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Fountoulakis KN, Karakatsoulis GN, Abraham S, Adorjan K, Ahmed HU, Alarcón RD, Arai K, Auwal SS, Berk M, Bjedov S, Bobes J, Bobes-Bascaran T, Bourgin-Duchesnay J, Bredicean CA, Bukelskis L, Burkadze A, Cabrera Abud II, Castilla-Puentes R, Cetkovich M, Colon-Rivera H, Corral R, Cortez-Vergara C, Crepin P, De Berardis D, Zamora Delgado S, Lucena DD, Sousa AD, Stefano RD, Dodd S, Priyanka Elek L, Elissa A, Erdelyi-Hamza B, Erzin G, Etchevers MJ, Falkai P, Farcas A, Fedotov I, Filatova V, Fountoulakis NK, Frankova I, Franza F, Frias P, Galako T, Garay CJ, Garcia-Álvarez L, García-Portilla MP, Gonda X, Gondek TM, Morera González D, Gould H, Grandinetti P, Grau A, Groudeva V, Hagin M, Harada T, Hasan TM, Azreen Hashim N, Hilbig J, Hossain S, Iakimova R, Ibrahim M, Iftene F, Ignatenko Y, Irarrazaval M, Ismail Z, Ismayilova J, Jakobs A, Jakovljević M, Jakšić N, Javed A, Kafali HY, Karia S, Kazakova O, Khalifa D, Khaustova O, Koh S, Kopishinskaia S, Kosenko K, Koupidis SA, Kovacs I, Kulig B, Lalljee A, Liewig J, Majid A, Malashonkova E, Malik K, Malik NI, Mammadzada G, Mandalia B, Marazziti D, Marčinko D, Martinez S, Matiekus E, Mejia G, Memon RS, Meza Martínez XE, Mickevičiūtė D, Milev R, Mohammed M, Molina-López A, Morozov P, Muhammad NS, Mustač F, Naor MS, Nassieb A, Navickas A, Okasha T, Pandova M, Panfil AL, Panteleeva L, Papava I, Patsali ME, Pavlichenko A, Pejuskovic B, Pinto Da Costa M, Popkov M, Popovic D, Raduan NJN, Vargas Ramírez F, Rancans E, Razali S, Rebok F, Rewekant A, Ninoska Reyes Flores E, Rivera-Encinas MT, Saiz P, Sánchez de Carmona M, Saucedo Martínez D, Saw JA, Saygili G, Schneidereit P, Shah B, Shirasaka T, Silagadze K, Sitanggang S, Skugarevsky O, Spikina A, Mahalingappa SS, Stoyanova M, Szczegielniak A, Tamasan SC, Tavormina G, Tavormina MGM, Theodorakis PN, Tohen M, Tsapakis EM, Tukhvatullina D, Ullah I, Vaidya R, Vega-Dienstmaier JM, Vrublevska J, Vukovic O, Vysotska O, Widiasih N, Yashikhina A, Prezerakos PE, Smirnova D. Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study). CNS Spectr 2024; 29:126-149. [PMID: 38269574 DOI: 10.1017/s1092852924000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders. METHODS The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions. RESULTS About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome. CONCLUSIONS The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki Greece, Thessaloniki, Greece
| | - Grigorios N Karakatsoulis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki Greece, Thessaloniki, Greece
| | - Seri Abraham
- Pennine Care NHS Foundation Trust, Heywood, UK
- Manchester Metropolitan University, Manchester, UK
- Core Psychiatry Training, Health Education England North West, Manchester, UK
| | - Kristina Adorjan
- Department of Psychiatry, Ludiwig-Maximilians-University, Munich, Germany
| | - Helal Uddin Ahmed
- Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | - Renato D Alarcón
- Section of Psychiatry and Mental Health, Universidad Peruana Cayetano Heredia, Facultad de Medicina Alberto Hurtado, Lima, Peru
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Kiyomi Arai
- School of Medicine and Health Science, Institute of Health Science Shinshu University, Matsumoto, Japan
| | - Sani Salihu Auwal
- Department of Psychiatry, Bayero University, Kano, Nigeria
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Michael Berk
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, Barwon Health, Geelong, Australia
- Orygen The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Sarah Bjedov
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Julio Bobes
- Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain
- Department of Psychiatry, Hospital Universitario Central de Asturias, Oviedo, Spain
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Teresa Bobes-Bascaran
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Mental Health Center of La Corredoria, Oviedo, Spain
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Julie Bourgin-Duchesnay
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
| | - Cristina Ana Bredicean
- Department of Neuroscience, Discipline of Psychiatry, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Laurynas Bukelskis
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Akaki Burkadze
- Mental Hub, Tbilisi, Georgia
- NGO Healthcare Research and Quality Agency, Tbilisi, Georgia
| | | | - Ruby Castilla-Puentes
- Janssen Research and Development, Johnson & Johnson, American Society of Hispanic Psychiatry and WARMI Women Mental Health, Cincinnati, OH, USA
| | - Marcelo Cetkovich
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Hector Colon-Rivera
- APM Board Certified in General Psychiatry and Neurology, Addiction Psychiatry, & Addiction Medicine, UPMC, DDAP, Philadelphia, PA, USA
| | - Ricardo Corral
- Department of Teaching and Research, Hospital Borda, Buenos Aires, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
| | | | - Piirika Crepin
- Sanitaire and Social Union for Accompaniment and Prevention, Center of Ambulatory Psychiatry of Narbonne and Lezigan, Narbonne, France
| | - Domenico De Berardis
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL Teramo, Teramo, Italy
- School of Nursing, University of L'Aquila, Italy
- Department of Neuroscience and Imaging, School of Psychiatry, University of Chieti, Chieti, Italy
| | - Sergio Zamora Delgado
- Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - David De Lucena
- Departamento de Fisiología e Farmacología, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
- Desousa Foundation, Mumbai, Maharashtra, India
| | - Ramona Di Stefano
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Seetal Dodd
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, Barwon Health, Geelong, Australia
- Orygen The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Livia Priyanka Elek
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Anna Elissa
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Berta Erdelyi-Hamza
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Gamze Erzin
- Department of Psychiatry, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martin J Etchevers
- Faculty of Psychology, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Peter Falkai
- Department of Psychiatry, Ludiwig-Maximilians-University, Munich, Germany
| | - Adriana Farcas
- Centre of Neuroscience, Queen's University, Kingston, Ontario, Canada
| | - Ilya Fedotov
- Department of Psychiatry and Narcology, Ryazan State Medical University n.a. Academician I.P. Pavlov, Ryazan, Russia
| | - Viktoriia Filatova
- State Budgetary Institution of the Rostov Region "Psychoneurological Dispensary", Rostov-on-Don, Russia
| | | | - Iryna Frankova
- Medical Psychology, Psychosomatic Medicine and Psychotherapy Department, Bogomolets National Medical University, Kyiv, Ukraine
| | - Francesco Franza
- "Villa dei Pini" Psychiatric Rehabilitation Center, Avellino, Italy
- Psychiatric Studies Centre, Provaglio d'Iseo, Italy
| | | | - Tatiana Galako
- Department of Psychiatry, Medical Psychology and Drug Abuse, Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic
| | - Cristian J Garay
- Faculty of Psychology, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Leticia Garcia-Álvarez
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Maria Paz García-Portilla
- Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Mental Health Center of La Ería, Oviedo, Spain
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Tomasz M Gondek
- Specialty Training Section, Polish Psychiatric Association, Wroclaw, Poland
| | | | - Hilary Gould
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Paolo Grandinetti
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL Teramo, Teramo, Italy
| | - Arturo Grau
- Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
- Universidad Diego Portales, Santiago, Chile
| | - Violeta Groudeva
- Department of Diagnostic Imaging, University Hospital Saint Ekaterina, Sofia, Bulgaria
| | - Michal Hagin
- Forensic Psychiatry Unit, Abarbanel Mental Health Center, Bat Yam, Israel
| | - Takayuki Harada
- Faculty of Human Sciences, Education Bureau of the Laboratory Schools, University of Tsukuba, Tokyo, Japan
| | - Tasdik M Hasan
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Public Health Foundation, Dhaka, Bangladesh
| | - Nurul Azreen Hashim
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Jan Hilbig
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Sahadat Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
| | - Rossitza Iakimova
- Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry "Saint Naum", Sofia, Bulgaria
| | - Mona Ibrahim
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Felicia Iftene
- Department of Psychiatry, Queens University, Kingston, ON, Canada
| | - Yulia Ignatenko
- Education Center, Mental Health Clinic No. 1 named after N.A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | - Matias Irarrazaval
- Ministry of Health, Millenium Institute for Research in Depression and Personality, Santiago, Chile
| | - Zaliha Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Jamila Ismayilova
- National Mental Health Center of the Ministry of Health of the Republic of Azerbaijan, Baku, Azerbaijan
| | - Asaf Jakobs
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
- New York Medical College, Valhalla, NY, USA
| | | | - Nenad Jakšić
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Afzal Javed
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | | | - Sagar Karia
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | | | - Doaa Khalifa
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Olena Khaustova
- Medical Psychology, Psychosomatic Medicine and Psychotherapy Department, Bogomolets National Medical University, Kyiv, Ukraine
| | - Steve Koh
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Svetlana Kopishinskaia
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia
- Kirov State Medical University, Kirov, Russia
| | - Korneliia Kosenko
- Department of Psychiatry, Drug Abuse and Psychology, Odessa National Medical University, Odessa, Ukraine
| | - Sotirios A Koupidis
- Occupational and Environmental Health Sector, Public Health Policy Department, School of Public Health, University of West Attica, Athens, Greece
| | - Illes Kovacs
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Barbara Kulig
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - Justine Liewig
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
| | - Abdul Majid
- Department of Psychiatry, SKIMS Medical College, Srinagar, India
| | - Evgeniia Malashonkova
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
| | - Khamelia Malik
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha, Pakistan
| | - Gulay Mammadzada
- Department of Psychiatry, Azerbaijan Medical University, Baku, Azerbaijan
| | | | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
- Brain Research Foundation onus, Lucca, Italy
| | - Darko Marčinko
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Stephanie Martinez
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Eimantas Matiekus
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Gabriela Mejia
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Roha Saeed Memon
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Roumen Milev
- Department of Psychiatry, Queens University, Kingston, ON, Canada
| | - Muftau Mohammed
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Kaduna, Nigeria
| | - Alejandro Molina-López
- General Office for the Psychiatric Services of the Ministry of Health, Mexico City, Mexico
| | - Petr Morozov
- Department of Postgraduate Education, Russian National Research Medical University n.a. N.I. Pirogov, Moscow, Russia
| | - Nuru Suleiman Muhammad
- Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Filip Mustač
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mika S Naor
- Sackler School of Medicine New York State American Program, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Amira Nassieb
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alvydas Navickas
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Tarek Okasha
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Milena Pandova
- Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry "Saint Naum", Sofia, Bulgaria
| | - Anca-Livia Panfil
- Compartment of Liaison Psychiatry, "Pius Brinzeu" County Emergency Clinical Hospital, Timisoara, Romania
| | - Liliya Panteleeva
- Department of Medical Psychology, Psychiatry and Psychotherapy, Kyrgyz-Russian Slavic University, Bishkek, Kyrgyz Republic
| | - Ion Papava
- Department of Neuroscience, Discipline of Psychiatry, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Mikaella E Patsali
- School of Social Sciences, Hellenic Open University, Patras, Greece
- Department of Internal Medicine, Nicosia General Hospital, Nicosia, Cyprus
| | - Alexey Pavlichenko
- Education Center, Mental Health Clinic No. 1 named after N.A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | - Bojana Pejuskovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Department for Crisis and Affective Disorders, Institute of Mental Health, Belgrade, Serbia
| | - Mariana Pinto Da Costa
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Mikhail Popkov
- Department of the Introduction to Internal Medicine and Family Medicine, International Higher School of Medicine, Bishkek, Kyrgyz Republic
| | | | - Nor Jannah Nasution Raduan
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Francisca Vargas Ramírez
- Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
- Universidad Diego Portales, Santiago, Chile
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
- Riga Centre of Psychiatry and Narcology, Riga, Latvia
| | - Salmi Razali
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Federico Rebok
- Servicio de Emergencia, Acute inpatient Unit, Hospital Moyano, Buenos Aires, Argentina
- Argentine Institute of Clinical Psychiatry (IAPC), Buenos Aires, Argentina
| | - Anna Rewekant
- General Psychiatry Unit I, Greater Poland Neuropsychiatric Center, Kościan, Poland
| | | | - María Teresa Rivera-Encinas
- Centro de Investigación en Salud Pública, Facultad de Medicina, Universidad de San Martín de Porres, Instituto Nacional de Salud Mental "Honorio Delgado - Hideyo Noguchi", Lima, Perú
| | - Pilar Saiz
- Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Mental Health Center of La Corredoria, Oviedo, Spain
| | | | - David Saucedo Martínez
- Department of Psychiatry, Escuela Nacional de Medicina, TEC de Monterrey, Servicio de geriatría. Hospital Universitario "José Eleuterio González" UANL, Monterrey, Nuevo León, Mexico
| | - Jo Anne Saw
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Görkem Saygili
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
| | - Patricia Schneidereit
- Klinik für Allgemeine Psychiatrie und Psychotherapie Ost, Psychiatrische Institutsambulanz, Klinikum am Weissenhof, Weissenhof, Germany
| | - Bhumika Shah
- DY Patil Medical College, Navi Mumbai, Maharashtra, India
| | - Tomohiro Shirasaka
- Department of Psychiatry, Teine Keijinkai Medical Center, Sapporo, Japan
| | | | - Satti Sitanggang
- Psychiatric Unit, Pambalah Batung General Hospital, South Kalimantan, Amuntai, Indonesia
| | - Oleg Skugarevsky
- Department of Psychiatry and Medical Psychology, Belarusian State Medical University, Minsk, Belarus
| | - Anna Spikina
- Saint Petersburg Psychoneurological Dispensary No. 2, Saint Petersburg, Russia
| | - Sridevi Sira Mahalingappa
- Derbyshire Healthcare NHS Foundation Trust, The Liasion Team, Royal Derby Hospital, Derby, Derbyshire, UK
| | - Maria Stoyanova
- Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry "Saint Naum", Sofia, Bulgaria
| | - Anna Szczegielniak
- Department of Psychiatric Rehabilitation, Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poland
| | - Simona Claudia Tamasan
- Compartment of Liaison Psychiatry, "Pius Brinzeu" County Emergency Clinical Hospital, Timisoara, Romania
| | - Giuseppe Tavormina
- Psychiatric Studies Centre, Provaglio d'Iseo, Italy
- European Depression Association and Italian Association on Depression, Brussels, Belgium
- Bedforshire Center for Mental Health Research, University of Cambridge, Cambridge, UK
| | | | | | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of New Mexico, Albuquerque, Nm, USA
| | - Eva Maria Tsapakis
- "Agios Charalambos" Mental Health Clinic, Heraklion, Crete, Greece
- 1st Department of Academic Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Dina Tukhvatullina
- Centre for Global Public Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Ratnaraj Vaidya
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jelena Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
- Riga Centre of Psychiatry and Narcology, Riga, Latvia
- Institute of Public Health, Riga Stradins University, Riga, Latvia
| | - Olivera Vukovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Research and Education, Institute of Mental Health, Belgrade, Serbia
| | - Olga Vysotska
- Educational and Research Center - Ukrainian Family Medicine Training Center, Bogomolets National Medical University, Kyiv, Ukraine
| | - Natalia Widiasih
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Anna Yashikhina
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia
- Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
| | - Panagiotis E Prezerakos
- Department of Nursing, University of Peloponnese, Laboratory of Integrated Health Care, Tripoli, Greece
| | - Daria Smirnova
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia
- Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
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Chan JKN, Correll CU, Wong CSM, Chu RST, Fung VSC, Wong GHS, Lei JHC, Chang WC. Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102294. [PMID: 37965432 PMCID: PMC10641487 DOI: 10.1016/j.eclinm.2023.102294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Mental disorders are associated with premature mortality. There is increasing research examining life expectancy and years-of-potential-life-lost (YPLL) to quantify the disease impact on survival in people with mental disorders. We aimed to systematically synthesize studies to estimate life expectancy and YPLL in people with any and specific mental disorders across a broad spectrum of diagnoses. Methods In this systematic review and meta-analysis, we searched Embase, MEDLINE, PsychINFO, WOS from inception to July 31, 2023, for published studies reporting life expectancy and/or YPLL for mental disorders. Criteria for study inclusion were: patients of all ages with any mental disorders; reported data on life expectancy and/or YPLL of a mental-disorder cohort relative to the general population or a comparison group without mental disorders; and cohort studies. We excluded non-cohort studies, publications containing non-peer-reviewed data or those restricted to population subgroups. Survival estimates, i.e., life expectancy and YPLL, were pooled (based on summary data extracted from the included studies) using random-effects models. Subgroup analyses and random-effects meta-regression analyses were performed to explore sources of heterogeneity. Risk-of-bias assessment was evaluated using the Newcastle-Ottawa Scale. This study is registered with PROSPERO (CRD42022321190). Findings Of 35,865 studies identified in our research, 109 studies from 24 countries or regions including 12,171,909 patients with mental disorders were eligible for analysis (54 for life expectancy and 109 for YPLL). Pooled life expectancy for mental disorders was 63.85 years (95% CI 62.63-65.06; I2 = 100.0%), and pooled YPLL was 14.66 years (95% CI 13.88-15.98; I2 = 100.0%). Disorder-stratified analyses revealed that substance-use disorders had the shortest life expectancy (57.07 years [95% CI 54.47-59.67]), while neurotic disorders had the longest lifespan (69.51 years [95% CI 67.26-71.76]). Substance-use disorders exhibited the greatest YPLL (20.38 years [95% CI 18.65-22.11]), followed by eating disorders (16.64 years [95% CI 7.45-25.82]), schizophrenia-spectrum disorders (15.37 years [95% CI 14.18-16.55]), and personality disorders (15.35 years [95% CI 12.80-17.89]). YPLLs attributable to natural and unnatural deaths in mental disorders were 4.38 years (95% CI 3.15-5.61) and 8.11 years (95% CI 6.10-10.13; suicide: 8.31 years [95% CI 6.43-10.19]), respectively. Stratified analyses by study period suggested that the longevity gap persisted over time. Significant cross-study heterogeneity was observed. Interpretation Mental disorders are associated with substantially reduced life expectancy, which is transdiagnostic in nature, encompassing a wide range of diagnoses. Implementation of comprehensive and multilevel intervention approaches is urgently needed to rectify lifespan inequalities for people with mental disorders. Funding None.
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Affiliation(s)
- Joe Kwun Nam Chan
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corine Sau Man Wong
- LKS Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ryan Sai Ting Chu
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Vivian Shi Cheng Fung
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Gabbie Hou Sem Wong
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Janet Hiu Ching Lei
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
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Jhawar S, Gupta SD, Das A. Perinatal Depression as a Growing Mental Health Concern: A Systematic Review. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221109313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mental health today, is a rising concern the world over. In order to focus prevention strategies and treatment options, it is important to study the types, and attributes, of illnesses under mental health. Among all types, depression is found to be the major contributor to the global burden of this disease and it is found to affect more women than men. Among women, perinatal depression is a serious and highly prevalent form of depression that affects women of childbearing age. Perinatal depression comprises of antenatal depression (AD) and postnatal depression (PD). AD is a precursor of PD and while it negatively impacts the health of the woman herself, it also has potential adverse effects on the health and socio-psychological development of the new born. Research from low- and middle-income countries (LMICs) finds prevalence of AD at 25.8%, and of PD at 19.7%. In spite of this, while studies on PD are available, studies and understanding of AD are limited and have not received the desired attention of the scientific community. Various global and local organisations have done policy advocacy on mental health, and to some extent within this framework, on perinatal depression, however, focus is still required in the LMICs for strengthening health systems for prevention and treatment.
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Affiliation(s)
- Sheenu Jhawar
- IIHMR University (Indian Institute of Health Management Research), Jaipur, Rajasthan, India
| | - S. D. Gupta
- IIHMR University (Indian Institute of Health Management Research), Jaipur, Rajasthan, India
| | - Arindam Das
- IIHMR University (Indian Institute of Health Management Research), Jaipur, Rajasthan, India
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Personal Resilience Can Be Well Estimated from Heart Rate Variability and Paralinguistic Features during Human-Robot Conversations. SENSORS 2021; 21:s21175844. [PMID: 34502736 PMCID: PMC8433993 DOI: 10.3390/s21175844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/04/2022]
Abstract
Mental health is as crucial as physical health, but it is underappreciated by mainstream biomedical research and the public. Compared to the use of AI or robots in physical healthcare, the use of AI or robots in mental healthcare is much more limited in number and scope. To date, psychological resilience—the ability to cope with a crisis and quickly return to the pre-crisis state—has been identified as an important predictor of psychological well-being but has not been commonly considered by AI systems (e.g., smart wearable devices) or social robots to personalize services such as emotion coaching. To address the dearth of investigations, the present study explores the possibility of estimating personal resilience using physiological and speech signals measured during human–robot conversations. Specifically, the physiological and speech signals of 32 research participants were recorded while the participants answered a humanoid social robot’s questions about their positive and negative memories about three periods of their lives. The results from machine learning models showed that heart rate variability and paralinguistic features were the overall best predictors of personal resilience. Such predictability of personal resilience can be leveraged by AI and social robots to improve user understanding and has great potential for various mental healthcare applications in the future.
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Keenan R, Chepulis L, Ly J, Carter S, Lao C, Asim M, Bhat A, Deo S, Lim KP, Mohammed R, Scarlet S, Lawrenson R. Metabolic screening in primary care for patients with schizophrenia or schizoaffective disorder and taking antipsychotic medication. J Prim Health Care 2021; 12:29-34. [PMID: 32223847 DOI: 10.1071/hc19023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Life expectancy in patients with schizophrenia is 15-20 years less than the general population. A dominant cause of morbidity and mortality in these patients is cardiovascular disease. Adverse consequences of modifiable cardiovascular risk factors can be reduced by regular monitoring of metabolic outcomes and intervention if required. AIM To evaluate the metabolic screening in primary care for patients with schizoaffective disorders managed in primary care. To show the usefulness of combining simple practice audits in evaluating such areas of clinical practice. METHODS An audit was undertaken in eight general practices in the Waikato and Bay of Plenty regions of New Zealand. Specifically, the monitoring of patients with schizophrenia or schizoaffective disorder whose antipsychotic medication was prescribed by primary care doctors was audited. Patient monitoring was compared to the guideline recommendation of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Best Practice Advisory Centre (BPAC). RESULTS In total, 117 patients were included in the audit and none were fully monitored, as recommended by the RANZCP guidelines. Although two-thirds of patients had been evaluated for glycosylated haemoglobin (HbA1c), lipids, blood pressure, complete blood count and weight, <10% of patients had had prolactin, waist circumference or electrocardiogram measurements recorded. The proportion of patients having a HbA1c measured was also significantly higher in younger patients and patients who were non-Māori or enrolled with an urban practice (all P<0.05). When using the simplified BPAC guidelines, half of all patients were correctly monitored. DISCUSSION These findings show there is room for improvement in the monitoring of patients receiving antipsychotic medication in primary care. This may indicate the need for clear guidance and general practitioner education around the monitoring requirements of these patients. Alternatively, a more simplified monitoring protocol may need to be developed. This audit has also shown that there is value in several practices completing the same audit and providing a larger cohort of patients for pooled data analysis.
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Affiliation(s)
- Rawiri Keenan
- Medical Research Centre, University of Waikato, Hamilton, Waikato, New Zealand; and Royal New Zealand College of General Practitioners, Wellington, New Zealand; and Corresponding author.
| | - Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, Waikato, New Zealand
| | - Joanna Ly
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Sally Carter
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Chunhuan Lao
- Medical Research Centre, University of Waikato, Hamilton, Waikato, New Zealand
| | - Muhammad Asim
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Abhijit Bhat
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Shivam Deo
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Kee Ping Lim
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Ruzaimah Mohammed
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Sophie Scarlet
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, Waikato, New Zealand
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Wilson R, Gaughran F, Whitburn T, Higginson IJ, Gao W. Acute care utilisation towards the end of life and the place of death for patients with serious mental disorders: a register-based cohort study in South London. Public Health 2021; 194:79-85. [PMID: 33866148 DOI: 10.1016/j.puhe.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to explore acute care utilisation towards end of life by and the place of death for patients with serious mental disorders and to demonstrate any inequalities in end-of-life care faced by this patient group. STUDY DESIGN This is a retrospective cohort study using linked, routinely collected data. METHODS This study used linked data extracted from mental health records, Hospital Episode Statistics and mortality data. Adult cases (≥18 years old) were included if they had a serious mental disorder and died between 2007 and 2015. Multiple imputation was used to manage missing data, and generalised linear models were used to assess multiple adjusted associations between sociodemographic and clinical explanatory variables and acute service use at the end of life and in-hospital deaths. RESULTS A cohort of 1350 adults was analysed. More than half visited the accident and emergency (A&E) department in the last 90 days of life, and a third had a burdensome transition (multiple hospital admissions in the last 90 days of life or at least one in the last three days); the median number of days spent in the hospital was 4 (range: 0-86). Having more comorbidities was a strong correlate of more A&E visits (adjusted odds ratio [OR] = 1.03 [95% confidence interval = 1.02-1.04]), burdensome transitions (adjusted OR = 1.06 [1.04-1.08]) and days spent in the hospital (adjusted OR = 1.04 [1.03-1.05]). Having a diagnosis of schizophrenia spectrum disorder, compared with other serious mental disorder diagnoses, was associated with fewer A&E visits (adjusted OR = 0.78 [0.71-0.88]) and fewer days in the hospital (adjusted OR = 0.77 [0.66-0.89]). Younger age was associated with more A&E visits (adjusted OR = 1.28 [1.07-1.53]) and fewer days spent in the hospital (adjusted OR = 0.70 [0.52-0.95]). Hospital deaths were high (51%), and in a fully adjusted model, they were associated with having more comorbidities (adjusted OR = 1.02 [1.01-1.03]) and accessing acute care at the end of life (including more A&E visits; adjusted OR = 1.07 [1.05-1.10]), burdensome transitions (adjusted OR = 1.53 [1.37-1.71]) and days spent in the hospital (adjusted OR = 2.05 [1.70-247]). CONCLUSION People with comorbidities are more likely to use more burdensome acute health care at the end of life and are more likely to die in the hospital. Hospital deaths could be reduced, and end-of-life care could be improved by targeting patients with comorbidities and who are accessing more acute healthcare services.
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Affiliation(s)
- R Wilson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, United Kingdom
| | - F Gaughran
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; National Psychosis Unit, South London and Maudsley NHS Foundation Trust 7th Floor, Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, United Kingdom
| | - T Whitburn
- Barts Health NHS Trust, Macmillan Palliative Care Team, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, United Kingdom
| | - I J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, United Kingdom
| | - W Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, United Kingdom.
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Edgcomb JB, Thiruvalluru R, Pathak J, Brooks JO. Machine Learning to Differentiate Risk of Suicide Attempt and Self-harm After General Medical Hospitalization of Women With Mental Illness. Med Care 2021; 59:S58-S64. [PMID: 33438884 PMCID: PMC7810157 DOI: 10.1097/mlr.0000000000001467] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suicide prevention is a public health priority, but risk factors for suicide after medical hospitalization remain understudied. This problem is critical for women, for whom suicide rates in the United States are disproportionately increasing. OBJECTIVE To differentiate the risk of suicide attempt and self-harm following general medical hospitalization among women with depression, bipolar disorder, and chronic psychosis. METHODS We developed a machine learning algorithm that identified risk factors of suicide attempt and self-harm after general hospitalization using electronic health record data from 1628 women in the University of California Los Angeles Integrated Clinical and Research Data Repository. To assess replicability, we applied the algorithm to a larger sample of 140,848 women in the New York City Clinical Data Research Network. RESULTS The classification tree algorithm identified risk groups in University of California Los Angeles Integrated Clinical and Research Data Repository (area under the curve 0.73, sensitivity 73.4, specificity 84.1, accuracy 0.84), and predictor combinations characterizing key risk groups were replicated in New York City Clinical Data Research Network (area under the curve 0.71, sensitivity 83.3, specificity 82.2, and accuracy 0.84). Predictors included medical comorbidity, history of pregnancy-related mental illness, age, and history of suicide-related behavior. Women with antecedent medical illness and history of pregnancy-related mental illness were at high risk (6.9%-17.2% readmitted for suicide-related behavior), as were women below 55 years old without antecedent medical illness (4.0%-7.5% readmitted). CONCLUSIONS Prevention of suicide attempt and self-harm among women following acute medical illness may be improved by screening for sex-specific predictors including perinatal mental health history.
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Affiliation(s)
- Juliet B Edgcomb
- Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rohith Thiruvalluru
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | - Jyotishman Pathak
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | - John O Brooks
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
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Mouchabac S, Adrien V, Falala-Séchet C, Bonnot O, Maatoug R, Millet B, Peretti CS, Bourla A, Ferreri F. Psychiatric Advance Directives and Artificial Intelligence: A Conceptual Framework for Theoretical and Ethical Principles. Front Psychiatry 2021; 11:622506. [PMID: 33551883 PMCID: PMC7862130 DOI: 10.3389/fpsyt.2020.622506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/16/2020] [Indexed: 01/19/2023] Open
Abstract
The patient's decision-making abilities are often altered in psychiatric disorders. The legal framework of psychiatric advance directives (PADs) has been made to provide care to patients in these situations while respecting their free and informed consent. The implementation of artificial intelligence (AI) within Clinical Decision Support Systems (CDSS) may result in improvements for complex decisions that are often made in situations covered by PADs. Still, it raises theoretical and ethical issues this paper aims to address. First, it goes through every level of possible intervention of AI in the PAD drafting process, beginning with what data sources it could access and if its data processing competencies should be limited, then treating of the opportune moments it should be used and its place in the contractual relationship between each party (patient, caregivers, and trusted person). Second, it focuses on ethical principles and how these principles, whether they are medical principles (autonomy, beneficence, non-maleficence, justice) applied to AI or AI principles (loyalty and vigilance) applied to medicine, should be taken into account in the future of the PAD drafting process. Some general guidelines are proposed in conclusion: AI must remain a decision support system as a partner of each party of the PAD contract; patients should be able to choose a personalized type of AI intervention or no AI intervention at all; they should stay informed, i.e., understand the functioning and relevance of AI thanks to educational programs; finally, a committee should be created for ensuring the principle of vigilance by auditing these new tools in terms of successes, failures, security, and relevance.
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Affiliation(s)
- Stéphane Mouchabac
- Sorbonne Université, AP-HP Department of Psychiatry, Hôpital Saint-Antoine, Paris, France
- Sorbonne Université, iCRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain and Spine Institute (ICM), INSERM, CNRS, Paris, France
| | - Vladimir Adrien
- Sorbonne Université, AP-HP Department of Psychiatry, Hôpital Saint-Antoine, Paris, France
- Sorbonne Université, iCRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain and Spine Institute (ICM), INSERM, CNRS, Paris, France
| | - Clara Falala-Séchet
- Laboratory of Psychopathology and Health Processes, EA 4057, Institute of Psychology, University of Paris, Paris, France
| | - Olivier Bonnot
- CHU de Nantes, Department of Child and Adolescent Psychiatry, Nantes, France
- Pays de la Loire Psychology Laboratory, EA 4638, Nantes, France
| | - Redwan Maatoug
- Sorbonne Université, iCRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain and Spine Institute (ICM), INSERM, CNRS, Paris, France
- Sorbonne Université, AP-HP Department of Psychiatry, Hôpital Pitié-Salpêtrière, Paris, France
| | - Bruno Millet
- Sorbonne Université, iCRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain and Spine Institute (ICM), INSERM, CNRS, Paris, France
- Sorbonne Université, AP-HP Department of Psychiatry, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Alexis Bourla
- Sorbonne Université, AP-HP Department of Psychiatry, Hôpital Saint-Antoine, Paris, France
- Jeanne d'Arc Hospital, INICEA Group, Saint-Mandé, France
| | - Florian Ferreri
- Sorbonne Université, AP-HP Department of Psychiatry, Hôpital Saint-Antoine, Paris, France
- Sorbonne Université, iCRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain and Spine Institute (ICM), INSERM, CNRS, Paris, France
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Fornaro M, Solmi M, Stubbs B, Veronese N, Monaco F, Novello S, Fusco A, Anastasia A, De Berardis D, Carvalho AF, de Bartolomeis A, Vieta E. Prevalence and correlates of major depressive disorder, bipolar disorder and schizophrenia among nursing home residents without dementia: systematic review and meta-analysis. Br J Psychiatry 2020; 216:6-15. [PMID: 30864533 DOI: 10.1192/bjp.2019.5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The elderly population and numbers of nursing homes residents are growing at a rapid pace globally. Uncertainty exists regarding the actual rates of major depressive disorder (MDD), bipolar disorder and schizophrenia as previous evidence documenting high rates relies on suboptimal methodology. AIMS To carry out a systematic review and meta-analysis on the prevalence and correlates of MDD, bipolar disorder and schizophrenia spectrum disorder among nursing homes residents without dementia. METHOD Major electronic databases were systematically searched from 1980 to July 2017 for original studies reporting on the prevalence and correlates of MDD among nursing homes residents without dementia. The prevalence of MDD in this population was meta-analysed through random-effects modelling and potential sources of heterogeneity were examined through subgroup/meta-regression analyses. RESULTS Across 32 observational studies encompassing 13 394 nursing homes residents, 2110 people were diagnosed with MDD, resulting in a pooled prevalence rate of 18.9% (95% CI 14.8-23.8). Heterogeneity was high (I2 = 97%, P≤0.001); no evidence of publication bias was observed. Sensitivity analysis indicated the highest rates of MDD among North American residents (25.4%, 95% CI 18-34.5, P≤0.001). Prevalence of either bipolar disorder or schizophrenia spectrum disorder could not be reliably pooled because of the paucity of data. CONCLUSIONS MDD is highly prevalent among nursing homes residents without dementia. Efforts towards prevention, early recognition and management of MDD in this population are warranted.
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Affiliation(s)
- Michele Fornaro
- Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry, University School of Medicine 'Federico II', Italy
| | - Marco Solmi
- Neuroscience Department, Psychiatry Unit, University of Padua; Psychiatry Unit, Azienda Ospedaliera di Padova, Padua Hospital, Italy; and Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Spain
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust; and Health Service and Population Research Department and the Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Francesco Monaco
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neuroscience, University of Salerno, Italy
| | - Stefano Novello
- Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry, University School of Medicine 'Federico II', Italy
| | - Andrea Fusco
- Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry, University School of Medicine 'Federico II', Italy
| | | | - Domenico De Berardis
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital 'G. Mazzini', Italy
| | - André F Carvalho
- Department of Psychiatry, University of Toronto; and Centre for Addiction & Mental Health (CAMH), Canada
| | - Andrea de Bartolomeis
- Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry, University School of Medicine 'Federico II', Italy
| | - Eduard Vieta
- Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Spain
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Reynolds RJ, Day SM, Shafer A, Becker E. Mortality Rates and Excess Death Rates for the Seriously Mentally Ill. J Insur Med 2019; 47:212-219. [PMID: 30653378 DOI: 10.17849/insm-47-04-1-8.1] [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: 11/20/2022]
Abstract
OBJECTIVES -To compute mortality rates and excess death rates for patients with serious mental illness, specific to categories of gender, age and race/ethnicity. BACKGROUND -People with serious mental illness are known to be at greatly increased risk of mortality across the lifespan. However, the measures of mortality reported for this high-risk population are typically only summary measures, which do not provide either the mortality rates or excess death rates needed to construct life tables for individuals with serious mental illness. METHODS -Mortality rates were computed by dividing the number of deaths by the amount of life-years lived in strata specific to gender, age and race/ethnicity. Age-specific excess death rates were determined as the difference between the study population rate and the corresponding general population rate in each stratum. To compute excess death rates beyond observed ages in the cohort, a method with documented reliability and validity for chronic medical conditions was used. RESULTS -For the cohort with mental illness, mortality rates for Black and White females were mostly equal, and consistently greater than those for Hispanic females; excess death rates for females displayed a similar pattern. Among males, mortality rates were highest for Whites, with Hispanics and Blacks close in magnitude at all ages. Excess death rates for males showed more divergence between the categories of race/ethnicity across the age range. CONCLUSIONS -Mortality rates specific to categories of gender, age and race/ethnicity show sufficient differences as to make them the preferred way to construct life tables. This is especially true in contrast to broader summary measures such as risk ratios, standardized incidence rates, or life expectancy.
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Affiliation(s)
| | - Steven M Day
- 1 Mortality Research & Consulting, Inc., City of Industry, CA
| | - Alan Shafer
- 2 Texas Department of State Health Services, Austin, TX
| | - Emilie Becker
- 3 Texas Department of Aging and Disability Services, Pollok, TX
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Iwagami M, Mansfield KE, Hayes JF, Walters K, Osborn DP, Smeeth L, Nitsch D, Tomlinson LA. Severe mental illness and chronic kidney disease: a cross-sectional study in the United Kingdom. Clin Epidemiol 2018; 10:421-429. [PMID: 29713199 PMCID: PMC5907783 DOI: 10.2147/clep.s154841] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective We investigated the burden of chronic kidney disease (CKD) among patients with severe mental illness (SMI). Methods We identified patients with SMI among all those aged 25–74 registered in the UK Clinical Practice Research Datalink as on March 31, 2014. We compared the prevalence of CKD (two measurements of estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥3 months) and renal replacement therapy between patients with and without SMI. For patients with and without a history of lithium prescription separately, we used logistic regression to examine the association between SMI and CKD, adjusting for demographics, lifestyle characteristics, and known CKD risk factors. Results The CKD prevalence was 14.6% among patients with SMI and a history of lithium prescription (n = 4,295), 3.3% among patients with SMI and no history of lithium prescription (n = 24,101), and 2.1% among patients without SMI (n = 2,387,988; P < 0.001). The prevalence of renal replacement therapy was 0.23%, 0.15%, and 0.11%, respectively (P = 0.012). Compared to patients without SMI, the fully adjusted odds ratio for CKD was 6.49 (95% CI 5.84–7.21) for patients with SMI and a history of lithium prescription and 1.45 (95% CI 1.34–1.58) for patients with SMI and no history of lithium prescription. The higher prevalence of CKD in patients with SMI may, in part, be explained by more frequent blood testing as compared to the general population. Conclusion CKD is identified more commonly among patients with SMI than in the general population.
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Affiliation(s)
- Masao Iwagami
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - David Pj Osborn
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Laurie A Tomlinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Jia H, Zack MM, Gottesman II, Thompson WW. Associations of Smoking, Physical Inactivity, Heavy Drinking, and Obesity with Quality-Adjusted Life Expectancy among US Adults with Depression. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:364-371. [PMID: 29566844 DOI: 10.1016/j.jval.2017.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 07/20/2017] [Accepted: 08/05/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine associations between four health behaviors (smoking, physical inactivity, heavy alcohol drinking, and obesity) and three health indices (health-related quality of life, life expectancy, and quality-adjusted life expectancy (QALE)) among US adults with depression. METHODS Data were obtained from the 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System data. The EuroQol five-dimensional questionnaire (EQ-5D) health preference scores were estimated on the basis of extrapolations from the Centers for Disease Control and Prevention's healthy days measures. Depression scores were estimated using the eight-item Patient Health Questionnaire. Life expectancy estimates were obtained from US life tables, and QALE was estimated from a weighted combination of the EQ-5D scores and the life expectancy estimates. Outcomes were summarized by depression status for the four health behaviors (smoking, physical inactivity, heavy alcohol drinking, and obesity). RESULTS For depressed adults, current smokers and the physically inactive had significantly lower EQ-5D scores (0.040 and 0.171, respectively), shorter life expectancy (12.9 and 10.8 years, respectively), and substantially less QALE (8.6 and 10.9 years, respectively). For nondepressed adults, estimated effects were similar but smaller. Heavy alcohol drinking among depressed adults, paradoxically, was associated with higher EQ-5D scores but shorter life expectancy. Obesity was strongly associated with lower EQ-5D scores but only weakly associated with shorter life expectancy. CONCLUSIONS Among depressed adults, physical inactivity and smoking were strongly associated with lower EQ-5D scores, life expectancy, and QALE, whereas obesity and heavy drinking were only weakly associated with these indices. These results suggest that reducing physical inactivity and smoking would improve health more among depressed adults.
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Affiliation(s)
- Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, New York, NY, USA.
| | - Matthew M Zack
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Irving I Gottesman
- Departments of Psychology and Psychiatry, University of Minnesota, Twin Cities, MN, USA
| | - William W Thompson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mitchell AJ, Delaffon V, Lord O. Let's get physical: improving the medical care of people with severe mental illness. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.111.009068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThere is clear evidence of increased medical comorbidity and related mortality in people with severe mental illness, despite numerous guidelines for managing medical conditions in this population. This article assesses inequalities in medical treatment and preventive healthcare received by psychiatric patients compared with the general population. It considers whether the medical care provided is adequate and whether published guidelines improve it. Mental health specialists, general practitioners and hospital specialists appear to deliver poorer than average medical care for this vulnerable population. Implementation of physical healthcare guidelines is incomplete and the guidelines must be matched with resources to address this deficit.
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Sajatovic M, Gunzler DD, Kanuch SW, Cassidy KA, Tatsuoka C, McCormick R, Blixen CE, Perzynski AT, Einstadter D, Thomas CL, Lawless ME, Martin S, Falck-Ytter C, Seeholzer EL, McKibben CL, Bauer MS, Dawson NV. A 60-Week Prospective RCT of a Self-Management Intervention for Individuals With Serious Mental Illness and Diabetes Mellitus. Psychiatr Serv 2017; 68:883-890. [PMID: 28502243 PMCID: PMC5675044 DOI: 10.1176/appi.ps.201600377] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES A 60-week randomized controlled trial assessed the effects of targeted training in illness management (TTIM) versus treatment as usual among 200 individuals with serious mental illness and diabetes mellitus. METHODS The study used the Clinical Global Impression (CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Brief Psychiatric Rating Scale (BPRS) to assess psychiatric symptoms; the Global Assessment of Functioning (GAF) and the Sheehan Disability Scale (SDS) to assess functioning; the 36-Item Short-Form Health Survey (SF-36) to assess general health, and serum glycosylated hemoglobin (HbA1c) to assess diabetes control. RESULTS Participants' mean±SD age was 52.7±9.5 years, and 54% were African American. They were diagnosed as having depression (48%), schizophrenia (25%), and bipolar disorder (28%). At baseline, depression severity was substantial but psychosis severity was modest. At 60 weeks, there was greater improvement among TTIM participants versus treatment-as-usual recipients on the CGI (p<.001), the MADRS (p=.016), and the GAF (p=.003). Diabetes knowledge was significantly improved among TTIM participants but not in the treatment-as-usual group. In post hoc analyses among participants whose HbA1c levels at baseline met recommendations set by the American Diabetes Association for persons with high comorbidity (53%), TTIM participants had minimal change in HbA1c over the 60-week follow-up, whereas HbA1c levels worsened in the treatment-as-usual group. CONCLUSIONS TTIM was associated with improved psychiatric symptoms, functioning, and diabetes knowledge compared with treatment as usual. Among participants with better diabetes control at baseline, TTIM participants had better diabetes control at 60 weeks compared with recipients of treatment as usual.
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Affiliation(s)
- Martha Sajatovic
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Douglas D Gunzler
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Stephanie W Kanuch
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Kristin A Cassidy
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Curtis Tatsuoka
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Richard McCormick
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Carol E Blixen
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Adam T Perzynski
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Douglas Einstadter
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Charles L Thomas
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Mary E Lawless
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Siobhan Martin
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Corinna Falck-Ytter
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Eileen L Seeholzer
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Christine L McKibben
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Mark S Bauer
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Neal V Dawson
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
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Ward MC, Druss BG. Reverse Integration Initiatives for Individuals With Serious Mental Illness. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2017; 15:271-278. [PMID: 31975857 PMCID: PMC6519558 DOI: 10.1176/appi.focus.20170011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Medical progress has greatly extended the life span of individuals living in the United States, yet certain groups have lagged behind in achieving wellness and longevity. Prominent among these are individuals with serious mental illness. Because of this, various initiatives have been launched at the community, state, and national level to improve the medical care of those with serious mental illness. Many of these initiatives promote "reverse integration," or the provision of collaborative care services in behavioral health locations. Despite significant barriers to implementation, these initiatives have shown moderate success in improving medical outcomes for those with serious mental illness, in both research and "real-life" settings. Additionally, the role of psychiatrists in addressing physical health has been explored, and there is a need for educational opportunities to optimize competency in this area. Overall, work still needs to be done before the mortality gap for those with serious mental illness dissipates.
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Affiliation(s)
- Martha C Ward
- Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Medicine, Emory University School of Medicine, Atlanta. Dr. Druss is the Rosalynn Carter Chair in Mental Health, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Benjamin G Druss
- Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Medicine, Emory University School of Medicine, Atlanta. Dr. Druss is the Rosalynn Carter Chair in Mental Health, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
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Blixen CE, Kanuch S, Perzynski AT, Thomas C, Dawson NV, Sajatovic M. Barriers to Self-management of Serious Mental Illness and Diabetes. Am J Health Behav 2016; 40:194-204. [PMID: 26931751 PMCID: PMC4928189 DOI: 10.5993/ajhb.40.2.4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Individuals with serious mental illness (SMI) (major depressive disorder, bipolar disorder, schizophrenia), and diabetes (DM), face significant challenges in managing their physical and mental health. The objective of this study was to assess perceived barriers to self-management among patients with both SMI and DM in order to inform healthcare delivery practices. METHODS We conducted 20 in-depth interviews with persons who had diagnoses of both SMI and DM. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. RESULTS Transcript-based analysis generated 3 major domains of barriers to disease self-management among patients with both DM and SMI: (1) personal level barriers (stress, isolation, stigma); (2) family and community level barriers (lack of support from family and friends); and (3) provider and health care system level barriers (poor relationships and communication with providers, fragmentation of care). CONCLUSIONS Care approaches that provide social support, help in managing stress, optimize communication with providers, and reduce compartmentalization of medical and psychiatric care are needed to help these vulnerable individuals avoid health complications and premature mortality.
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Affiliation(s)
- Carol E Blixen
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.
| | - Stephanie Kanuch
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Adam T Perzynski
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Charles Thomas
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Neal V Dawson
- Epidemiology & Biostatistics, Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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Abstract
Since the beginning of the twenty-first century, research on stigma has continued. Building on conceptual and empirical work, the recent period clarifies new types of stigmas, expansion of measures, identification of new directions, and increasingly complex levels. Standard beliefs have been challenged, the relationship between stigma research and public debates reconsidered, and new scientific foundations for policy and programs suggested. We begin with a summary of the most recent Annual Review articles on stigma, which reminded sociologists of conceptual tools, informed them of developments from academic neighbors, and claimed findings from the early period of "resurgence." Continued (even accelerated) progress has also revealed a central problem. Terms and measures are often used interchangeably, leading to confusion and decreasing accumulated knowledge. Drawing from this work but focusing on the past 14 years of stigma research (including mental illness, sexual orientation, HIV/AIDS, and race/ethnicity), we provide a theoretical architecture of concepts (e.g., prejudice, experienced/received discrimination), drawn together through a stigma process (i.e., stigmatization), based on four theoretical premises. Many characteristics of the mark (e.g., discredited, concealable) and variants (i.e., stigma types and targets) become the focus of increasingly specific and multidimensional definitions. Drawing from complex and systems science, we propose a stigma complex, a system of interrelated, heterogeneous parts bringing together insights across disciplines to provide a more realistic and complicated sense of the challenge facing research and change efforts. The Framework Integrating Normative Influences on Stigma (FINIS) offers a multilevel approach that can be tailored to stigmatized statuses. Finally, we outline challenges for the next phase of stigma research, with the goal of continuing scientific activity that enhances our understanding of stigma and builds the scientific foundation for efforts to reduce intolerance.
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Jia H, Zack MM, Thompson WW, Crosby AE, Gottesman II. Impact of depression on quality-adjusted life expectancy (QALE) directly as well as indirectly through suicide. Soc Psychiatry Psychiatr Epidemiol 2015; 50:939-49. [PMID: 25660550 PMCID: PMC4590980 DOI: 10.1007/s00127-015-1019-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 01/27/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE To estimate quality-adjusted life expectancy (QALE) loss among US adults due to depression and QALE losses associated with the increased risk of suicide attributable to depression. METHOD We ascertained depressive symptoms using the eight-item Patient Health Questionnaire (PHQ-8) on the 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys. We estimated health-related quality of life (HRQOL) scores from BRFSS data (n = 276,442) and constructed life tables from US Compressed Mortality Files to calculate QALE by depression status. QALE loss due to depression is the difference in QALE between depressed and non-depressed adults. QALE loss associated with suicide deaths is the difference between QALE from only those deaths that did not have suicide recorded on the death certificate and QALE from all deaths including those with a suicide recorded on the death certificate. RESULTS At age 18, QALE was 28.0 more years for depressed adults and 56.8 more years for non-depressed adults, a 28.9-year QALE loss due to depression. For depressed adults, only 0.41 years of QALE loss resulted from deaths by suicide, and only 0.26 years of this loss could be attributed to depression. CONCLUSION Depression symptoms lead to a significant burden of disease from both mortality and morbidity as assessed by QALE loss. The 28.9-year QALE loss at age 18 associated with depression markedly exceeds estimates reported elsewhere for stroke (12.4-year loss), heart disease (10.3-year loss), diabetes mellitus (11.1-year loss), hypertension (6.3-year loss), asthma (7.0-year loss), smoking (11.0-year loss), and physical inactivity (8.0-year loss).
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Affiliation(s)
- Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, USA,
| | - Matthew M. Zack
- Division of Population Health, National Center for Chronic, Disease Prevention and Health Promotion, Centers for Disease, Control and Prevention, Atlanta, GA, USA,
| | - William W. Thompson
- Division of Population Health, National Center for Chronic, Disease Prevention and Health Promotion, Centers for Disease, Control and Prevention, Atlanta, GA, USA
| | - Alex E. Crosby
- Division of Violence Prevention, National Center for Injury, Prevention and Control, Centers for Disease Control and, Prevention, Atlanta, GA, USA,
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Disability status, mortality, and leading causes of death in the United States community population. Med Care 2015; 53:346-54. [PMID: 25719432 DOI: 10.1097/mlr.0000000000000321] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined the effect of functional disability on all-cause mortality and cause-specific deaths among community-dwelling US adults. METHODS We used data from 142,636 adults who participated in the 1994-1995 National Health Interview Survey-Disability Supplement eligible for linkage to National Death Index records from 1994 to 2006 to estimate the effects of disability on mortality and leading causes of death. RESULTS Adults with any disability were more likely to die than adults without disability (19.92% vs. 10.94%; hazard ratio=1.51, 95% confidence interval, 1.45-1.57). This association was statistically significant for most causes of death and for most types of disability studied. The leading cause of death for adults with and without disability differed (heart disease and malignant neoplasms, respectively). CONCLUSIONS Our results suggest that all-cause mortality rates are higher among adults with disabilities than among adults without disabilities and that significant associations exist between several types of disability and cause-specific mortality. Interventions are needed that effectively address the poorer health status of people with disabilities and reduce the risk of death.
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Carson NE, Blake CE, Saunders R. Perceptions and dietary intake of self-described healthy and unhealthy eaters with severe mental illness. Community Ment Health J 2015; 51:281-8. [PMID: 25535051 DOI: 10.1007/s10597-014-9806-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 12/08/2014] [Indexed: 12/01/2022]
Abstract
The aim of this exploratory study was to examine how community-dwelling adults with severe mental illness describe themselves as eaters and how these eating identities relate to dietary intake. Twenty participants completed one in-depth qualitative interview and three 24-h dietary recalls. Two distinct groups were identified; self-described healthy eaters (n = 10) and self-described unhealthy eaters (n = 10). Healthy eaters emphasized fruits and vegetables, limiting sweets, three meals a day, overcoming cost concerns, and benefits of healthy eating. Unhealthy eaters emphasized junk foods, fried foods, few fruits and vegetables, cost and household barriers to healthy eating, and concerns about consequences of unhealthy eating. Self-described healthy eaters consumed significantly more vegetables and less kilocalories, carbohydrates, fat, and saturated fat than self-described unhealthy eaters. Understanding how eating identities relate to dietary intake provides important insights for development of more effective approaches to promote healthy eating in this high risk population.
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Affiliation(s)
- Nancy E Carson
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA,
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Mortality of people suffering from mental illness: a study of a cohort of patients hospitalised in psychiatry in the north of France. Soc Psychiatry Psychiatr Epidemiol 2015; 50:269-77. [PMID: 25028200 DOI: 10.1007/s00127-014-0913-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The mortality of people suffering from psychiatric illnesses is far higher than that of the general population, all categories of diagnosis combined; mortality statistics can be used as an index of quality of care. The aim of this study was to assess the all-cause mortality in psychiatric patients covering all diagnostic groups. METHODS The living or deceased status of 4,417 patients of majority age hospitalised in a public mental health establishment between 2004 and 2007 were requested from French National Institute for Statistics and Economic Studies on 1st January 2011. The cause of death of those people who had died was obtained from French National Institute for Health and Medical Research and comparative standardized mortality ratios (SMR) were established from the population in a region of northern France of the same age in 2006. RESULTS The study population was made up of 54% men and 46% women, median age 41 and 45 years old, respectively. Four hundred and seventy-three people died during the period studied. The SMR were 421 for men (95% CI 378-470) and 330 for women (95% CI 281-388). The highest SMRs were found in patients aged 35-54, with a 20-time higher mortality risk than the general population of the same age. CONCLUSION Our study confirms the considerably higher mortality in psychiatric patients than in general population, particularly in mean age and mostly due to an unnatural cause.
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Rodway C, Flynn S, While D, Rahman MS, Kapur N, Appleby L, Shaw J. Patients with mental illness as victims of homicide: a national consecutive case series. Lancet Psychiatry 2014; 1:129-34. [PMID: 26360576 DOI: 10.1016/s2215-0366(14)70221-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The media attention received by homicides committed by patients with mental illness is thought to increase stigma. However, people with mental illness can also be victims of violence. We aimed to assess how often victims of homicide are current mental health patients and their relationship to the perpetrators. METHODS In a national consecutive case-series study, we obtained data for victims and perpetrators of all confirmed homicides between Jan 1, 2003, and Dec 31, 2005, in England and Wales. We requested information about contact with mental health services in the 12 months before the homicide for all victims and perpetrators. For victims and perpetrators who had contact with mental health services in the 12 months before homicide, we sent questionnaires to the clinician responsible for the patient's care. FINDINGS 1496 victims of confirmed homicide died between Jan 1, 2003, and Dec 31, 2005, in England and Wales. Patients with mental illness were more likely to die by homicide than were people in the general population (incidence rate ratio 2·6, 95% CI 1·9-3·4). 90 homicide victims (6%) had contact with mental health services in the 12 months before their death. 213 patients with mental illness were convicted of homicide in the same 3 year period. 29 of 90 patient victims were killed by another patient with mental illness. In 23 of these 29 cases, the victim and perpetrator were known to each other, and in 21 of these cases, the victims and perpetrators were undergoing treatment at the same National Health Service Trust. In these 29 cases in which patient victims were killed by another patient with mental illness, alcohol and drug misuse (19 victims [66%], 27 perpetrators [93%]) and previous violence (7 victims [24%], 7 perpetrators [24%]) were common in both victims and, particularly, perpetrators. In seven of the 29 cases in which the victim was killed by another patient with mental illness, both victim and perpetrator were diagnosed with schizophrenia. INTERPRETATION The high risk of patients with mental illness being victims of homicide is an important antistigma message, although this risk partly comes from other patients with mental illness; overall, the risk of patients committing homicide is greater than the risk of being a victim of homicide. Identification and safeguarding of patients at risk of violence should be prominent in clinical risk assessment. FUNDING Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Cathryn Rodway
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK.
| | - Sandra Flynn
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - David While
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Mohammed S Rahman
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Navneet Kapur
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Louis Appleby
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
| | - Jenny Shaw
- Centre for Mental Health and Risk, University of Manchester, Manchester, UK
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Training peer educators to promote self-management skills in people with serious mental illness (SMI) and diabetes (DM) in a primary health care setting. Prim Health Care Res Dev 2014; 16:127-37. [PMID: 24703014 DOI: 10.1017/s1463423614000176] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM To describe the training and participant experience of patients with both severe mental illness (SMI) and diabetes (DM) who were enrolled in a Peer Educator Training Program adapted to a primary health care setting. BACKGROUND The mortality of patients with both SMI and DM is high. Illness self-management includes medications, psychosocial treatments, and healthy behaviors, yet treatment engagement is often sub-optimal with adherence rates of 52% for diabetic medications and 62% for antipsychotic medications among the SMI. To address this problem, a new behavioral intervention study targeting SMI and DM self-management used trained peer educators (PEs) with the same chronic conditions to enhance program effectiveness. A manual facilitated training on intervention topics such as SMI and DM therapies, stress management, and stigma reduction as well as training in group intervention techniques, telephone skills, and crisis management. METHODS We assessed PE attitudes and input using in-depth face-to-face interviews. Interviews were audio-taped, transcribed, coded, and analyzed using the classic method of content analysis emphasizing dominant themes. A member check-in was conducted where participants commented on analysis results. FINDINGS Six relevant descriptive themes emerged: (1) positive group experience; (2) success with learning manual content; (3) increased knowledge about SMI and DM; (4) improved self-management skills; (5) increased self-confidence and self-efficacy in becoming a PE; and being (6) united in purpose to help others self-manage their SMI and DM. Qualitative evidence supports structured training for SMI-DM PEs. Key components include written educational materials and the power of the group process to increase knowledge, self-management skills, confidence, and self-efficacy. Recommendations are offered to support further endeavors to mobilize peers with SMI to help other patients with complex comorbidities better manage their own health.
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Chang CK, Hayes RD, Broadbent MTM, Hotopf M, Davies E, Møller H, Stewart R. A cohort study on mental disorders, stage of cancer at diagnosis and subsequent survival. BMJ Open 2014; 4:e004295. [PMID: 24477317 PMCID: PMC3913023 DOI: 10.1136/bmjopen-2013-004295] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To assess the stage at cancer diagnosis and survival after cancer diagnosis among people served by secondary mental health services, compared with other local people. SETTING Using the anonymised linkage between a regional monopoly secondary mental health service provider in southeast London of four London boroughs, Croydon, Lambeth, Lewisham and Southwark, and a population-based cancer register, a historical cohort study was constructed. PARTICIPANTS A total of 28 477 cancer cases aged 15+ years with stage of cancer recorded at diagnosis were identified. Among these, 2206 participants had been previously assessed or treated in secondary mental healthcare before their cancer diagnosis and 125 for severe mental illness (schizophrenia, schizoaffective or bipolar disorders). PRIMARY AND SECONDARY OUTCOME MEASURES Stage when cancer was diagnosed and all-cause mortality after cancer diagnosis among cancer cases registered in the geographical area of southeast London. RESULTS Comparisons between people with and without specific psychiatric diagnosis in the same residence area for risks of advanced stage of cancer at diagnosis and general survival after cancer diagnosed were analysed using logistic and Cox models. No associations were found between specific mental disorder diagnoses and beyond local spread of cancer at presentation. However, people with severe mental disorders, depression, dementia and substance use disorders had significantly worse survival after cancer diagnosis, independent of cancer stage at diagnosis and other potential confounders. CONCLUSIONS Previous findings of associations between mental disorders and cancer mortality are more likely to be accounted for by differences in survival after cancer diagnosis rather than by delayed diagnosis.
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Affiliation(s)
- Chin-Kuo Chang
- King's College London (Institute of Psychiatry), London, UK
| | | | | | - Matthew Hotopf
- King's College London (Institute of Psychiatry), London, UK
| | - Elizabeth Davies
- King's College London (Section of Cancer Epidemiology and Population Health), London, UK
| | - Henrik Møller
- King's College London (Section of Cancer Epidemiology and Population Health), London, UK
| | - Robert Stewart
- King's College London (Institute of Psychiatry), London, UK
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Prakash J, Ramakrishnan T, Das RC, Srivastava K, Mehta S, Shashikumar R. Central registry in psychiatry: A structured review. Ind Psychiatry J 2014; 23:10-4. [PMID: 25535438 PMCID: PMC4261206 DOI: 10.4103/0972-6748.144939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Central registry in psychiatry is being practiced in few countries and has been found useful in research and clinical management. Role of central registry has also expanded over the years. MATERIALS AND METHODS All accessible internet database Medline, Scopus, Embase were accessed from 1990 till date. Available data were systematically reviewed in structured manner and analyzed. RESULTS Central registry was found useful in epidemiological analysis, association studies, outcome studies, comorbidity studies, forensic issue, effective of medication, qualitative analysis etc.. CONCLUSION Central registry proves to be effective tool in quantitative and qualitative understanding of psychiatry practice. Findings of studies from central registry can be useful in modifying best practice and evidence based treatment in psychiatry.
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Affiliation(s)
- Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ts Ramakrishnan
- Associate Professor, Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - R C Das
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - K Srivastava
- Scientist F and Clinical Psychologist, Armed Forces Medical College, Pune, Maharashtra, India
| | - Suresh Mehta
- Department of Psychiatry, DY Patil Medical College, Pune, Maharashtra, India
| | - R Shashikumar
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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Rentmeester CA. Challenges for policy makers and organizational leaders: addressing trends in mental health inequalities. Int J Health Policy Manag 2013; 1:99-101. [PMID: 24596844 DOI: 10.15171/ijhpm.2013.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/17/2013] [Indexed: 11/09/2022] Open
Abstract
We typically think of acutely and chronically mentally ill patients as those who belong in psychiatric hospitals and the latter category of patients belonging in "regular" hospitals, but the intersection of physical and mental illness draws attention to important challenges for policy makers and organizational leaders. This article illuminates some broad trends in the health status of people with mental illnesses, canvasses important features of inequalities suffered by people with mental illnesses, and suggests strategies for systemic reform. Most reform recommendations I offer are in the area of healthcare organization leadership and management. Other key reforms will likely be legislative, regulatory, and insurance-related. Social and cultural reforms in organizational practices and structures will also be critical.
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Affiliation(s)
- Christy A Rentmeester
- Center for Health Policy and Ethics, School of Medicine, Creighton University, Omaha, Nebraska, USA
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Lemogne C, Nabi H, Melchior M, Goldberg M, Limosin F, Consoli SM, Zins M. Mortality associated with depression as compared with other severe mental disorders: a 20-year follow-up study of the GAZEL cohort. J Psychiatr Res 2013; 47:851-7. [PMID: 23590806 DOI: 10.1016/j.jpsychires.2013.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 11/19/2022]
Abstract
Individuals with severe mental disorders (SMD) have an increased risk of mortality from somatic diseases. This study examined whether this risk is different in persons with depressive disorders compared to those with other SMD (i.e. schizophrenia and bipolar disorder). In 1989, 20,625 employees of the French national gas and electricity company (15,011 men and 5614 women, aged 35-50) agreed to participate in the GAZEL cohort study. Three diagnosis groups were created based on sick leave spells from 1978 onwards: 1) no SMD, 2) depressive disorders and 3) other SMD. Dates and causes of death were available from January 1, 1990 to December 31, 2010. The association of diagnosis groups with mortality was estimated with hazard ratios (HR) and 95% confidence intervals (CI) computed using Cox regression. During a mean follow-up of 19.8 years, 1544 participants died, including 1343 from a natural cause, of which 258 died from cardiovascular diseases. After adjustment for age, gender, occupational status, alcohol consumption, smoking and body-mass index, participants with a history of sickness absence for SMD had a greater risk of natural mortality (HR: 1.24, CI: 1.08-1.43), cardiovascular mortality (HR: 1.49, CI: 1.08-2.05) and non-cardiovascular natural mortality (HR: 1.19, CI: 1.02-1.39). Compared to depressive disorders, other SMD were associated with an increased risk of natural mortality (HR: 1.94, CI: 1.17-3.22) and cardiovascular mortality (HR: 3.58, CI: 1.53-8.39). Job security and systematic medical follow-up may fall short of preventing premature death among workers with sickness absence due to SMD.
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Affiliation(s)
- Cédric Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
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Reynolds RJ, Becker EA, Shafer AB. Causes of death and comparative mortality in Texas public mental health clients, 2006–2008. Ment Health Clin 2013. [DOI: 10.9740/mhc.n161217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Seriously mentally ill patients are known to have rates of mortality much greater than those of the general population. Prior research in Texas has shown inpatient Public Mental Health Clients (PMHCs) treated in in-patient settings were subject to greatly increased mortality, but little is known about the mortality of PMHCs in an outpatient setting in Texas.
For this study outpatient service records for PMHCs treated in Texas were combined with death data from the Texas Department of State Health Services for 2006–2008. Frequencies of causes of death, age-adjusted death rates, standardized mortality ratios, and life expectancies were calculated from these data.
The most frequent causes of death were external causes, followed by circulatory disease, and then neoplasms. Examination of the outcomes suggests that substance abuse plays a major role in the mortality of PMHCs in Texas in the form of drug overdoses, tobacco-related cancers, and alcoholic liver disease. Prevention efforts should therefore aim at integrating mental health services, substance abuse services, and careful medical and pharmacological monitoring, including medication monitoring to prevent suicides and accidental overdoses.
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Affiliation(s)
| | - Emilie A. Becker
- 2 Corresponding author, Texas Medicaid Chip Mental Health Director, Texas Health and Human Services Commission, Austin, Texas
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Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ 2013; 346:f2539. [PMID: 23694688 PMCID: PMC3660620 DOI: 10.1136/bmj.f2539] [Citation(s) in RCA: 526] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To examine the mortality experience of psychiatric patients in Western Australia compared with the general population. DESIGN Population based study. SETTING Western Australia, 1985-2005. PARTICIPANTS Psychiatric patients (292,585) registered with mental health services in Western Australia. MAIN OUTCOME MEASURES Trends in life expectancy for psychiatric patients compared with the Western Australian population and causes of excess mortality, including physical health conditions and unnatural causes of death. RESULTS When using active prevalence of disorder (contact with services in previous five years), the life expectancy gap increased from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females between 1985 and 2005. Additionally, 77.7% of excess deaths were attributed to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%). Suicide was the cause of 13.9% of excess deaths. CONCLUSIONS Despite knowledge about excess mortality in people with mental illness, the gap in their life expectancy compared with the general population has widened since 1985. With most excess deaths being due to physical health conditions, public efforts should be directed towards improving physical health to reduce mortality in people with mental illness, in addition to ongoing efforts to prevent suicide.
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Affiliation(s)
- David Lawrence
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, PO Box 855 West Perth WA 6872 Australia.
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Sherman ME, Knudsen KJ, Sweeney HA, Tam K, Musuuza J, Koroukian SM. Analysis of causes of death for all decedents in Ohio with and without mental illness, 2004-2007. Psychiatr Serv 2013; 64:245-51. [PMID: 23318767 PMCID: PMC4167627 DOI: 10.1176/appi.ps.201100238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study compared causes of death, crude mortality rates, and standardized mortality ratios (SMRs) between decedents with mental illness in Ohio's publicly funded mental health system ("mental illness decedents") and all Ohio decedents. METHODS Ohio death certificates and Ohio Department of Mental Health service utilization data were used to assess mortality among decedents from 2004 to 2007. Age-adjusted SMRs and age-adjusted mortality rates were calculated across race and sex strata. RESULTS Mental illness decedents accounted for 3.3% of all 438,749 Ohio deaths. Age-adjusted SMRs varied widely across the race and sex strata and by cause of death. Nonblacks with or without mental illness showed higher SMRs than blacks. Nonblack females with mental illness showed the highest SMRs in injury-related deaths. Higher SMRs were found for deaths associated with substance abuse; mental illness; diabetes; issues related to the nervous, cardiovascular, or respiratory systems; and injury. With and without mental illness, the top cause of death was violence for youths and cardiovascular disease for adults >35. CONCLUSIONS Deaths from injury and violence, especially among those <35, should be specifically addressed to reduce excess mortality for persons with mental illness. Mental health care should be integrated with primary care to better manage chronic disease, especially cardiovascular disease. Methodological contributions included use of linked files to compare SMR and leading causes of death between mental illness decedents and all Ohio decedents. More research is needed on patterns in cause of death and any interactions from demographic characteristics and mental illness. Health care data silos must be bridged between private and public sectors and the Departments of Veterans Affairs and Defense.
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Affiliation(s)
- Marion E Sherman
- VA Gulf Coast Veterans Health Care System, US Department of Veterans Affairs, Biloxi, MS 39531, USA.
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Osborn DPJ, Limburg H, Walters K, Petersen I, King M, Green J, Watson J, Nazareth I. Relative incidence of common cancers in people with severe mental illness. Cohort study in the United Kingdom THIN primary care database. Schizophr Res 2013; 143:44-9. [PMID: 23218562 DOI: 10.1016/j.schres.2012.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND A recent United Kingdom (UK) report found that breast and colorectal cancers were more common in people with severe mental illness (SMI) and recommended targeted screening. Epidemiological evidence is however inconsistent. OBJECTIVES To estimate relative incidence rates for colorectal, breast and lung cancer, and the overall incidence of the commonest other UK cancers, in people with SMI compared with people without SMI. METHOD Cohort study in the UK using The Health Improvement Network (THIN) primary care database between 1990 and June 2008. Poisson regression was used to obtain adjusted incidence rate ratios (IRRs) for cancer, comparing two cohorts of people over 18; with and without a diagnosis of SMI. RESULTS We identified 20,632 people with SMI and 116,152 people without, with median follow up of over 6years. No significant associations were observed between SMI and cancers of the breast (adjusted IRR 1.17; 95% confidence interval 0.95-1.45), colon (0.70; 0.46-1.05), rectum (1.05; 0.65-1.69) or lung (0.84; 0.65-1.10). The adjusted IRR for an aggregate cancer outcome in SMI was 0.95; 0.85-1.06. Results were similar for schizophrenia and bipolar disorder. CONCLUSIONS In a cohort analysis within a large UK primary care database, the incidence of colo-rectal, breast and lung cancer, and of all common cancers, did not differ significantly in people with SMI, including schizophrenia, compared with people without SMI. Our results do not support enhanced screening procedures for cancer in people with SMI.
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Affiliation(s)
- David P J Osborn
- UCL Mental Health Sciences Unit, UCL, Charles Bell House, Riding House Street, London W1W 7EJ, UK.
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Kasckow J, Appelt C, Haas GL, Huegel S, Fox L, Gurklis J, Zickmund S, Daley D. Development of a recovery manual for suicidal patients with schizophrenia: consumer feedback. Community Ment Health J 2012; 48:564-7. [PMID: 22187086 PMCID: PMC3535324 DOI: 10.1007/s10597-011-9477-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 11/29/2011] [Indexed: 11/24/2022]
Abstract
A recovery-oriented manual was developed for patients with schizophrenia and suicidality. It included psychoeducational information, vignettes, "workbook" sections and was reviewed by experts in suicidology, recovery, patient education, manual development and psychosocial interventions. The revised version was tested in 22 consumers with schizophrenia and a history of suicidality. Consumer-based focus groups yielded five key themes which were used to further refine the manual. A satisfaction survey indicated that 85% stated the manual was 'somewhat easy', 'easy' or 'very easy to read.' All stated it was 'very useful', 'useful' or 'somewhat useful. Thus, the manual appears to be acceptable and useful.
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Affiliation(s)
- J Kasckow
- VA Pittsburgh Health Care System MIRECC, Behavioral Health, 7180 Highland Dr, Pittsburgh, PA 15206, USA.
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Athay MM. Caregiver life satisfaction: relationship to youth symptom severity through treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 41:433-44. [PMID: 22571285 DOI: 10.1080/15374416.2012.684273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study utilized the Satisfaction with Life Scale to investigate the life satisfaction of caregivers for youth receiving mental health services (N = 383). Specifically, this study assessed how caregiver life satisfaction relates to youth symptom severity throughout treatment. Hierarchical linear modeling with a time-varying covariate was used to estimate the linear trajectory of caregiver life satisfaction and how it relates to youth symptom severity as rated by caregivers, youth, and clinicians. Results found initial caregiver life satisfaction was inversely related to caregiver and clinician rated youth symptom severity. In addition, subsequent caregiver life satisfaction demonstrated a small but significant relationship to changes in youth symptom severity during treatment where a decrease in youth symptoms corresponded to an increase in caregiver life satisfaction, and vice versa. Caregiver background characteristics related to higher life satisfaction included being (a) married, a birth parent, and younger than 40 years old, and (b) having the absence of previous diagnoses of an emotional, behavioral, or substance use disorder. Despite significant change over time, caregivers of clinically referred youth demonstrated low levels of life satisfaction throughout youth treatment. Given the bidirectional influences on one another, tending to the well-being of caregivers may positively influence both caregivers and youths.
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Affiliation(s)
- M Michele Athay
- Center for Evaluation and Program Improvement, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203, USA.
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The impact of shelter use and housing placement on mortality hazard for unaccompanied adults and adults in family households entering New York City shelters: 1990-2002. J Urban Health 2011; 88:1091-104. [PMID: 21809153 PMCID: PMC3232418 DOI: 10.1007/s11524-011-9602-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study examines mortality among New York City (NYC) homeless shelter users, assessing the relationships between mortality hazard and time in shelter, patterns of homelessness, and subsequent housing exits for both adults in families and single adults. Administrative records from the NYC shelter system were matched with death records from the Social Security Administration for 160,525 persons. Crude mortality rates and life tables were calculated, and survival analyses were undertaken using these data. Life expectancy was 64.2 and 68.6 years for single adult males and single adult females, respectively, and among adults in families, life expectancy was 67.2 and 70.1 years for males and females, respectively. For both groups, exits to stable housing (subsidized or non-subsidized) were associated with reduced mortality hazard. And while mortality hazard was substantially reduced for the time adults were in shelters, extended shelter use patterns were associated with increased mortality hazard. Differences between single homelessness and family homelessness extend to disparities in mortality rates. Although causal links cannot be established here, results suggest that, for both subgroups of the homeless population, prompt resolution of homelessness and availability of housing interventions may contribute to reduced mortality.
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Associations between substance use disorder sub-groups, life expectancy and all-cause mortality in a large British specialist mental healthcare service. Drug Alcohol Depend 2011; 118:56-61. [PMID: 21440382 DOI: 10.1016/j.drugalcdep.2011.02.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 02/10/2011] [Accepted: 02/25/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with substance use disorders (SUDs) have increased risk of mortality but risk in sub-groups is poorly understood. METHODS SUD cases, aged 15 years or older, were identified in the South London and Maudsley Case Register which contains over 150,000 specialist mental healthcare and addictions service users linked to regular national mortality tracing. Standardized mortality ratios (SMRs) for the period 2007-2009 were calculated based on expected numbers of deaths for England and Wales in 2008 then stratified by gender, age, ethnicity, and type of substance use disorder. Life expectancies at birth were estimated. RESULTS We detected 10,927 cases with a primary substance use disorder diagnosis prior to 2010, who were active to South London and Maudsley NHS Foundation Trust services between 2007 and 2009. Alcohol and opioid use disorders were the most common disorders (45.4% and 44.2% of the SUD cohort respectively) and were associated with increased mortality (SMRs 4.04 and 4.85 respectively). Subgroups at particularly high risk were women with opioid use disorder (SMR 7.32) and those under the age of 45 years with alcohol use disorder (SMR 9.25). SMRs associated with alcohol and opioid use disorders diminished with age. Life expectancies of individuals with alcohol and opioid use disorders were reduced by 9-17 years compared to national norms. CONCLUSIONS Those under 45 years with alcohol use disorder and women with opioid use disorder are at particularly high risk of mortality. More targeted health care is required to address the specific needs of these vulnerable subgroups.
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de las Cuevas C, Ramallo Y, Sanz EJ. Are obesity and other physical comorbidities related to mental illness? ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.rpsmen.2011.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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de las Cuevas C, Ramallo Y, Sanz EJ. ¿Están relacionadas la obesidad y otras comorbilidades físicas con la enfermedad mental? REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2011; 4:119-25. [DOI: 10.1016/j.rpsm.2011.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 02/13/2011] [Accepted: 02/18/2011] [Indexed: 10/17/2022]
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Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS One 2011; 6:e19590. [PMID: 21611123 PMCID: PMC3097201 DOI: 10.1371/journal.pone.0019590] [Citation(s) in RCA: 420] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 04/01/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Despite improving healthcare, the gap in mortality between people with serious mental illness (SMI) and general population persists, especially for younger age groups. The electronic database from a large and comprehensive secondary mental healthcare provider in London was utilized to assess the impact of SMI diagnoses on life expectancy at birth. METHOD People who were diagnosed with SMI (schizophrenia, schizoaffective disorder, bipolar disorder), substance use disorder, and depressive episode/disorder before the end of 2009 and under active review by the South London and Maudsley NHS Foundation Trust (SLAM) in southeast London during 2007-09 comprised the sample, retrieved by the SLAM Case Register Interactive Search (CRIS) system. We estimated life expectancy at birth for people with SMI and each diagnosis, from national mortality returns between 2007-09, using a life table method. RESULTS A total of 31,719 eligible people, aged 15 years or older, with SMI were analyzed. Among them, 1,370 died during 2007-09. Compared to national figures, all disorders were associated with substantially lower life expectancy: 8.0 to 14.6 life years lost for men and 9.8 to 17.5 life years lost for women. Highest reductions were found for men with schizophrenia (14.6 years lost) and women with schizoaffective disorders (17.5 years lost). CONCLUSION The impact of serious mental illness on life expectancy is marked and generally higher than similarly calculated impacts of well-recognised adverse exposures such as smoking, diabetes and obesity. Strategies to identify and prevent causes of premature death are urgently required.
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Verhaeghe N, De Maeseneer J, Maes L, Van Heeringen C, Annemans L. Effectiveness and cost-effectiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: a systematic review. Int J Behav Nutr Phys Act 2011; 8:28. [PMID: 21481247 PMCID: PMC3094265 DOI: 10.1186/1479-5868-8-28] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 04/11/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is a high prevalence of overweight and obesity in persons with severe mental disorders and this has serious implications on the short and long term health outcomes of these patients. The aim of this review was to evaluate the effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders. Special attention was given if any of the included studies in the review also examined the cost-effectiveness of these health promotion interventions. METHODS A systematic search through the electronic databases Medline, Web of Science, CINAHL and Cohrane Library was conducted, and by hand-searching the reference lists of the retrieved articles from the electronic databases. Studies were included if they examined effectiveness and/or cost-effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders, with primary outcome changes in Body Mass Index and body weight. RESULTS Fourteen studies met the inclusion criteria. Weight loss and Body Mass Index decrease were observed in intervention groups in 11 studies. The difference in weight change between intervention and control groups was statistically significant in nine studies. Differences in mean Body Mass Index between intervention and control groups were statistically significant in eight studies. Five studies reported improvements in quality of life and general health. In none of the studies cost-effectiveness of lifestyle interventions was examined. CONCLUSION Further research on both effectiveness and cost-effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders is required to assist in the development of new health promotion interventions in this population.
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Affiliation(s)
- Nick Verhaeghe
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Jan De Maeseneer
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Lea Maes
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Cornelis Van Heeringen
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 B-1090 Brussel, Belgium
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Mookhoek EJ, Van De Kerkhof PCM, Hovens JEJM, Brouwers JRBJ, Loonen AJM. Skin disorders in chronic psychiatric illness. J Eur Acad Dermatol Venereol 2011; 24:1151-6. [PMID: 20236199 DOI: 10.1111/j.1468-3083.2010.03609.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. OBJECTIVE To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. METHODS Ninety-one randomly chosen patients of the residential wards of a general psychiatric hospital completed a short, structured interview concerning skin disease and underwent a physical examination of the skin. RESULTS Of the examined patients, 69% reported symptoms of skin disease in the month prior to the interview and 77% had skin disorders at physical examination. In 34 (37%) patients, skin disorders were diagnosed, which were not mentioned in the interview. Patients with diabetes had infectious skin disease more often than their fellow patients [odds ratio (OR) 10.9; 95% confidence interval (CI): 2.40-49.75]. Moreover, overweight patients had infectious skin disease more often (OR 7.4; 95% CI: 1.38-39.3). Women reported more skin complaints (OR 6.4: 95% CI: 1.67-24.2), and also had skin problems other than infection, tumours or dermatitis more frequently (OR 3.7; 95% CI: 1.34-10.14). Clozapine use was associated with benign neoplasms of the skin. The nature of this association remains unclear and merits further investigation. CONCLUSIONS Many chronic psychiatric patients have skin problems. Clinical examination of the skin is important to discover these problems. Patients with diabetes mellitus are particularly at risk for skin infections. Because of their relationship with overweight and diabetes mellitus, atypical antipsychotics may be partly responsible for these serious complications. Only a few other relationships between psychiatric medication and specific skin problems were found.
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Affiliation(s)
- E J Mookhoek
- Department of Pharmacy, Division of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands
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Scott D, Happell B. The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness. Issues Ment Health Nurs 2011; 32:589-97. [PMID: 21859410 DOI: 10.3109/01612840.2011.569846] [Citation(s) in RCA: 275] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent mental health care policy has addressed the need for health care professionals to consider the physical health of consumers. Mental health nurses are particularly well-placed for this role. To provide mental health nurses with practical information, this narrative review summarises evidence from recent research on the physical health of individuals with Serious Mental Illness (SMI). In those with SMI, the international prevalence of obesity, the metabolic syndrome, diabetes mellitus, symptoms of cardiovascular disease, and respiratory disease all exceed that of the general population by at least two times, and HIV prevalence may be increased by as much as eight times. This increased prevalence of chronic disease may be largely responsible for an increased risk of death of up to five times, resulting in as much as 30 years of potential life lost. Of particular concern, the recent evidence suggests that for physical health and increased mortality, the gap between individuals with SMI and the general population is worsening. Unhealthy lifestyle behaviours undoubtedly play a role in the development of poor physical health and chronic disease, and the present review indicates that low physical activity, poor diet, smoking, alcohol and substance abuse, and risky sexual behaviour are common in individuals with SMI. This narrative review demonstrates that the prevalence of poor physical health and health behaviours in people with SMI far exceed that observed in the general population, and reinforces the urgent need for mental health nurses to address physical health concerns in patients.
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Affiliation(s)
- David Scott
- CQUniversity Australia, Institute for Health and Social Science Research and School of Nursing and Midwifery, Rockhampton, Queensland, Australia
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Lawrence D, Kisely S, Pais J. The epidemiology of excess mortality in people with mental illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:752-60. [PMID: 21172095 DOI: 10.1177/070674371005501202] [Citation(s) in RCA: 171] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE to investigate the burden of excess mortality among people with mental illness in developed countries, how it is distributed, and whether it has changed over time. METHOD we conducted a systematic search of MEDLINE, restricting our attention to peer-reviewed studies and reviews published in English relating to mortality and mental illness. Because of the large number of studies that have been undertaken during the last 30 years, we have selected a representative cross-section of studies for inclusion in our review. RESULTS there is substantial excess mortality in people with mental illness for almost all psychiatric disorders and all main causes of death. Consistently elevated rates have been observed across settings and over time. The highest numbers of excess deaths are due to cardiovascular and respiratory diseases. With life expectancy increasing in the general population, the disparity in mortality outcomes for people with mental illness is increasing. CONCLUSIONS without the development of alternative approaches to promoting and treating the physical health of people with mental illness, it is possible that the disparity in mortality outcomes will persist.
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Affiliation(s)
- David Lawrence
- Centre for Developmental Health, Curtin University of Technology and Telethon Institute for Child Health Research, Perth, Australia.
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Use of HIV and Psychotropic Medications among Persons with Serious Mental Illness and HIV/AIDS. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 38:335-44. [DOI: 10.1007/s10488-010-0320-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vinogradova Y, Coupland C, Hippisley-Cox J, Whyte S, Penny C. Effects of severe mental illness on survival of people with diabetes. Br J Psychiatry 2010; 197:272-7. [PMID: 20884949 DOI: 10.1192/bjp.bp.109.074674] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with mental health problems are more likely to die prematurely than the general population but no study has examined this in individuals with diabetes. AIMS To compare survival rates in people with diabetes with and without schizophrenia or bipolar disorder. METHOD A total of 43,992 people with diabetes were drawn from the QRESEARCH database population of over 9 million patients. Survival rates during the study period, between 1 April 2000 and 1 April 2005, and hazard ratios for deaths associated with schizophrenia and bipolar disorder were adjusted by age and gender and additionally for socioeconomic status, obesity, smoking and use of statins. RESULTS Among the participants, we identified 257 people diagnosed with schizophrenia, 159 with bipolar disorder and 14 with both conditions. Although crude survival rates did not show significant differences between the groups during the study period, people with schizophrenia or bipolar disorder and diabetes, compared with those with diabetes alone, had a significantly increased risk of death after adjusting for age and gender, with hazard ratios for schizophrenia of 1.84 (95% CI 1.42-2.40) and for bipolar disorder of 1.51 (95% CI 1.10-2.07). After adjusting for the other factors, hazard ratios were 1.52 (95 CI 1.17-1.97) for schizophrenia and 1.47 (95% CI 1.07-2.02) for bipolar disorder. CONCLUSIONS People with schizophrenia or bipolar disorder in addition to diabetes have a relatively higher mortality rate. This suggests that diabetes either progresses more rapidly or is more poorly controlled in these individuals, or that they have higher levels of comorbidity and so are more likely to die of other causes.
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Affiliation(s)
- Yana Vinogradova
- Department of Primary Care, Tower Building 13th Floor, University Park, University of Nottingham, Nottingham NG7 2RD, UK.
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Daumit GL, Anthony CB, Ford DE, Fahey M, Skinner EA, Lehman AF, Hwang W, Steinwachs DM. Pattern of mortality in a sample of Maryland residents with severe mental illness. Psychiatry Res 2010; 176:242-5. [PMID: 20207013 PMCID: PMC2966471 DOI: 10.1016/j.psychres.2009.01.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 11/26/2008] [Accepted: 01/04/2009] [Indexed: 11/19/2022]
Abstract
In a cohort of Maryland Medicaid recipients with severe mental illness followed from 1993-2001, we compared mortality with rates in the Maryland general population including race and gender subgroups. Persons with severe mental illness died at a mean age of 51.8 years, with a standardized mortality ratio of 3.7 (95%CI, 3.6-3.7).
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Affiliation(s)
- Gail L Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Factors associated with substance use problem among Maryland Medicaid enrollees affected by serious mental illness. Addict Behav 2009; 34:757-63. [PMID: 19487082 DOI: 10.1016/j.addbeh.2009.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 05/04/2009] [Accepted: 05/11/2009] [Indexed: 11/21/2022]
Abstract
The objective of this study was to identify long-term factors associated with substance use problem among individuals affected by severe mental illness. Prospective data come from the 1994, 1998, and 2000 waves of the Maryland Mental Health Outcomes Survey conducted among a sub-cohort of adult Medicaid recipients affected by serious mental illness. We estimated factors associated with alcohol and drug problem, as well as a hierarchy of substance use problem severity constructed from the alcohol and drug problem outcomes. Drug problem was the strongest factor associated with alcohol problem, and vice versa. Conceptualizing alcohol and drug problem separately, and as a hierarchy of severity, revealed distinct profiles of significant factors. Further research is warranted to explore the utility of modeling substance use problem in terms of a hierarchy of severity.
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Weiser P, Becker T, Losert C, Alptekin K, Berti L, Burti L, Burton A, Dernovsek M, Dragomirecka E, Freidl M, Friedrich F, Genova A, Germanavicius A, Halis U, Henderson J, Hjorth P, Lai T, Larsen JI, Lech K, Lucas R, Marginean R, McDaid D, Mladenova M, Munk-Jørgensen P, Paziuc A, Paziuc P, Priebe S, Prot-Klinger K, Wancata J, Kilian R. European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods. BMC Public Health 2009; 9:315. [PMID: 19715560 PMCID: PMC2741451 DOI: 10.1186/1471-2458-9-315] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 08/28/2009] [Indexed: 11/23/2022] Open
Abstract
Background People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities.
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Affiliation(s)
- Prisca Weiser
- Department of Psychiatry and Psychotherapy II, Ulm University, Günzburg, Germany.
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Macias C, Aronson E, Hargreaves W, Weary G, Barreira PJ, Harvey J, Rodican CF, Bickman L, Fisher W. Transforming Dissatisfaction with Services into Self-Determination: A Social Psychological Perspective on Community Program Effectiveness. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2009; 39:1835-1859. [PMID: 20037662 PMCID: PMC2796807 DOI: 10.1111/j.1559-1816.2009.00506.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A field study of supported employment for adults with mental illness (N=174) provided an experimental test of cognitive dissonance theory. We predicted that most work-interested individuals randomly assigned to a non-preferred program would reject services and lower their work aspirations. However, individuals who chose to pursue employment through a non-preferred program were expected to resolve this dissonance through favorable service evaluations and strong efforts to succeed at work. Significant work interest-by-service preference interactions supported these predictions. Over two years, participants interested in employment who obtained work through a non-preferred program stayed employed a median of 362 days versus 108 days for those assigned to a preferred program, and participants who obtained work through a non-preferred program had higher service satisfaction.
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Lowe T, Lubos E. Effectiveness of weight management interventions for people with serious mental illness who receive treatment with atypical antipsychotic medications. A literature review. J Psychiatr Ment Health Nurs 2008; 15:857-63. [PMID: 19012677 DOI: 10.1111/j.1365-2850.2008.01337.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Weight gain associated with treatment with atypical antipsychotic medication has been widely recognized as a risk factor for the development of diabetes and cardiovascular diseases. A systematic search was conducted of major databases and of citations for material about the effectiveness of weight management interventions for people with serious mental illness who receive treatment with atypical antipsychotic medications. Studies were included if the focus was on improvement in weight profile through the application of psychoeducational or exercise and dietary interventions and where outcome measures were reported and presented in recognized values. Out of 221 studies, 19 met the inclusion criteria and after assessment of the quality of the studies, eight were selected for detailed review.
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Affiliation(s)
- T Lowe
- Thames Valley University, Slough, UK
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