The onset and accumulation of physical multimorbidity in severe and common mental disorders

Multimorbidity and its association with mental health in an adult population of Peru

BACKGROUND

Motivation for the study. The presence of multimorbidity is increasingly frequent in the general population, and this may be associated with mental health problems. Main findings. The presence of multimorbidity, and a great number of chronic conditions, was associated with a higher prevalence of depressive symptoms, anxiety and perceived stress in an adult population in a region of northern Peru. Implications. Our findings suggest the need for adequate mental health management in patients with more than one chronic disease.

OBJECTIVE.

To evaluate the association between multimorbidity and mental health in adults aged 30 to 69 years.

MATERIALS AND METHODS.

Secondary data analysis of a population-based study conducted in the peri-urban area of Tumbes in the northern coast of Peru. The dependent variables were: depressive symptoms, using the PHQ-9; anxiety symptoms, using the Goldberg scale; and perceived stress, assessed with the Cohen's 14-question scale. The exposure variable was the presence of multimorbidity (presence or not of two or more chronic conditions and the number of chronic conditions). We assessed associations using crude and adjusted Poisson regression models.

RESULTS.

Data from 1600 participants were analyzed, mean age was 48.1 years (SD: 10.5), and 50.4% were women. The prevalence of multimorbidity was 15.9%, 23.3% presented depressive symptoms, 42.0% anxiety symptoms and 31.4% had high levels of perceived stress. The multivariable model showed that multimorbidity was associated with a higher prevalence of depressive symptoms (61%, 95%CI: 32% - 98%), anxiety symptoms (46%, 95%CI: 28% - 66%) and high (22%, 95%CI: 14% - 33%) but not moderate levels of perceived stress (6%; 95%CI: 0% - 12%). A higher number of chronic conditions was associated with higher prevalence of depressive symptoms, anxiety symptoms, and perceived stress levels.

CONCLUSIONS.

The presence of multimorbidity is associated with a higher prevalence of depressive symptoms, anxiety symptoms, and perceived stress levels. Our results suggest the need for adequate mental health management in patients with multimorbidity.

National study comparing psychiatric presentations among migrants and citizens in Qatar

Arab countries host 10 % of the global migrant population, yet research on the mental health of migrant workers within this region is notably lacking. Addressing this gap, our study marks the inaugural nationwide investigation into psychiatric conditions among migrant workers compared to native Qatari citizens in an inpatient setting. Employing a retrospective cohort methodology, we scrutinized psychiatric presentations among two cohorts: migrant workers (cohort 1) and Qatari nationals (cohort 2) admitted to psychiatric inpatient facilities in Qatar. Our sample comprised 150 migrant workers and 138 Qatari inpatients, with a predominance of males in both cohorts and mean ages around 34-35 years. The median length of hospitalization was 13 days for migrant workers and 14 days for Qatari patients. Qatari inpatients exhibited a higher prevalence of prior psychiatric history and comorbid physical conditions. The primary diagnosis upon discharge for approximately one-third of patients in both groups was schizophrenia spectrum and other psychotic disorders, with bipolar disorder representing roughly one-quarter of cases in each cohort. Notably, migrant workers demonstrated a higher incidence of depressive disorders, trauma, and stress-related conditions, while Qatari patients were more frequently diagnosed with substance use disorder and displayed aggressive behaviors.

Anticholinergic load: A commonly neglected and preventable risk to cognition during schizophrenia treatment?

Background

Cognitive impairment is a widespread feature of schizophrenia, affecting nearly 80 % of patients. Prior research has linked the anticholinergic burden of psychiatric medications to these cognitive deficits. However, the impact of the anticholinergic burden from medications for physical morbidity remains underexplored. This study aimed to evaluate the anticholinergic burden of psychiatric and physical medications in patients with schizophrenia and assess its impact on cognitive function.

Methods

A total of 178 patients with schizophrenia were recruited. The assessments included an ad hoc questionnaire for collecting demographic and clinical data. Anticholinergic burden was evaluated using the cumulative Drug Burden Index (cDBI) for each participant, and cognitive function was assessed using MATRICS. Psychopathology was measured using the PANSS, CDSS, CAINS, and the CGI-S. Statistical analysis included Student's t-tests, ANOVA, Pearson correlations, and multiple linear regressions.

Results

The average cDBI was 1.3 (SD = 0.9). The model developed explained 40.80 % of the variance. The variable with the greatest weight was the cDBI (B = -11.148, p = 0.010). Negative-expression (B = -2.740, p = 0.011) and negative-experiential (B = -1.175, p = 0.030) symptoms were also associated with lower global cognitive score. However, more years of education (B = 5.140, p < 0.001) and cigarettes per day (B = 1.331, p < 0.001) predicted a better global cognitive score.

Conclusion

This study identified specific predictors of global cognition in schizophrenia, with anticholinergic burden emerging as the strongest factor. Our findings underscore the importance of considering the anticholinergic burden of treatments, in addition to negative symptoms, when designing interventions to optimize or maintain cognitive function in patients with schizophrenia.

Epidemiology, mortality, and health service use of local-level multimorbidity patterns in South Spain

Multimorbidity -understood as the occurrence of chronic diseases together- represents a major challenge for healthcare systems due to its impact on disability, quality of life, increased use of services and mortality. However, despite the global need to address this health problem, evidence is still needed to advance our understanding of its clinical and social implications. Our study aims to characterise multimorbidity patterns in a dataset of 1,375,068 patients residing in southern Spain. Combining LCA techniques and geographic information, together with service use, mortality, and socioeconomic data, 25 chronicity profiles were identified and subsequently characterised by sex and age. The present study has led us to several findings that take a step forward in this field of knowledge. Specifically, we contribute to the identification of an extensive range of at-risk groups. Moreover, our study reveals that the complexity of multimorbidity patterns escalates at a faster rate and is associated with a poorer prognosis in local areas characterised by lower socioeconomic status. These results emphasize the persistence of social inequalities in multimorbidity, highlighting the need for targeted interventions to mitigate the impact on patients' quality of life, healthcare utilisation, and mortality rates.

Multimorbidity Patterns and Their Association with Social Determinants, Mental and Physical Health during the COVID-19 Pandemic

BACKGROUND

The challenge posed by multimorbidity makes it necessary to look at new forms of prevention, a fact that has become heightened in the context of the pandemic. We designed a questionnaire to detect multimorbidity patterns in people over 50 and to associate these patterns with mental and physical health, COVID-19, and possible social inequalities.

METHODS

This was an observational study conducted through a telephone interview. The sample size was 1592 individuals with multimorbidity. We use Latent Class Analysis to detect patterns and SF-12 scale to measure mental and physical quality-of-life health. We introduced the two dimensions of health and other social determinants in a multinomial regression model.

RESULTS

We obtained a model with five patterns (entropy = 0.727): 'Relative Healthy', 'Cardiometabolic', 'Musculoskeletal', 'Musculoskeletal and Mental', and 'Complex Multimorbidity'. We found some differences in mental and physical health among patterns and COVID-19 diagnoses, and some social determinants were significant in the multinomial regression.

CONCLUSIONS

We identified that prevention requires the location of certain inequalities associated with the multimorbidity patterns and how physical and mental health have been affected not only by the patterns but also by COVID-19. These findings may be critical in future interventions by health services and governments.

Prevalence and Factors Associated with Metabolic Syndrome in Patients at a Psychosocial Care Center: A Cross-Sectional Study

BACKGROUND

Metabolic syndrome (MS) is associated with greater risk of morbimortality and it has high prevalence in people with mental illness.

OBJECTIVE

Estimate the prevalence of Metabolic Syndrome (MS) and its associated factors in the patients of a Psychosocial Care Center (CAPS in Brazilian Portuguese) in the city of Salvador, state of Bahia, Brazil.

METHOD

Cross-sectional study set at CAPS in the city of Salvador-Bahia between August 2019 and February 2020. MS was evaluated according to the National Cholesterol Education Program's Adult Treatment Panel III. In addition to descriptive statistics, gross and adjusted prevalence ratios were described.

RESULTS

MS was found in 100 (35.2%) individuals, 116 (40.9%) were obese and 165 (58.1%) had increased waist circumference. Polypharmacy was identified in 63 (22.3%) patients and 243 (85.9%) used antipsychotics. Under gross evaluation, women (PR = 1.88; 95%CI: 1.35-2.63) and those who used antidepressants (PR = 1.41; 95%CI: 1.05-1.88) showed an association with MS. After logistic regression, depression (PR = 1.86; 95%CI: 1.38-2.51), acanthosis (PR = 1.50; 95%CI: 1.18-1.90), use of antipsychotics (PR = 1.88; 95%CI: 1.13-2.75), and hypertriglyceridemic waist (PR = 3.33; 95%CI: 2.48-4.46) were associated with MS.

CONCLUSION

The prevalence of MS signals multimorbidity among individuals with mental disorders and suggests a need for clinical screening.

Sex Differences in Comorbidity Combinations in the Swedish Population

High comorbidity rates, especially mental–physical comorbidity, constitute an increasing health care burden, with women and men being differentially affected. To gain an overview of comorbidity rates stratified by sex across a range of different conditions, this study examines comorbidity patterns within and between cardiovascular, pulmonary, skin, endocrine, digestive, urogenital, musculoskeletal, neurological diseases, and psychiatric conditions. Self-report data from the LifeGene cohort of 31,825 participants from the general Swedish population (62.5% female, 18–84 years) were analyzed. Pairwise comorbidity rates of 54 self-reported conditions in women and men and adjusted odds ratios (ORs) for their comparison were calculated. Overall, the rate of pairwise disease combinations with significant comorbidity was higher in women than men (14.36% vs. 9.40%). Among psychiatric conditions, this rate was considerably high, with 41.76% in women and 39.01% in men. The highest percentages of elevated mental–physical comorbidity in women were found for musculoskeletal diseases (21.43%), digestive diseases (20.71%), and skin diseases (13.39%); in men, for musculoskeletal diseases (14.29%), neurological diseases (11.22%), and digestive diseases (10%). Implications include the need for integrating mental and physical health care services and a shift from a disease-centered to an individualized, patient-centered focus in clinical care.

Pre-existing chronic physical morbidity and excess mortality in people with schizophrenia: a population-based cohort study

PURPOSE

Schizophrenia is associated with increased premature mortality and physical morbidity. This study aimed to examine prevalence of pre-existing chronic physical diseases, and association between physical multimorbidity burden and mortality rates among patients with newly diagnosed schizophrenia.

METHODS

This population-based cohort study investigated patients with first-recorded diagnosis of schizophrenia between January 2006 and December 2016, using territory-wide medical-record database of public healthcare service in Hong Kong. Physical morbidities were measured by Charlson Comorbidity Index (CCI), taking into consideration both number and severity of physical diseases, and were grouped into nine broad disease categories for analyses. Physical multimorbidity burden was stratified into three levels according to CCI of 0, 1 or ≥ 2. Cox proportional hazards regression models were used to examine associations of physical multimorbidity with mortality rates.

RESULTS

Of the 13,945 patients, 8.6% (n = 1207) had pre-existing physical morbidity. Patients with physical morbidity exhibited elevated all-cause mortality rate relative to those without physical morbidity [adjusted HR 2.38 (95% CI 2.04-2.77)]. Gastrointestinal/liver diseases, diabetes and cardiovascular diseases constituted the three most frequently diagnosed physical morbidities, whereas cancers displayed the highest all-cause mortality rate. An increase in physical multimorbidity burden was associated with increased all-cause mortality rate [CCI = 1: 1.98 (1.64-2.40); CCI ≥ 2: 3.08 (2.51-3.77), CCI = 0 as reference].

CONCLUSION

Schizophrenia patients with pre-existing physical morbidity had two-fold increased risk of premature mortality compared to those without physical morbidity. Physical multimorbidity confers incremental impact on excess mortality. Early detection and intervention of physical morbidity in the initial phase of schizophrenia is necessary to reduce avoidable mortality.

Pandemics and Mental Health: an Unfortunate Alliance

Mental health issues not only affect the person but society as a whole. This is especially apparent during times of pandemics or other social unrest situations as currently seen during the COVID-19 crisis. It can manifest itself as violence (towards or from the mentally ill person), increased substance use, increased overcrowding of our prisons, tackling with comorbid medical conditions which have worsened due to lack of initial attention (a particularly big problem among the mentally ill), increased strain on tax payers, and overall affecting the quality of everyone’s life. Furthermore, mental health maladies can cause increase work absenteeism and poor work performance and decreased economic productivity. The stigma associated with mental health also leads to poor funding form policy makers, as there is a lack of forceful advocacy in dealing with these issues. The World Health Organization (WHO) estimates that the loss of productivity due to mental health disability accounts to close to 5% of the gross national product of the European Union (WHO 2019). One of the most crucial causes of lack of mental screening, recognition, and treatment is the limited availability of mental health trained providers. The physician assistant profession is in a unique role to fill this niche as they have been trained as generalists who specialize only when getting trained in their specific field during their employment. Additionally, the fact that PAs do have lateral mobility does lend this profession to meet the needs of society, especially in the psychiatric fields, in a prompt and competent manner. The need for physician assistants (PAs) in psychiatry and addiction medicine is a nationwide trend resulting in existing and emerging shortages of psychiatric and addiction medicine providers. They can provide relatively inexpensive, easily accessible, and good quality care to their clients.