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Corrao G, Monzio Compagnoni M, Conflitti C, Lora A. Is the long-term poor prognosis of acute myocardial infarction in patients with mental illness mediated through their poor adherence with recommended healthcare? Eur J Public Health 2024:ckae005. [PMID: 38268304 DOI: 10.1093/eurpub/ckae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Compared with patients without evidence of psychiatric symptoms, those with mental disorders experience reduced adherence with recommended healthcare and poorer clinical outcomes. This study aimed to evaluate whether the worse prognosis of patients with mental disorders after experiencing acute myocardial infarction could be fully or partially mediated by their reduced adherence to recommended healthcare. METHODS In this retrospective cohort population-based study, 103 389 residents in the Italian Lombardy Region who experienced acute myocardial infarction in 2007-19 were identified. Among them, 1549 patients with severe mental illness (SMI) were matched with five cohort members without evidence of mental disorders (references). Recommended healthcare (cardiac medicaments and selected outpatient services) was evaluated in the year after the date of index hospital discharge. The first occurrences of cardiovascular (CV) hospital admissions and any-cause-death were considered as endpoints. Mediation analysis was performed to investigate whether post-discharge use of recommended healthcare may be considered a mediator of the relationship between healthcare exposure and endpoints occurrence. RESULTS Compared with references, patients with SMI had lower adherence with recommended healthcare and adjusted risk excesses of 39% and 73% for CV hospitalizations and all-cause mortality. Mediation analysis showed that 4.1% and 11.3% of, respectively, CV hospitalizations and deaths occurred among psychiatric patients was mediated by their worse adherence to specific healthcare. CONCLUSION The reduced use of recommended outpatient healthcare by patients with SMI had only a marginal effect on their worse prognosis. Other key factors mediating the prognostic gap between patients with and without mental disorders should be investigated.
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Affiliation(s)
- Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Claudia Conflitti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Girardi P, Schievano E, Fedeli U, Braggion M, Nuti M, Amaddeo F. Causes of mortality in a large population-based cohort of psychiatric patients in Southern Europe. J Psychiatr Res 2021; 136:167-172. [PMID: 33601168 DOI: 10.1016/j.jpsychires.2021.01.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/25/2022]
Abstract
The World Health Organization considers excess morbidity and mortality among people with mental disorders as a high public health priority. This study aims to estimate the mortality risk and causes of death among a large population-based cohort of psychiatric patients. All residents in Veneto (Northeastern Italy) aged between 18 and 84 years with a contact with Community Mental Health Centers in 2008 and a psychiatric diagnosis (n = 54,350) were followed-up for 10 years. Standardized Mortality Ratios (SMR) and excess mortality were computed, with the general regional population as a reference. Mortality was more than doubled (males SMR = 2.4; females SMR = 2.2) and the relative increase in mortality was much larger in young and middle-aged adults (18-44 and 45-64 years) across all diagnostic groups. The most frequent causes were circulatory diseases (27%) and neoplasms (26%). Although the risk was increased by about tenfold, deaths from suicide were limited to 6% and 4% of all decedents in males and females, respectively. Patients with schizophrenia showed a very high risk for mortality for diabetes and cardiovascular disorders. A large excess was found also for respiratory diseases and a two-fold increase for lung cancer in males and breast cancer in females. Although chronic physical disorders are known to be the main causes of mortality in such patients, they receive far less attention than suicide or accidents. Our results suggest that there is still a need to plan actions to prevent excess mortality and to improve the quality of life of patients with mental disorders.
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Affiliation(s)
- Paolo Girardi
- Department of Developmental Psychology and Socialization, University of Padua, Via Venezia 8, 35131, Padua, Italy.
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Marco Braggion
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Marco Nuti
- Mental Health and Penitentiary Health Care Unit, Veneto Region, Rio Novo, Dorsoduro 3493, 30123, Venice, Italy.
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
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Access to and Use of Psychiatric Services by Migrants Resettled in Northern Italy. J Immigr Minor Health 2019; 20:1309-1316. [PMID: 29354861 DOI: 10.1007/s10903-018-0703-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The present study was conducted to describe access to and use of psychiatric services by migrants resettled in a large and well-defined catchment area. The study was conducted in a catchment area of 459,536 inhabitants in Verona, a city located in the Northeast of Italy. Using a psychiatric case register, all native and migrant individuals with a first ever psychiatric contact from 2000 to 2015 were identified. Service use data during the 12 months following first contact were collected. During the study period a total of 2610 migrants and 28,860 natives had at least one psychiatric contact. A progressive rise in the proportion of migrants seeking psychiatric care was observed, from 2.5% in 2000 to more than 14% in 2015. During the 12 months following first contact, the proportion of patients with a single consultation did not differ between resettled migrants and natives. However, migrants were more often marked users or heavy users of psychiatric services. Multivariate linear regression analyses showed that younger male individuals with psychotic disorders experienced higher psychiatric services use regardless their native or migrant condition. In a large catchment area with a well-developed community-based system of mental health care a progressive rise in the number of migrants seeking psychiatric care was observed. The pattern of service use during the 12 months after first contact was not related to nationality, suggesting the capacity of community psychiatric services to retain people in care. These findings call for the development of culturally and linguistically appropriate community psychiatric services.
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Wall-Wieler E, Vinnerljung B, Liu C, Roos LL, Hjern A. Avoidable mortality among parents whose children were placed in care in Sweden: a population-based study. J Epidemiol Community Health 2018; 72:1091-1098. [PMID: 30077964 DOI: 10.1136/jech-2018-210672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/12/2018] [Accepted: 07/18/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Separation from one's child can have significant consequences for parental health and well-being. We aimed to investigate whether parents whose children were placed in care had higher rates of avoidable mortality. METHODS Data were obtained from the Swedish national registers. Mortality rates among parents whose children were placed in care between 1990 and 2012 (17 503 mothers, 18 298 fathers) were compared with a 1:5 matched cohort of parents whose children were not placed. We computed rate differences and HRs of all-cause and avoidable mortality. RESULTS Among mothers, deaths due to preventable causes were 3.09 times greater (95% CI 2.24 to 4.26) and deaths due to amenable causes were 3.04 times greater (95% CI 2.03 to 4.57) for those whose children were placed in care. Among fathers, death due to preventable causes were 1.64 times greater (95% CI 1.32 to 2.02) and deaths due to amenable causes were 1.84 times greater (95% CI 1.33 to 2.55) for those whose children were placed in care. Avoidable mortality rates were higher among mothers whose children were young when placed in care and among parents whose children were all placed in care. CONCLUSIONS Parents who had a child placed in out-of-home care are at higher risk of avoidable mortality. Interventions targeting mothers who had a child aged less than 13 placed in care, and parents whose children were all placed in care could have the greatest impact in reducing avoidable mortality in this population.
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Affiliation(s)
- Elizabeth Wall-Wieler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bo Vinnerljung
- Department of Social Work, Stockholm University, Stockholm, Sweden
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Can Liu
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anders Hjern
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Abstract
The present study was conducted to describe access to and use of psychiatric services by migrants resettled in a large and well-defined catchment area. The study was conducted in a catchment area of 459,536 inhabitants in Verona, a city located in the Northeast of Italy. Using a psychiatric case register, all native and migrant individuals with a first ever psychiatric contact from 2000 to 2015 were identified. Service use data during the 12 months following first contact were collected. During the study period a total of 2610 migrants and 28,860 natives had at least one psychiatric contact. A progressive rise in the proportion of migrants seeking psychiatric care was observed, from 2.5% in 2000 to more than 14% in 2015. During the 12 months following first contact, the proportion of patients with a single consultation did not differ between resettled migrants and natives. However, migrants were more often marked users or heavy users of psychiatric services. Multivariate linear regression analyses showed that younger male individuals with psychotic disorders experienced higher psychiatric services use regardless their native or migrant condition. In a large catchment area with a well-developed community-based system of mental health care a progressive rise in the number of migrants seeking psychiatric care was observed. The pattern of service use during the 12 months after first contact was not related to nationality, suggesting the capacity of community psychiatric services to retain people in care. These findings call for the development of culturally and linguistically appropriate community psychiatric services.
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Bartlem KM, Bowman J, Freund M, Wye PM, Barker D, McElwaine KM, Wolfenden L, Campbell EM, McElduff P, Gillham K, Wiggers J. Effectiveness of an intervention in increasing the provision of preventive care by community mental health services: a non-randomized, multiple baseline implementation trial. Implement Sci 2016; 11:46. [PMID: 27039077 PMCID: PMC4818909 DOI: 10.1186/s13012-016-0408-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/09/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Relative to the general population, people with a mental illness are more likely to have modifiable chronic disease health risk behaviours. Care to reduce such risks is not routinely provided by community mental health clinicians. This study aimed to determine the effectiveness of an intervention in increasing the provision of preventive care by such clinicians addressing four chronic disease risk behaviours. METHODS A multiple baseline trial was undertaken in two groups of community mental health services in New South Wales, Australia (2011-2014). A 12-month practice change intervention was sequentially implemented in each group. Outcome data were collected continuously via telephone interviews with a random sample of clients over a 3-year period, from 6 months pre-intervention in the first group, to 6 months post intervention in the second group. Outcomes were client-reported receipt of assessment, advice and referral for tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption and inadequate physical activity and for the four behaviours combined. Logistic regression analyses examined change in client-reported receipt of care. RESULTS There was an increase in assessment for all risks combined following the intervention (18 to 29 %; OR 3.55, p = 0.002: n = 805 at baseline, 982 at follow-up). No significant change in assessment, advice or referral for each individual risk was found. CONCLUSIONS The intervention had a limited effect on increasing the provision of preventive care. Further research is required to determine how to increase the provision of preventive care in community mental health services. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12613000693729.
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Affiliation(s)
- Kate M. Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
| | - Jenny Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
| | - Megan Freund
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Paula M. Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Daniel Barker
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Kathleen M. McElwaine
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Elizabeth M. Campbell
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Patrick McElduff
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
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Hayes JF, Miles J, Walters K, King M, Osborn DPJ. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand 2015; 131:417-25. [PMID: 25735195 PMCID: PMC4939858 DOI: 10.1111/acps.12408] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To review and complete meta-analysis of studies estimating standardised mortality ratios (SMRs) in bipolar affective disorder (BPAD) for all-cause and cause-specific mortalities. METHOD Cause-specific mortality was grouped into natural and unnatural causes. These subgroups were further divided into circulatory, respiratory, neoplastic and infectious causes, and suicide and other violent deaths. Summary SMRs were calculated using random-effects meta-analysis. Heterogeneity was examined via subgroup analysis and meta-regression. RESULTS Systematic searching found 31 studies meeting inclusion criteria. Summary SMR for all-cause mortality = 2.05 (95% CI 1.89-2.23), but heterogeneity was high (I(2) = 96.2%). This heterogeneity could not be accounted for by date of publication, cohort size, mid-decade of data collection, population type or geographical region. Unnatural death summary SMR = 7.42 (95% CI 6.43-8.55) and natural death = 1.64 (95% CI 1.47-1.83). Specifically, suicide SMR = 14.44 (95% CI 12.43-16.78), other violent death SMR = 3.68 (95% CI 2.77-4.90), deaths from circulatory disease = 1.73 (95% CI 1.54-1.94), respiratory disease = 2.92 (95% CI 2.00-4.23), infection = 2.25 (95% CI 1.70-3.00) and neoplasm = 1.14 (95% CI 1.10-1.21). CONCLUSION Despite considerable heterogeneity, all summary SMR estimates and a large majority of individual studies showed elevated mortality in BPAD compared to the general population. This was true for all causes of mortality studied.
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Affiliation(s)
- J. F. Hayes
- Division of PsychiatryUCLLondonUK,Camden & Islington NHS Foundation TrustNHSLondonUK
| | - J. Miles
- Camden & Islington NHS Foundation TrustNHSLondonUK
| | - K. Walters
- Department of Primary Care and Population HealthUCLLondonUK
| | - M. King
- Division of PsychiatryUCLLondonUK
| | - D. P. J. Osborn
- Division of PsychiatryUCLLondonUK,Camden & Islington NHS Foundation TrustNHSLondonUK
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Azevedo Da Silva M, Lemogne C, Melchior M, Zins M, Van Der Waerden J, Consoli SM, Goldberg M, Elbaz A, Singh-Manoux A, Nabi H. Excess non-psychiatric hospitalizations among employees with mental disorders: a 10-year prospective study of the GAZEL cohort. Acta Psychiatr Scand 2015; 131:307-17. [PMID: 25289581 PMCID: PMC4402031 DOI: 10.1111/acps.12341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine whether non-psychiatric hospitalizations rates were higher in those with mental disorders. METHOD In a cohort of 15,811 employees, aged 35-50 years in 1989, mental disorder status was defined from 1989 to 2000. Hospitalizations for all-causes, myocardial infarction (MI), stroke, and cancer, were recorded yearly from 2001 to 2011. Negative binomial regression models were used to estimate hospitalization rates over the follow-up. RESULTS After controlling for baseline sociodemographic factors, health-related behaviors, self-rated health, and self-reported medical conditions, participants with a mental disorder had significantly higher rates of all-cause hospitalization [incidence rate ratio, IRR=1.20 (95%, 1.14-1.26)], as well as hospitalization due to MI [IRR=1.44 (95%, 1.12-1.85)]. For stroke, the IRR did not reach statistical significance [IRR=1.37 (95%, 0.95-1.99)] and there was no association with cancer [IRR=1.01 (95%, 0.86-1.19)]. A similar trend was observed when mental disorders groups were considered (no mental disorder, depressive disorder, mental disorders due to psychoactive substance use, other mental disorders, mixed mental disorders, and severe mental disorder). CONCLUSION In this prospective cohort of employees with stable employment as well as universal access to healthcare, we found participants with mental disorders to have higher rates of non-psychiatric hospitalizations.
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Affiliation(s)
- M Azevedo Da Silva
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - C Lemogne
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris DescartesParis, France,Service universitaire de Psychiatrie de l'adulte et du sujet âgé, AP-HP, Hôpitaux Universitaires Paris OuestParis, France,Centre Psychiatrie et Neurosciences, INSERM U894Paris, France
| | - M Melchior
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - M Zins
- Université de Versailles St QuentinVillejuif, France,Cohortes épidémiologiques en population, Unité Mixte de Service 011 INSERM-UNSQVillejuif, France
| | - J Van Der Waerden
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - S M Consoli
- Faculté de Médecine, Sorbonne Paris Cité, Université Paris DescartesParis, France,Service universitaire de Psychiatrie de l'adulte et du sujet âgé, AP-HP, Hôpitaux Universitaires Paris OuestParis, France
| | - M Goldberg
- Université de Versailles St QuentinVillejuif, France,Cohortes épidémiologiques en population, Unité Mixte de Service 011 INSERM-UNSQVillejuif, France
| | - A Elbaz
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
| | - A Singh-Manoux
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France,Centre de Gérontologie, Hôpital Ste Périne, AP-HPParis, France,Department of Epidemiology and Public Health, University College LondonLondon, UK
| | - H Nabi
- Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, INSERM U1018Villejuif, France,Université de Versailles St QuentinVillejuif, France
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Kemp V, Fisher C, Lawn S, Battersby M, Isaac MK. Small steps: physical health promotion for people living with mental illness. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2015. [DOI: 10.1080/14623730.2015.1010370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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10
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Affiliation(s)
- F Amaddeo
- Department of Public Health and Community Medicine, Section of Psychiatry, Verona, Italy.
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11
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Munk-Jørgensen P, Okkels N, Golberg D, Ruggeri M, Thornicroft G. Fifty years' development and future perspectives of psychiatric register research. Acta Psychiatr Scand 2014; 130:87-98. [PMID: 24749690 DOI: 10.1111/acps.12281] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This article illustrates the development of psychiatric register research and discusses the strengths, limitations, and possible directions for future activities. METHOD Examples illustrating the development from the post-World War II introduction of psychiatric register research until today are selected. RESULTS The strengths of register research are seen especially within health service. Until recently, when starting linking registers to biobanks, register research had limited value in cause-seeking. Register research benefits from the possibilities for following identifiable persons over long time (lifelong) and the possibilities for linking to other registers and databases. Important limitations of register research are the heterogeneity and questionable validity of the clinical data collected. CONCLUSION Future register research can go in the direction of big is beautiful collecting data from all possible sources creating giga-registers. In that case, low data quality will still be an unsolved problem. Or it can take the direction of smaller local clinical databases which has many advantages, for example, integrating clinical knowledge and experience into register research. However, in that case, registers will not be able to deal with rare conditions and diseases.
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Affiliation(s)
- P Munk-Jørgensen
- Department of Organic Psychiatric Disorders and Emergency Ward, Aarhus University Hospital, Risskov, Denmark
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12
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Kemp V, Fisher C, Lawn S, Battersby M, Isaac MK. Small steps: barriers and facilitators to physical health self-management by people living with mental illness. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2014. [DOI: 10.1080/14623730.2014.931069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Perini G, Grigoletti L, Hanife B, Biggeri A, Tansella M, Amaddeo F. Cancer mortality among psychiatric patients treated in a community-based system of care: a 25-year case register study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:693-701. [PMID: 24092521 DOI: 10.1007/s00127-013-0765-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 09/17/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE Cancer mortality data allow assessing, at the same time, the risk of developing the disease and the quality of care provided to patients after the oncologic diagnosis. This study explores the risk of death caused by a single tumor site in a psychiatric population treated in a community-based psychiatric service. METHODS All patients with an ICD-10 psychiatric diagnosis, seeking care in 1982-2006 (25 years), were included. Data were drawn from the South Verona Psychiatric Case Register (PCR). Mortality and cause of death were ascertained using different procedures and sources. Standardized mortality ratios (SMRs) were used to compare the observed number of deaths with the expected number using as reference a population in the Veneto region. RESULTS Having been admitted to the hospital (SMR = 1.32), having a short interval from registration (1.52), having a diagnosis of alcoholism (2.03), and being a middle-aged male (1.83) were factors showing an increased risk of death from cancer. Increased SMRs were found for cancer of the oral cavity (22.93), lymphoma, leukemias, Hodgkin's lymphoma (8.01), and central nervous system (CNS) and cranial nerve tumors (4.75). The SMR decreased for stomach tumors (0.49). Patients with alcoholism (5.90 for larynx), affective disorders (20.00 for lymphomas), and personality disorders (28.00 for SNC) were found to be exposed to a high risk of cancer death in specific sites. CONCLUSIONS Psychiatric patients showed different patterns of site-specific cancer mortality when compared with the general population. The 20-fold higher risk of dying from hematological neoplasms needs further investigation. Chronic use of phenothiazines could be involved in the relative protection from stomach and prostate cancer found in psychiatric patients.
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Affiliation(s)
- Giovanni Perini
- Section of Psychiatry and Section of Clinical Psychology, Department of Public Health and Community Medicine, Policlinico GB Rossi, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
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14
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Abstract
BACKGROUND For too long there have been heated debates between those who believe that mental health care should be largely or solely provided from hospitals and those who adhere to the view that community care should fully replace hospitals. The aim of this study was to propose a conceptual model relevant for mental health service development in low-, medium- and high-resource settings worldwide. Method We conducted a review of the relevant peer-reviewed evidence and a series of surveys including more than 170 individual experts with direct experience of mental health system change worldwide. We integrated data from these multiple sources to develop the balanced care model (BCM), framed in three sequential steps relevant to different resource settings. RESULTS Low-resource settings need to focus on improving the recognition and treatment of people with mental illnesses in primary care. Medium-resource settings in addition can develop 'general adult mental health services', namely (i) out-patient clinics, (ii) community mental health teams (CMHTs), (iii) acute in-patient services, (iv) community residential care and (v) work/occupation. High-resource settings, in addition to primary care and general adult mental health services, can also provide specialized services in these same five categories. CONCLUSIONS The BCM refers both to a balance between hospital and community care and to a balance between all of the service components (e.g. clinical teams) that are present in any system, whether this is in low-, medium- or high-resource settings. The BCM therefore indicates that a comprehensive mental health system includes both community- and hospital-based components of care.
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Affiliation(s)
- G Thornicroft
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK.
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Hoang U, Goldacre MJ, Stewart R. Avoidable mortality in people with schizophrenia or bipolar disorder in England. Acta Psychiatr Scand 2013; 127:195-201. [PMID: 23216065 DOI: 10.1111/acps.12045] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To quantify the extent of 'avoidable mortality' in those with schizophrenia or bipolar disorder and to quantify the effect a reduction in these might have on the mortality gap associated with severe mental illness. METHOD A cohort was studied of people aged <75 years, discharged from inpatient care with schizophrenia or bipolar disorder in 2006-2007, and followed up for 365 days. Standardised mortality ratios (SMRs) were calculated followed by hypothetical SMRs, estimating the residual mortality gap if 'avoidable' causes and suicide in the cohorts had occurred at the same level as those in the general population. RESULTS Avoidable deaths comprised 60.2% and 59.2% of all deaths in the schizophrenia and bipolar disorder cohorts respectively. All-cause SMRs were 4.23 (95% CI 3.85-4.60) and 2.60 (2.21-3.00) respectively. After discounting the excess attributable to avoidable causes and suicide, the SMRs fell to 2.38 (2.09-2.66) and 1.66 (1.35-1.98) respectively. CONCLUSION Bringing mortality from avoidable causes and suicide down to general population levels would reduce the overall mortality excess in severe mental illness substantially, by about 50%, but would not eliminate it. Other underlying factors beyond those conventionally considered as 'avoidable' need further research.
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Affiliation(s)
- U Hoang
- Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford, UK.
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Mitchell AJ, Lord O, Malone D. Differences in the prescribing of medication for physical disorders in individuals with v. without mental illness: meta-analysis. Br J Psychiatry 2012. [PMID: 23209089 DOI: 10.1192/bjp.bp.111.094532] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is some concern that patients with mental illness may be in receipt of inferior medical care, including prescribed medication for medical conditions. AIMS We aimed to quantify possible differences in the prescription of medication for medical conditions in those with v. without mental illness. METHOD Systematic review and random effects meta-analysis with a minimum of three independent studies to warrant pooling by drug class. RESULTS We found 61 comparative analyses (from 23 publications) relating to the prescription of 12 classes of medication for cardiovascular health, diabetes, cancer, arthritis, osteoporosis and HIV in a total sample of 1 931 509 people. In those with severe mental illness the adjusted odds ratio (OR) for an equitable prescription was 0.74 (95% CI 0.63-0.86), with lower than expected prescriptions for angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE/ARBs), beta-blockers and statins. People with affective disorder had an odds ratio of 0.75 (95% CI 0.55-1.02) but this was not significant. Individuals with a history of other (miscellaneous) mental illness had an odds ratio of 0.95 (95% CI 0.92-0.98) of comparable medication with lower receipt of ACE/ARBs but not highly active antiretroviral therapy (HAART) medication. Results were significant in both adjusted and unadjusted analyses. CONCLUSIONS Individuals with severe mental illness (including schizophrenia) appear to be prescribed significantly lower quantities of several common medications for medical disorders, largely for cardiovascular indications, although further work is required to clarify to what extent this is because of prescriber intent.
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Affiliation(s)
- Alex J Mitchell
- Department of Psycho-oncology, Leicestershire Partnership Trust, Leicester LE5 0TD, UK.
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Amaddeo F, Barbui C, Tansella M. State of psychiatry in Italy 35 years after psychiatric reform. A critical appraisal of national and local data. Int Rev Psychiatry 2012; 24:314-20. [PMID: 22950770 DOI: 10.3109/09540261.2012.694855] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Thirty-four years have elapsed since the passing of the Italian Law 180, the reform law that marked the transition from a hospital-based system of care to a model of community psychiatry that was designed to be an alternative to, rather than to complement, the old hospital-centred services. The main principle of Law 180 is that psychiatric patients have the right to be treated the same way as patients with other diseases and only voluntary treatments are allowed, with a few exceptions that are strictly regulated. The main features and consequences of the Italian reform are initially reviewed; national and local level experiences and epidemiological data are then analysed in order to highlight and disentangle the 'active ingredients' of the Italian experience. A public health attitude with the capacity to network good practice in service organization by giving voice to successful experiences and promoting health service research, apart from some local services, is still generally lacking. Furthermore, it is still difficult to provide an evidence-based reply to the question: can à l'Italienne community-care be exported elsewhere?
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Affiliation(s)
- Francesco Amaddeo
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Italy.
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Fok MLY, Hayes RD, Chang CK, Stewart R, Callard FJ, Moran P. Life expectancy at birth and all-cause mortality among people with personality disorder. J Psychosom Res 2012; 73:104-7. [PMID: 22789412 DOI: 10.1016/j.jpsychores.2012.05.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 05/03/2012] [Accepted: 05/03/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE It is well established that serious mental illness is associated with raised mortality, yet few studies have looked at the life expectancy of people with personality disorder (PD). This study aims to examine the life expectancy and relative mortality in people with PD within secondary mental health care. METHODS We set out to examine this using a large psychiatric case register in southeast London, UK. Mortality was obtained through national mortality tracing procedures. In a cohort of patients with a primary diagnosis of PD (n=1836), standardised mortality ratios (SMRs) and life expectancies at birth were calculated, using general population mortality statistics as the comparator. RESULTS Life expectancy at birth was 63.3 years for women and 59.1 years for men with PD-18.7 years and 17.7 years shorter than females and males respectively in the general population in England and Wales. The SMR was 4.2 (95% CI: 3.03-5.64) overall; 5.0 (95% CI: 3.15-7.45) for females and 3.5 (95% CI: 2.17-5.47) for males. The highest SMRs were found in the younger age groups for both genders. CONCLUSION People with PD using mental health services have a substantially reduced life expectancy, highlighting the significant public health burden of the disorder.
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Affiliation(s)
- Marcella Lei-Yee Fok
- King's College London, King's Health Partners, Dept of Health Service and Population Research, Institute of Psychiatry, London, UK
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Nome S, Holsten F. Changes in mortality after first psychiatric admission: a 20-year prospective longitudinal clinical study. Nord J Psychiatry 2012; 66:97-106. [PMID: 21859397 DOI: 10.3109/08039488.2011.605170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine changes in the mortality of patients admitted to a Norwegian psychiatric hospital from 1985 to 2003: this period saw profound changes in structure and organization of the mental healthcare system. METHOD A 20-year prospective longitudinal, record linkage study of all patients admitted to a psychiatric hospital with sector responsibility from 1985 to 2003. RESULTS Excess mortality was found for the patient group. Overall standardized mortality ratio (SMR) (95% confidence interval, CI) was 2.85 (2.53-3.07)/2.15 (1.94-2.41) for male/female patients. One third of the patients who died in the study period died within 2 years after first admission, and 45% of the deaths happened within 2 years after last discharge. The median age at death decreased in the study period for patients who were younger than 65 years at their first admission. The median difference of lost years of life for the patients younger than 65 years at first admittance was 26.95/23.96 years for male/female patients. SMR increased for the youngest cohorts during the study period over time. From 1985 to 2003, SMR increased dramatically for both genders. CONCLUSION Patients admitted to a Norwegian psychiatric hospital for their first stay during 1985-2003 suffered increased excess mortality, whereas mortality in the general population decreased. The mortality was highest in the first 2 years after admission. Despite profound changes in the mental healthcare system, the mortality gap increased in the study period and was highest in the youngest birth cohorts.
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Affiliation(s)
- Siri Nome
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Sandviken, Bergen, Norway
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Björkenstam E, Ljung R, Burström B, Mittendorfer-Rutz E, Hallqvist J, Weitoft GR. Quality of medical care and excess mortality in psychiatric patients--a nationwide register-based study in Sweden. BMJ Open 2012; 2:e000778. [PMID: 22368297 PMCID: PMC3289986 DOI: 10.1136/bmjopen-2011-000778] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess overall and cause-specific mortality and the quality of somatic care among psychiatric patients. DESIGN A register-based cohort study. SETTING All individuals aged 20-79 years in Sweden in 2005. PARTICIPANTS In total 6 294 339 individuals. PRIMARY OUTCOME MEASURE The individuals were followed for mortality in 2006 and 2007, generating 72 187 deaths. Psychiatric patients were grouped according to their diagnosis in the National Patient Register. Mortality risk of psychiatric patients was compared with that of non-psychiatric patients. Estimates of RR of mortality were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Psychiatric patients were compared with non-psychiatric patients for three healthcare quality indicators: the proportion of avoidable hospitalisations, case death rate after myocardial infarction and statin use among diabetic patients. RESULTS Compared with individuals with no episodes of treatment for mental disorder, psychiatric patients had a substantially increased risk of all studied causes of death as well as death from conditions considered amenable to intervention by the health service, that is, avoidable mortality. The highest mortality was found among those with another mental disorder, predominantly substance abuse (for women, an IRR of 4.7 (95% CI 4.3 to 5.0) and for men, an IRR of 4.8 (95% CI 4.6 to 5.0)). The analysis of quality of somatic care revealed lower levels of healthcare quality for psychiatric patients, signalling failures in public health and medical care. CONCLUSION This study shows a marked increase in excess mortality, suggesting a lower quality of somatic healthcare in psychiatric patients.
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Affiliation(s)
- Emma Björkenstam
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Statistics, Monitoring and Evaluation, National Board of Health and Welfare, Stockholm, Sweden
| | - Rickard Ljung
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Statistics, Monitoring and Evaluation, National Board of Health and Welfare, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Upper Gastrointestinal Research, Karolinska Institute, Stockholm, Sweden
| | - Bo Burström
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institute, Stockholm, Sweden
| | - Johan Hallqvist
- Department of Public Health Sciences, Division of Public Health Epidemiology, Karolinska Institute, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunilla Ringbäck Weitoft
- Department of Statistics, Monitoring and Evaluation, National Board of Health and Welfare, Stockholm, Sweden
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Høye A, Jacobsen BK, Hansen V. Increasing mortality in schizophrenia: are women at particular risk? A follow-up of 1111 patients admitted during 1980-2006 in Northern Norway. Schizophr Res 2011; 132:228-32. [PMID: 21868200 DOI: 10.1016/j.schres.2011.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/08/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
Abstract
A study of mortality for all patients with schizophrenia admitted to the University Hospital of North Norway during 1980-2006 was performed, with a special focus on gender differences and changes in mortality during a period of transition from hospital-based to community-based care. A total of 1111 patients with schizophrenia were included, and the cohort was linked to the Causes of Death Register of Norway. Males and females had 3.5 and 2.6 times, respectively, higher mortality than the general population. The standardized mortality ratios were higher during the last nine years than the first nine years, and for women admitted after 1992, we found evidence for an increasing difference in mortality compared to the general female population as well as an increase in absolute mortality. In the subgroup of patients who had always been admitted voluntarily, women tended to have higher mortality, and a particularly high standardized mortality rate (SMR) was found in this group of female schizophrenic patients. Our results confirmed a persisting mortality gap between patients with schizophrenia and the general population over a period of 27 years, with a tendency of increasing standardized mortality ratios over time. The SMR for total mortality of women with schizophrenia is rising and becoming just as high as for men, both for unnatural and natural causes of death.
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Affiliation(s)
- Anne Høye
- Centre for Clinical Documentation and Evaluation Regional Health Authority of North Norway Mailbox 6, University Hospital of North Norway 9037 Tromsø, Norway.
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Abstract
The use of information systems and computer science applications in the health sector is now entrenched and widespread. In mental health services there are the typical applications of information systems concerning administrative, clinical and research issues, as well as innovative applications concerning diagnostic procedures, self-help, communication and delivery of psychotherapy.
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What can we do to reduce the burden of avoidable deaths in those with serious mental illness? ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00001524] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractIndividuals with schizophrenia have higher mortality rates compared to the general community. Apart from an increased risk of suicide, people with schizophrenia have an increased risk of death related to a wide range of comorbid physical conditions. There is evidence to suggest that much of this mortality is avoidable. The provision of assertive management of comorbid physical disorders has the potential to help close the differential mortality gap. While the primary data are robust, there is less empirical evidence to guide policy makers and service providers when dealing with these problems. Focused clinical programs aimed at reducing risk factors (e.g. smoking, obesity) and shared care between mental health teams and primary care providers can help reduce the burden of avoidable deaths. In light of recent evidence suggesting that the mortality gap has widened in recent decades, there is an urgent need to address the burden of avoidable deaths in those with serious mental illnesses.
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Abstract
Mortality among psychiatric patients has been found to be higher than the general population, not only in those long-term residents in old-fashioned psychiatric hospitals or attending hospital-based psychiatric services (Harris & Barraclough, 1998) but also in those treated in modern community-based systems of care (Amaddeo et al., 1995; Grigoletti et al., 2009).
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Mitchell AJ, Lord O. Do deficits in cardiac care influence high mortality rates in schizophrenia? A systematic review and pooled analysis. J Psychopharmacol 2010; 24:69-80. [PMID: 20923922 PMCID: PMC2951596 DOI: 10.1177/1359786810382056] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We have previously documented inequalities in the quality of medical care provided to those with mental ill health but the implications for mortality are unclear. We aimed to test whether disparities in medical treatment of cardiovascular conditions, specifically receipt of medical procedures and receipt of prescribed medication, are linked with elevated rates of mortality in people with schizophrenia and severe mental illness. We undertook a systematic review of studies that examined medical procedures and a pooled analysis of prescribed medication in those with and without comorbid mental illness, focusing on those which recruited individuals with schizophrenia and measured mortality as an outcome. From 17 studies of treatment adequacy in cardiovascular conditions, eight examined cardiac procedures and nine examined adequacy of prescribed cardiac medication. Six of eight studies examining the adequacy of cardiac procedures found lower than average provision of medical care and two studies found no difference. Meta-analytic pooling of nine medication studies showed lower than average rates of prescribing evident for the following individual classes of medication; angiotensin converting enzyme inhibitors (n = 6, aOR = 0.779, 95% CI = 0.638-0.950, p = 0.0137), beta-blockers (n = 9, aOR = 0.844, 95% CI = 0.690-1.03, p = 0.1036) and statins (n = 5, aOR = 0.604, 95% CI = 0.408-0.89, p = 0.0117). No inequality was evident for aspirin (n = 7, aOR = 0.986, 95% CI = 0.7955-1.02, p = 0.382). Interestingly higher than expected prescribing was found for older non-statin cholesterol-lowering agents (n = 4, aOR = 1.55, 95% CI = 1.04-2.32, p = 0.0312). A search for outcomes in this sample revealed ten studies linking poor quality of care and possible effects on mortality in specialist settings. In half of the studies there was significantly higher mortality in those with mental ill health compared with controls but there was inadequate data to confirm a causative link. Nevertheless, indirect evidence supports the observation that deficits in quality of care are contributing to higher than expected mortality in those with severe mental illness (SMI) and schizophrenia. The quality of medical treatment provided to those with cardiac conditions and comorbid schizophrenia is often suboptimal and may be linked with avoidable excess mortality. Every effort should be made to deliver high-quality medical care to people with severe mental illness.
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Affiliation(s)
- Alex J Mitchell
- Department of Liaison Psychiatry, Leicester General Hospital, Leicester, UK.
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Grigoletti L, Perini G, Rossi A, Biggeri A, Barbui C, Tansella M, Amaddeo F. Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care. Psychol Med 2009; 39:1875-1884. [PMID: 19379535 DOI: 10.1017/s0033291709005790] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services. METHOD All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population. RESULTS The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95% confidence interval (CI) 1.6-1.8], and higher still following the first admission (SMR 2.61, 95% CI 2.4-2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5-328.6) and personality disorders (20.87, 95% CI 5.2-83.4). CONCLUSIONS This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.
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Affiliation(s)
- L Grigoletti
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy.
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Implications of long-term conditions for both mental and physical health: comparison of rheumatoid arthritis and schizophrenia. Qual Life Res 2009; 18:699-707. [DOI: 10.1007/s11136-009-9486-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 04/20/2009] [Indexed: 12/18/2022]
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Abstract
PURPOSE OF REVIEW To follow up on reviews of case register research. Literature searches over a 2-year period were conducted to determine whether psychiatric case registers still have a role for research and service monitoring. RECENT FINDINGS Case register research covers a wide range of topics, and is most often found in Denmark where national databases support all kinds of record linkage studies. Typically, case registers are used in studies of treated prevalence and incidence of psychiatric disorders, in research on patterns of care, as sampling frames in epidemiological studies, and in studies on risk factors and treatment outcome. SUMMARY Despite a wide range of research based on administrative data, stakeholders in most countries are probably not well served by current priorities. Few studies investigate longitudinal patterns of service use to evaluate healthcare policies. There is a lack of comparative record linkage studies to inform local authorities on the cooperation between mental healthcare and public services. Implementing standard tools and procedures for routine outcome assessment seems still to be in an early phase in most register areas. When case register staff can capitalize on new opportunities, old and new case registers will continue to be important for research and service monitoring.
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Affiliation(s)
- Povl Munk-Jørgensen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Mølleparkvej 10, DK-9000 Aalborg, Denmark
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