2 mmol/l, TG ≥ 1·7 mmol/l, and more frequent follow-ups in the past year were associated with higher odds of obesity.

CONCLUSION

We observed a high prevalence of overweight and obesity in patients with SMD in this study. The findings highlight the need for integrated management of overweight and obesity risk factors among patients with SMD.

Severe mental illness and infectious disease mortality: a systematic review and meta-analysis

Background

Evidence from meta-analyses suggest that people with severe mental illness (SMI) are at increased risk of death from infectious diseases compared to those without SMI. However, few reviews have focused on mortality risk from specific infection types, apart from COVID-19. The aim of this systematic review and meta-analysis was to comprehensively describe and quantify the risk of death from infections (excluding COVID-19) in people with SMI, exploring specific infection types where possible.

Methods

PubMed, Web of Science, PsycINFO, and EMBASE were searched for relevant studies up to 18th June 2024. Studies were included if they assessed the impact of SMI (bipolar disorder, schizophrenia and schizoaffective disorders, other psychoses) on risk of mortality from any infectious disease excluding COVID-19. Random-effects meta-analyses of the risk of death from 'infectious diseases', respiratory infections, sepsis, and 'other' infections in SMI were performed. The review protocol was registered in PROSPERO (CRD42023422151).

Findings

Twenty-nine articles were included in the review. All were observational cohort studies carried out in high income countries and 59% were judged to be of good quality. Narrative analysis indicated that having SMI was associated with increased risk of death from infectious disease (23/29 studies), with mixed results for sepsis. People with SMI were more than twice as likely to die from 'infectious diseases' than the general population (pooled relative risk (RR) = 2.71, 95% confidence interval (CI) = 2.33-3.16, N = 739,852) and more than three times more likely to die from respiratory infections (pooled RR = 3.27, 95% CI = 2.57-4.17, N = 1,353,905). Sources of heterogeneity across studies included SMI diagnosis, gender, type of control group, and infection type.

Interpretation

People with SMI are at an increased risk of death from infection, particularly from respiratory infections like influenza and pneumonia and should be prioritised for preventative strategies including influenza and pneumococcal vaccines. More work is needed to fully understand why infection mortality risk is increased in SMI.

Funding

MQ Mental Health Research Fellowship MQF22∖12.

Modifiable risk factors and excess mortality in depression: Data from the UK Biobank

OBJECTIVE

To study the role of modifiable risk factors in explaining the excess mortality associated with depression using data from the UK Biobank, a middle-aged and elderly cohort recruited in 2006-2010.

METHODS

We estimated the prevalence and relative mortality associated with modifiable risk factors and groups of risk factors (socioeconomic factors, diet and exercise, smoking and substance-related disorders, and cardiometabolic diseases) in a subsample of probable cases of lifetime/current depression (n = 51,302) versus non-cases. We also estimated the relative mortality associated with depression and the percentages of excess mortality associated with depression explained by modifiable risk factors in the total sample (499,762).

RESULTS

In our depression subsample, all modifiable risk factors were associated with increased prevalence and mortality. In our total sample, depression was associated with an age and sex-adjusted mortality hazard ratio of 1.63 (95% CI = [1.58-1.68]). Modifiable risk factors explained 70.5% [66.9%-75.0%] of the excess mortality associated with depression.

CONCLUSIONS

In the UK Biobank cohort, depression was associated with a higher prevalence of modifiable risk factors. These risk factors were associated with increased mortality in the depression subsample and explained most of the excess mortality risk associated with depression in the total sample.

Estimating expected years of life lost of psychiatric disorders in Taiwan: A Nationwide cohort study

OBJECTIVES

This study employed a national longitudinal cohort to assess expected years of life lost (EYLL) in newly diagnosed psychiatric patients.

METHODS

Data from Taiwan's National Death Registry and Health Insurance Research Database were scrutinized to identify patients with various psychiatric disorders. Disorders were ranked hierarchically, and age groups were categorized as young, middle-aged, and older adults. We utilized the semiparametric survival extrapolation method to estimate life expectancy (LE) and EYLL. Modifying effect of comorbid conditions and socioeconomic characteristics were also explored.

RESULTS

Among the 5,757,431 cases, young adults with dementia, alcohol use disorder, schizophrenia, and bipolar disorder experienced an excess of 15 years of EYLL. Middle-aged adults faced approximately 9 years or more of EYLL, while older adults had lower EYLL values. Comorbid conditions, low income levels, and living in rural areas were associated with higher EYLL.

CONCLUSIONS

This study underscores the substantial EYLL among young adults with psychiatric disorders and the significant impact of specific disorders on EYLL. Early intervention, tailored support, and healthcare system readiness are imperative for improved outcomes. Resource allocation and targeted interventions focusing on early detection and comprehensive treatment can alleviate the economic burden.

The economic burden of schizophrenia spectrum disorders: clinical and functional correlates and predictors of direct costs. A retrospective longitudinal study

The economic burden of schizophrenia amounts for 1.5-3 % of healthcare expenses in developed countries, and ∼50 % derives from direct costs: 81 % of these are due to hospitalization, residential facilities and semi-residential facilities. Therefore, a better characterization of variables that influence direct costs represents a relevant issue. A total of 276 individuals with schizophrenia spectrum disorders receiving treatment from the Community Mental Health Centers of Brescia (Italy) were included in the study: for each participant socio-demographic, clinical and functional characteristics were assessed, and data related to the use of services in 2022 (then converted to costs) were collected. Regression analyses were performed to identify predictors of costs. A direct healthcare expenditure of 16477.23 (±32856.47) € per patient per year was identified. The main cost predictor was the PSP total score (p=0.005), followed by age of onset (p=0.020), and PANSS total score (p=0.033). Including PANSS sub-scales scores and PSP single items as potential predictors, the main predictor was the "socially useful activities" PSP item (p=0.002), followed by age of onset (p=0.011), and PANSS negative scale score (p=0.027). Our findings underline the need to implement rehabilitative intervention focused on the improvement of psychosocial functioning and negative symptoms, also to reduce healthcare expenses.

Evaluating a volunteer 'Health Champions' intervention supporting people with severe mental illness to manage their physical health: feasibility hybrid randomised controlled trial

BACKGROUND

People with severe mental illness (SMI) have worse physical health than the general population. There is evidence that support from volunteers can help the mental health of people with SMI, but little evidence regarding the support they can give for physical health.

AIMS

To evaluate the feasibility of an intervention where volunteer 'Health Champions' support people with SMI in managing their physical health.

METHOD

A feasibility hybrid randomised controlled trial conducted in mental health teams with people with SMI. Volunteers delivered the Health Champions intervention. We collected data on the feasibility of delivering the intervention, and clinical and cost-effectiveness. Participants were randomised by a statistician independent of the research team, to either having a Health Champion or treatment as usual. Blinding was not done.

RESULTS

We recruited 48 participants: 27 to the intervention group and 21 to the control group. Data were analysed for 34 participants. No changes were found in clinical effectiveness for either group. Implementation outcomes measures showed high acceptability, feasibility and appropriateness, but with low response rates. No adverse events were identified in either group. Interviews with participants found they identified changes they had made to their physical health. The cost of implementing the intervention was £312 per participant.

CONCLUSIONS

The Health Champion intervention was feasible to implement, but the implementation of the study measures was problematic. Participants found the intervention acceptable, feasible and appropriate, and it led them to make changes in their physical health. A larger trial is recommended, with tailored implementation outcome measures.

Conceptualization and characterization of "primary" and "secondary" cognitive impairment in schizophrenia

Cognitive impairment represents one of the core features of schizophrenia, involves both neurocognition and social cognition domains, and has a significant negative impact on real-world functioning. The present review provides a framework for the conceptualization and characterization of "primary" and "secondary" cognitive impairment in schizophrenia. In this conceptualization, primary cognitive impairment can be defined as a consequence of the neurobiological alterations that underlie psychopathological manifestations of the disorder, while secondary cognitive impairment can be defined as the results of a source issue that has a negative impact on cognitive performance. Sources of secondary cognitive impairment are frequent in people with schizophrenia and include several different factors, such as positive and negative symptoms, depressive symptoms, autistic symptoms, pharmacotherapy, substance abuse, metabolic syndrome, social deprivation, and sleep disorders. It can be hypothesized that secondary cognitive impairment may be improved by effectively resolving the source issue, while primary cognitive impairment may benefit from dedicated treatment. Further research is required to confirm this hypothesis, to better characterize the distinction between primary and secondary cognitive impairment in a clinical and in a neurobiological perspective, and to evaluate the impact of systematically assessing and treating secondary cognitive impairment.

Effectiveness of educational interventions in reducing the stigma of healthcare professionals and healthcare students towards mental illness: A systematic review and meta-analysis

AIM

To examine the effectiveness of educational interventions in reducing stigma among healthcare professionals and students towards people with mental illness.

DESIGN

A systematic review and meta-analysis of randomized controlled trials (RCTs) and cluster RCTs.

DATA SOURCES

Articles published from database inception to October 2023 were systematically searched from seven databases (CINAHL, Embase, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Random-effect meta-analyses were conducted. Heterogeneity was evaluated using the I2 statistics and Cochran's Q chi-squared test. A quality appraisal conducted at the study level used the Cochrane risk of bias tool and an outcome-level quality assessment utilized the Grades of Recommendation, Assessment, Development and Evaluation Approach. Publication bias was assessed using the funnel plot.

RESULTS

Twenty-five articles were included in this review. Meta-analysis reported statistically significant medium and small effect sizes for attitudes towards mental illness and attitudes towards people with mental illness respectively, showing the association between educational interventions and improved attitudes among healthcare professionals and students. However, a statistically non-significant effect was reported for knowledge of mental illness. Subgroup analyses indicated that face-to-face and contact-based interventions were particularly effective at reducing stigma. Notably, single-session interventions were just as effective as multiple sessions, suggesting a potential for resource-efficient approaches.

CONCLUSION

Educational interventions demonstrate promise in fostering more positive attitudes towards mental health issues. Future research should aim to determine the long-term effects of these interventions and include patient feedback on the stigmatizing behaviours of healthcare professionals and students, to holistically evaluate the effect of interventions.

NO PATIENT OR PUBLIC CONTRIBUTION

This study is a secondary review and does not require relevant contributions from patients or the public. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Face-to-face contact-based educational sessions have proven to be the most effective. Reinforcing learning may be achieved through a series of repeated single-session interventions.

A feasibility study of a participatory designed program for preventing cardiovascular disease in mentally vulnerable patients

AIM

To test the feasibility of a participatory design intervention aimed at reducing the risk of cardio-vascular disease among patients suffering from alcohol use disorder (AUD) or severe mental illness (SMI).

METHODS

The intervention was developed by patients from the Community Mental Health Center and the Alcohol Treatment Facility in Odense, Denmark, and consisted of eight modules (health interviews, screening and treatment, introduction, diet/alcohol, physical activity, smoking, health app, and sleep problems). The intervention was tested using pre- and post-measurements of selected variables, patients' intervention attendance, and interviews and dialogue workshops at the end of the study.

RESULTS

A total of 21 out of 42 eligible patients from the Alcohol Treatment Facility and two out of 443 eligible patients from the Community Mental Health Center accepted participation in the study. The two patients from the Community Mental Health Center were not included in the analyses due to General Data Protection Regulation (GDPR). All patients accepted being screened for risk factors at inclusion, and the majority enrolled in at least one of the subsequent modules. The study indicated that the patients followed recommendations from their GPs.

CONCLUSIONS

There is a great need for focus on cardio-vascular disease in patients with SMI and those with AUD. Results indicate that the intervention is feasible for patients with AUD, but due to inclusion of too few patients with SMI, nothing can be concluded for this patient group. Patients and staff in the Alcohol Treatment Facility agreed that the intervention has future perspectives.

Negotiating familial mental illness stigma: The role of family members of persons living with mental illnesses

BACKGROUND

This study explores how family members of individuals with mental illnesses address potential familial mental illness stigma. Previous studies have concentrated on self, social, and associative stigma and its impacts on families and persons with mental illnesses. Far less work has considered family members as perpetrators of mental illness stigma towards their loved ones with mental illnesses.

METHODOLOGY/PRINCIPAL FINDINGS

We conducted this study with 15 participants who were family members of persons with mental illnesses using semi-structured qualitative interviews. The in-depth interviews were followed by inductive analysis using Braun and Clarke's technique for thematic analysis. Participants' views on familial mental illness stigma and ways to reduce this were reported in five key themes. The themes included: (1) layered perspectives of social and family stigma; (2) family-related stigma; (3) complex interplay of family relationships and mental illness; (4) confronting stigma personally; and (5) envisioning a better future. The uncertainties connected with mental illnesses and the increased social stigma were conceptualized as contributors to familial mental illness stigma as ways to prevent potential associative stigma.

CONCLUSION/SIGNIFICANCE

Participants suggested the need for more social contact-based education and positive media reporting to correct the ongoing fallacies around mental illnesses. This study highlights how higher-order reforms to social systems and services would support both families and those living with mental illnesses to have more positive experiences.

Are perceived barriers to physical activity related to depression, anxiety and stress among adolescents? The EHDLA study

Objective

The aim of this study was twofold: first, to examine the association between perceived barriers to physical activity (PA) practice and depression, anxiety and stress in a sample of Spanish adolescents; and second, to determine which barriers are specifically associated with depression, anxiety and stress.

Methods

This cross-sectional study was conducted with 765 adolescents aged 12-17 (55.6% girls) in the Valle of Ricote, Murcia, Spain. Depression, anxiety and stress symptoms were assessed using the Depression, Anxiety and Stress Scale (DASS-21), with validated cut points employed to determine the presence of each of these mental conditions. The perception of barriers to PA was assessed using a validated questionnaire for the Spanish adolescent population.

Results

The barrier 'Because I feel that my physical appearance is worse than that of others' was related to a higher likelihood of having depression (OR=2.41; 95% CI 1.35 to 4.28; p=0.003), anxiety (OR=2.65; 95% CI 1.51 to 4.71; p=0.001) and stress (OR=2.82; 95% CI 1.59 to 5.07; p<0.001). Similarly, the barrier 'Because nobody encourages me to engage in physical activity' was related to a higher likelihood of having depression (OR=1.92; 95% CI 1.08 to 3.43; p=0.026), anxiety (OR=1.97; 95% CI 1.11 to 3.50; p=0.021) and stress (OR=1.99; 95% CI 1.12 to 3.59; p=0.021).

Conclusion

Perceived barriers to PA related to physical appearance and social support seem to be associated with a greater likelihood of depression, anxiety and stress among Spanish adolescents.

Relapse rate and predictors among people with severe mental illnesses at Debre Markos Comprehensive specialized hospital, Northwest Ethiopia: a prospective follow up study

Severe mental illness is usually marked by periods of remission, when symptoms are absent or well controlled, and of exacerbation, when symptoms return or worsen. Relapse of these severe illnesses costs a lot for patients and their families and imposes a financial burden on hospital and community services. Costs for relapse cases were four times higher than that of non-relapse cases. There is a dearth of evidence in on relapse rate on these vulnerable population in Sub-Saharan Africa, therefore this study assessed relapse rate and predictors among people with severe mental illnesses at Debre Markos Comprehensive specialized hospital, Northwest Ethiopia. Prospective follow up study design was employed among 315 people with severe mental illnesses who were selected by systematic random sampling technique. Epi.data version 4.2 was used for data entry and exported to STATA 14 for analysis. The Kaplan-Meier curve was used to estimate the median duration of occurrence and the Log rank test was used to compare survival curves between different categories of explanatory variables. A survival analysis was used to estimate the cumulative rate of relapse, Cox proportional hazards models was used to examine independent factors associated with time to develop relapse. To estimate the association between predictors and relapse, hazard ratio with 95% confidence intervals was used. Variables score p value < 0.25 with in the Bivariable analysis was entered in to the multivariable analysis model. The statistical significance was accepted at p-value < 0.05. Around 119 (37.78%) had develop relapse, and the remaining 196 (62.22%) were censored. The overall incidence rate of relapse was 3.66 per 100 person-month (95% CI:3.06-4.38) with a total of 3250 patient-month observations. Variables such as: age (18-36 years) [(AHR) = 3.42:95% (CI) :1.67,6.97)], marital status (single and widowed) 1.87 [AHR: 1.87; 95% CI: (1.06 ,3.27)] and 2.14 [AHR: 2.14; 95% CI: (1.03 ,4.44)], duration of delay in getting treatment ( > = 1 year) [(AHR = 2.55:CI:1.20, 5.38)], types of diagnosis (Major Depressive Disorder) (AHR = 2.38, CI:1.37 ,4.14), medication adherence (low adherence) (AHR = 5.252.45, 11.21) were statistically significant (P value < 0.05). Nearly two-fifth of people diagnosis with severe mental illnesses had develop relapse and the median survival time to develop relapse was nine months. It is advised that early detection of severe mental illness and early initiation of treatments are very crucial to prevent relapse. Psycho education, counseling that alleviates poor treatment adherence are highly recommended.

Understanding the costs and economic impact of mental disorders in South Asia: A systematic review

BACKGROUND

Mental disorders remain the most significant contributor to years lived with disability in South Asia, yet governmental health expenditure on mental health in South Asia remains very low with limited strategic policy development. To strengthen the case for action it is important to better understand the profound economic costs associated with poor mental health.

METHODS

We conducted a systematic review on the costs of all mental disorders, as well as intentional self-harm and suicide, in the World Bank South Asia Region. Ten global and South Asian databases as well as grey literature sources were searched.

RESULTS

72 studies were identified, including 38 meeting high quality criteria for good reporting of costs. Of these, 27 covered India, five Pakistan, four Nepal and three Bangladesh and Sri Lanka. Most studies focused on depressive disorders (15), psychoses (14) and harmful alcohol use (7); knowledge of economic impacts for other conditions was limited. Profound economic impacts within and beyond health care systems were found. In 15 of 18 studies which included productivity losses to individuals and/or carers, these costs more than outweighed costs of health care.

CONCLUSION

Mental disorders represent a considerable economic burden, but existing estimates are conservative as they do not consider long-term impacts or the full range of conditions. Modelling studies could be employed covering longer time periods and more conditions. Clear distinctions should be reported between out-of-pocket and health system costs, as well as between mental health service-specific and physical health-related costs.

Association between air pollutants and four major mental disorders: Evidence from a Mendelian randomization study

BACKGROUND

Existing epidemiological studies have indicated a correlation between air pollutants and the occurrence of mental disorders. However, it is difficult to estimate the causal relationship between the two because of the limitations of traditional epidemiological research. In our study, we aimed to extensively explore the causal relationship between five types of air pollutants and four types of mental disorders.

METHODS

Based on the IEU OPEN GWAS database, we performed a two-sample MR analysis. The primary analysis method utilized was the inverse variance weighted (IVW) method, supplemented by the MR-Egger method and the weighted median method. Additionally, we conducted sensitivity analyses with the Cochran's Q statistic method, the leave-one-out method, and the MR-Egger intercept. We chose at least 4 GWAS datasets for each of the four psychiatric diseases and conducted a meta-analysis of our results of the MR analysis.

RESULTS

The meta-analysis's findings demonstrated a causal link between depression and PM2.5 (OR=1.020, 95 %CI: (1.010,1.030), P=0.001). PM10 and schizophrenia are also causally related (OR=1.136, 95 %CI: (1.034,1.248), P=0.008). Nitrogen oxides and bipolar disorder have a causal relationship (OR=1.002, 95 %CI: (1.000,1.003), P=0.022). Nitrogen oxides and schizophrenia have a high causal association (OR=1.439, 95 %CI: (1.183,1.752), P<0.001).

CONCLUSION

This study observed a causal association between increased concentrations of PM2.5, PM10, and nitrogen oxides and the occurrence of depression, schizophrenia, and bipolar disorder. Our research findings have certain guiding implications for treating and preventing mental disorders.

A bibliometric analysis of studies on death anxiety in patients with cancer

Purpose: This study evaluates the evolution and focal points of research on death anxiety among cancer patients over the last three decades, utilizing bibliometric analyses.

Methods: We analyzed publications related to death anxiety among cancer patients from January 1994 to January 2024 using data from the Web of Science Core Collection. Bibliometric indicators such as the number of publications, leading countries, institutions, and research themes were examined.

Results: A total of 2,602 papers from 286 institutions across 97 countries were identified. There has been a significant increase in research interest, particularly between 2014 and 2023, with a peak in 2022. The United States and Harvard University were found to be the most prolific contributors. Major research themes include quality of life, palliative care, mental health, and cancer-specific concerns.

Conclusion: The results highlight the rapid development in the field of death anxiety research among cancer patients, with an increase in publications and emerging research themes. However, there is limited international and institutional collaboration. The study underscores the need for enhanced cooperative efforts to advance understanding and research in this area, suggesting directions for future research.