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Chen D, Ejlskov L, Laustsen LM, Weye N, Sørensen CLB, Momen NC, Dreier JW, Zheng Y, Damgaard AJ, McGrath JJ, Sørensen HT, Plana-Ripoll O. The Role of Socioeconomic Position in the Association Between Mental Disorders and Mortality: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2024; 81:125-134. [PMID: 37966825 PMCID: PMC10652216 DOI: 10.1001/jamapsychiatry.2023.4316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 11/16/2023]
Abstract
Importance Studies are lacking summarizing how the association between mental disorders and mortality varies by socioeconomic position (SEP), particularly considering different aspects of SEP, specific types of mental disorders, and causes of death. Objective To investigate the role of SEP in the association between mental disorders and mortality and the association between SEP and mortality among people with mental disorders. Data Sources MEDLINE, Embase, PsycINFO, and Web of Science were searched from January 1, 1980, through April 3, 2023, and a snowball search of reference and citation lists was conducted. Study Selection Inclusion criteria were observational studies estimating the associations between different types of mental disorders and mortality, stratified by SEP and between SEP and mortality in people with mental disorders. Data Extraction and Synthesis Pairs of reviewers independently extracted data using a predefined data extraction form and assessed the risk of bias using the adapted Newcastle-Ottawa scale. Graphical analyses of the dose-response associations and random-effects meta-analyses were performed. Heterogeneity was explored through meta-regressions and sensitivity analyses. Main Outcomes and Measures All-cause and cause-specific mortality. Results Of 28 274 articles screened, 71 including more than 4 million people with mental disorders met the inclusion criteria (most of which were conducted in high-income countries). The relative associations between mental disorders and mortality were similar across SEP levels. Among people with mental disorders, belonging to the highest rather than the lowest SEP group was associated with lower all-cause mortality (pooled relative risk [RR], 0.79; 95% CI, 0.73-0.86) and mortality from natural causes (RR, 0.73; 95% CI, 0.62-0.85) and higher mortality from external causes (RR, 1.18; 95% CI, 0.99-1.41). Heterogeneity was high (I2 = 83% to 99%). Results from subgroup, sensitivity, and meta-regression analyses were consistent with those from the main analyses. Evidence on absolute scales, specific diagnoses, and specific causes of death was scarce. Conclusion and Relevance This study did not find a sufficient body of evidence that SEP moderated the relative association between mental disorders and mortality, but the underlying mortality rates may differ by SEP group, despite having scarcely been reported. This information gap, together with our findings related to SEP and a possible differential risk between natural and external causes of death in individuals with specific types of mental disorders, warrants further research.
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Affiliation(s)
- Danni Chen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Linda Ejlskov
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Mølgaard Laustsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Nanna Weye
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Natalie C. Momen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | - Yan Zheng
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Jensen Damgaard
- Master Program in Health Science, Rehabilitation and Prevention, Aarhus University, Aarhus, Denmark
| | - John J. McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, University of Queensland, Wacol, Queensland, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
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2
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Kisely S, Alotiby MKN, Protani MM, Soole R, Arnautovska U, Siskind D. Breast cancer treatment disparities in patients with severe mental illness: A systematic review and meta-analysis. Psychooncology 2023; 32:651-662. [PMID: 36892099 DOI: 10.1002/pon.6120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE The incidence and mortality rates of breast cancer in individuals with pre-existing severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are higher than in the general population. Reduced screening is one factor but there is less information on possible barriers to subsequent treatment following diagnosis. METHODS We undertook a systematic review and meta-analysis on access to guideline-appropriate care following a diagnosis of breast cancer in people with SMI including the receipt of surgery, endocrine, chemo- or radiotherapy. We searched for full-text articles indexed by PubMed, EMBASE, PsycInfo and CINAHL that compared breast cancer treatment in those with and without pre-existing SMI. Study designs included population-based cohort or case-control studies. RESULTS There were 13 studies included in the review, of which 4 contributed adjusted outcomes to the meta-analyses. People with SMI had a reduced likelihood of guideline-appropriate care (RR = 0.83, 95% CI = 0.77-0.90). Meta-analyses were not possible for the other outcomes but in adjusted results from a single study, people with SMI had longer wait-times to receiving guideline-appropriate care. The results for specific outcomes such as surgery, hormone, radio- or chemotherapy were mixed, possibly because results were largely unadjusted for age, comorbidities, or cancer stage. CONCLUSIONS People with SMI receive less and/or delayed guideline-appropriate care for breast cancer than the general population. The reasons for this disparity warrant further investigation, as does the extent to which differences in treatment access or quality contribute to excess breast cancer mortality in people with SMI.
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Affiliation(s)
- Steve Kisely
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Melinda M Protani
- University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - Rebecca Soole
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Urska Arnautovska
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Dan Siskind
- University of Queensland, School of Clinical Medicine, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
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3
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Olaya B, Moneta MV, Plana-Ripoll O, Haro JM. Association between mental disorders and mortality: A register-based cohort study from the region of Catalonia. Psychiatry Res 2023; 320:115037. [PMID: 36603385 DOI: 10.1016/j.psychres.2022.115037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/18/2022] [Accepted: 12/25/2022] [Indexed: 12/27/2022]
Abstract
We estimated all-cause and cause-specific mortality associated with mental disorder diagnoses using outpatient and inpatient registers from Catalonia. A historical register-based cohort was used, including 516,944 adults diagnosed with psychotic, mood, or anxiety disorders in 2005-2016, and their matched controls. Six psychiatric groups were created using hierarchical rules. Mortality rate ratios (MRRs), calculated with stratified Cox proportional-hazards models adjusted for mental comorbidity, ranged from 2.45 (95%CI = 2.28-2.64) for other non-organic psychoses to 1.11 (95%CI = 1.08-1.15) for anxiety disorders. Higher MRRs were found in males compared to females with non-organic psychoses, other affective and anxiety disorders, and the excess risk of death was higher in younger ages for all the diagnoses except for schizophrenia. Overall, suicide mortality rates were higher for those with mental disorder diagnoses. The highest MRRs due to natural causes were found for metabolic disorders in schizophrenia, infectious diseases in other non-organic psychoses, and respiratory diseases for bipolar, other affective and anxiety disorders. In the most comprehensive study in Southern Europe, excess mortality is observed not only in people with diagnoses of severe mental disorders, but also in those with other mental disorder diagnoses considered less severe, with an important contribution of both natural and unnatural causes.
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Affiliation(s)
- Beatriz Olaya
- Epidemiology of Mental Health Disorders and Ageing Research Group, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain; Research, Teaching, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Carrer Doctor Antoni Pujada, 42, 08830, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Victoria Moneta
- Epidemiology of Mental Health Disorders and Ageing Research Group, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain; Research, Teaching, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Carrer Doctor Antoni Pujada, 42, 08830, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, alle Juul-Jensens Boulevard 99., Aarhus DK-8200, Denmark; National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Josep Maria Haro
- Epidemiology of Mental Health Disorders and Ageing Research Group, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain; Research, Teaching, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Carrer Doctor Antoni Pujada, 42, 08830, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, Universitat de Barcelona, Barcelona, Spain
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4
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Suokas K, Hakulinen C, Sund R, Kampman O, Pirkola S. Mortality in persons with recent primary or secondary care contacts for mental disorders in Finland. World Psychiatry 2022; 21:470-471. [PMID: 36073698 PMCID: PMC9453896 DOI: 10.1002/wps.21027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kimmo Suokas
- Faculty of Social SciencesTampere UniversityTampereFinland
| | - Christian Hakulinen
- Department of Psychology and LogopedicsFaculty of Medicine, University of HelsinkiHelsinkiFinland,Department of Health and Social Care SystemsNational Institute for Health and WelfareHelsinkiFinland
| | - Reijo Sund
- Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
| | - Olli Kampman
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland,Department of PsychiatryPirkanmaa Hospital DistrictTampereFinland
| | - Sami Pirkola
- Faculty of Social SciencesTampere UniversityTampereFinland,Department of PsychiatryPirkanmaa Hospital DistrictTampereFinland
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5
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Tan XW, Chan CYW, Lum AWM, Lee ES, Mok YM, Fung DSS, Tor PC. Association of cardiovascular metabolic risk factor measurements with psychiatric readmission among in-hospital patients with severe mental illness: a retrospective study. BMC Psychiatry 2022; 22:43. [PMID: 35042498 PMCID: PMC8767705 DOI: 10.1186/s12888-022-03704-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI) and comorbid physical conditions were often associated with higher risks of mortality and hospital readmission. In this study, we aim to examine the association of cardiovascular metabolic risk factor measurements with risks of psychiatric readmissions among in-hospital patients with severe mental illness (SMI). METHODS We collected the longitudinal information of laboratory investigations, blood pressure and body mass index (BMI) among in-hospital patients who had been diagnosed with schizophrenia, major depression disorder or bipolar disorder and with comorbid diagnosis of hypertension, hyperlipidemia or diabetes from Jan 2014 to Jan 2019. The primary outcome was time to first psychiatric readmission. Cox proportional hazard model was utilized to calculate the hazard risks (HR) of cardiovascular metabolic risk factors with psychiatric readmission. RESULTS A total of 5,256 patients were included in the analysis. Compared to patients with normal blood parameters, patients with aberrant tests of high-density dyslipidemia (HDL) and diastolic blood pressure (DBP) during in-hospitalization period were associated with higher risks to first psychiatric readmission [ HR (Hazard Ratio), 1.37 95% Confidence interval (CI), 1.03-1.83 for HDL and HR, 1.32 (95% CI, 1.04-1.67])for DBP]. Compared to patients with optimal monitoring, patients with suboptimal monitoring of blood lipids and blood pressure during in-hospitalization period or recommended window period of cardiovascular disease (CVD) risk management were associated with higher risks to first psychiatric readmission. CONCLUSIONS Aberrant cardiovascular metabolic blood test and blood pressure and missing measurements among in-hospital patients with SMI were associated with increased risks of psychiatric readmissions. This calls for more active screening and monitoring of CVD risk factors for those in-hospital patients in need.
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Affiliation(s)
- Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Christopher Yi Wen Chan
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Alvin Wai Mum Lum
- grid.414752.10000 0004 0469 9592Medical Care Service, Institute of Mental Health, Singapore, 539747 Singapore
| | - Eng Sing Lee
- grid.466910.c0000 0004 0451 6215Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, 138543 Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, Singapore, 308232 Singapore
| | - Yee Ming Mok
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Graduate Medical School, Singapore, 169857 Singapore
| | - Daniel Shuen Sheng Fung
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, Singapore, 308232 Singapore
| | - Phern Chern Tor
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Graduate Medical School, Singapore, 169857 Singapore
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6
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Kisely S, Siskind D. Excess mortality from cancer in people with mental illness-Out of sight and out of mind. Acta Psychiatr Scand 2021; 144:315-317. [PMID: 34519045 DOI: 10.1111/acps.13363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen Kisely
- Metro South Addiction and Mental Health Service, Brisbane, Qld, Australia.,School of Clinical Medicine, University of Queensland, Woolloongabba, Qld, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Qld, Australia.,School of Clinical Medicine, University of Queensland, Woolloongabba, Qld, Australia
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7
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Tan XW, Lee ES, Toh MPHS, Lum AWM, Seah DEJ, Leong KP, Chan CYW, Fung DSS, Tor PC. Comparison of mental-physical comorbidity, risk of death and mortality among patients with mental disorders - A retrospective cohort study. J Psychiatr Res 2021; 142:48-53. [PMID: 34320455 DOI: 10.1016/j.jpsychires.2021.07.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/27/2022]
Abstract
AIM To compare the risk of death, the prevalence of comorbid chronic physical illness and mortality among an Asian population of patients with mental disorders. METHODS This was a retrospective data analysing of medical records of patients with schizophrenia, depression, anxiety, bipolar disorder, alcohol use disorder (AUD) or substance use disorder and the comorbid chronic physical illnesses. The hazard risk of death was calculated with Cox regression and compared between patients with and without comorbid chronic physical illness(es). Odds ratios of specific comorbid chronic physical illness were calculated with logistic regression and mean crude death rate was calculated for patients with different mental disorders. RESULTS A total of 56,447 patients with mental disorders were included in the analysis. Compared to patients without comorbid physical illness, patients with mental-physical comorbidity were associated with a higher risk of death [2.36 (2.22-2.52); hazard ratio (95% CI)] and less estimated survival days [2157 (2142-2172) vs 2508 (2504-2513)]. Compared to other mental disorders, those with AUD had the highest prevalence of two or more comorbid chronic physical illnesses and associated with the highest odds of comorbid hypertension, diabetes mellitus, stroke, nephritis, chronic kidney disease, and cancer. The highest one-year crude death rate was similarly observed in patients with AUD. CONCLUSIONS Mental-physical comorbidity was associated with a higher risk of death compared to patients with mental disorders only. The highest prevalence of mental-physical comorbidity and mortality were observed in patients with AUD. More attention and resources may be needed to tackle the burden of AUD.
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Affiliation(s)
- Xiao Wei Tan
- Department of Mood Disorder and Anxiety, Institute of Mental Health, 539747, Singapore.
| | - Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, 138543, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, 308232, Singapore
| | - Matthias Paul Han Sim Toh
- National Public Health & Epidemiology Unit, National Centre for Infectious Diseases, 308442, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, 539747, Singapore
| | | | - Darren Ee Jin Seah
- Clinical Research Unit, National Healthcare Group Polyclinics, 138543, Singapore
| | | | | | - Daniel Shuen Sheng Fung
- Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, 308232, Singapore; Department of Child Psychiatry, Institute of Mental Health, Singapore, 539747
| | - Phern Chern Tor
- Department of Mood Disorder and Anxiety, Institute of Mental Health, 539747, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, 308232, Singapore; Duke-NUS Graduate Medical School, Singapore, 169857
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8
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Kisely S, Lalloo R. A state-wide study of dental comorbidities in psychiatric disorders resulting in avoidable emergency department presentations. Aust Dent J 2021; 66:423-429. [PMID: 34325489 DOI: 10.1111/adj.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Attendances at emergency departments (EDs) for dental conditions are unnecessary and come at a significant cost to health services. METHODS A population-based record-linkage analysis of a retrospective cohort over 2 years across state-based facilities in Queensland. This was to determine if people with mental illness were more likely than the general population to attend EDs for a range of non-traumatic or avoidable dental conditions. RESULTS There were 1 381 428 individuals in the linked database, of whom 177 157 (13%) had a psychiatric history and 22 046 (1.5%) had one or more avoidable dental presentations. These were toothache (n = 9619), dental abscesses (n = 8449), caries (n = 1826), stomatitis (n = 1213) and gum disease (n = 939). After adjusting for confounders, psychiatric patients were significantly more likely to present with toothache, dental abscesses and caries but not stomatitis or gum disease. Depending on the dental outcome, other risk factors were male sex, lower income, rurality and Indigenous status. CONCLUSIONS Given these findings, possible interventions should include an increased emphasis on assessing oral health in mental health or primary care, especially in non-metropolitan areas, as well as early dental referral. Service planning for this population should including easier navigation of dental services, availability outside normal office hours and free outreach dental clinics.
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Affiliation(s)
- S Kisely
- School of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia.,Addiction and Mental Health Services, Metro South Health, Woolloongabba, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - R Lalloo
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
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9
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Protani MM, Jordan SJ, Kendall BJ, Siskind D, Lawrence D, Sara G, Brophy L, Kisely S. Colorectal cancer Outcomes in people with Severe Mental Illness Cohort (COSMIC): a protocol for an Australian retrospective cohort using linked administrative data. BMJ Open 2021; 11:e044737. [PMID: 34103315 PMCID: PMC8190058 DOI: 10.1136/bmjopen-2020-044737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/21/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) mortality is significantly higher in those with severe mental illness (SMI) compared with the general population, despite similar incidence rates, suggesting that barriers to optimal screening and cancer care may contribute to disparities in CRC mortality in those with SMI. This study aims to compare participation in Australia's National Bowel Cancer Screening Programme (NBCSP) in those with SMI and those in the general population. We will also investigate treatment pathways after diagnosis to determine whether treatment variations could explain differences in CRC mortality. METHODS AND ANALYSIS We will undertake a retrospective cohort study of Australians using linked administrative data to assess differences in screening and cancer care between those with and without SMI, aged 50-74 years on or after 1 January 2006. People with SMI will be defined using antipsychotic medication prescription data. The comparison group will be people enrolled in Medicare (Australia's universal healthcare system) who have not been prescribed antipsychotic medication. Data on outcomes (NBCSP participation, follow-up colonoscopy, CRC incidence and CRC-cause and all-cause mortality) and confounders will be obtained from national-based and state-based administrative health datasets. All people in New South Wales, aged 50-74 with a new diagnosis of CRC on or after 1 January 2006, will be ascertained to examine stage at diagnosis and cancer treatment in those with and without SMI. Poisson regression will be used to calculate incidence rates and rate ratios for each outcome. ETHICS AND DISSEMINATION Ethics approval has been obtained from the University of Queensland Human Research Ethics Committee, the Australian Institute of Health and Welfare Ethics Committee and data custodians from every Australian State/Territory. Findings will be disseminated via publications in peer-reviewed journals and presented at appropriate conferences. TRIAL REGISTRATION NUMBER ACTRN12620000781943.
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Affiliation(s)
- Melinda M Protani
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Susan J Jordan
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Bradley J Kendall
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Dan Siskind
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - David Lawrence
- Graduate School of Education, University of Western Australia, Perth, Western Australia, Australia
| | - Grant Sara
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, North Ryde, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Brophy
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Steve Kisely
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
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10
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Sadeghi Z, Ghoreishi ZS, Flowers H, Mohammadkhani P, Ashtari F, Noroozi M. Depression, Anxiety, and Stress Relative to Swallowing Impairment in Persons with Multiple Sclerosis. Dysphagia 2021; 36:902-909. [PMID: 33783621 DOI: 10.1007/s00455-020-10207-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Abstract
Dysphagia and symptoms of depression, anxiety and stress are common in persons with multiple sclerosis (MS). We posited a relationship between dysphagia and increased frequency of psychological symptoms. Therefore, the aim of the present study was to examine associations between symptoms of psychological difficulties, use of emotional suppression and cognitive reappraisal strategies, and dysphagia status in persons with MS. One hundred persons with MS were prospectively assessed in multiple domains of functioning: cognitive, psychological, and dysphagia-related. Participants underwent cognitive screening with the Mini Mental State Examination and completed two psychological inventories: The depression, anxiety and stress scale (DASS)-21 and the Emotion Regulation Questionnaire. Further, they completed the dysphagia in Multiple Sclerosis questionnaire. A speech-language pathologist evaluated persons suspected of having dysphagia with the Mann Assessment of Swallowing Ability. Dysphagia was present in 29 persons with MS, and the sample was split accordingly. The two groups differed at baseline with respect to Expanded Disability Status Scale scores. There were significant between-group differences for mental health symptoms and for use of emotional regulation strategies. Accordingly, multivariate logistic regressions showed that increased symptoms of psychological stress, decreased use of cognitive reappraisal strategies, and increased indicators of emotional suppression independently predicted the presence of dysphagia. There was a clear pattern towards poorer psychological well-being in persons with dysphagia compared to those without. Psychological difficulties may contribute to the manifestation or worsening of dysphagia and should be addressed in treatment planning and future investigations. Therapeutic interventions that promote improvement in mental state alongside swallowing function may be highly beneficial.
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Affiliation(s)
- Zahra Sadeghi
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Koodakyar Avenue, Evin, Tehran, Iran
| | - Zahra Sadat Ghoreishi
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Koodakyar Avenue, Evin, Tehran, Iran.
| | - Heather Flowers
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Parvaneh Mohammadkhani
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereshteh Ashtari
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Noroozi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Yung NCL, Wong CSM, Chan JKN, Chen EYH, Chang WC. Excess Mortality and Life-Years Lost in People With Schizophrenia and Other Non-affective Psychoses: An 11-Year Population-Based Cohort Study. Schizophr Bull 2020; 47:474-484. [PMID: 33009566 PMCID: PMC7965070 DOI: 10.1093/schbul/sbaa137] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Psychotic disorders are associated with premature mortality, but research was primarily based on Western countries and rarely examined non-affective psychoses other than schizophrenia (ONAP). This population-based cohort study investigated excess mortality in 46 896 schizophrenia and 20 651 ONAP patients between January 2006 and December 2016 in Hong Kong (HK), by estimating all-cause and cause-specific standardized mortality ratios (SMRs), and life-years lost (LYLs), a recently developed, more precise reduced life expectancy measure taking into account the illness onset (age at first-recorded diagnosis). Changes in mortality metrics over the study period were assessed. Study data were retrieved from a territory-wide medical-record database of public healthcare services to 7.5 million HK residents. Results showed that schizophrenia and ONAP patients had higher all-cause (schizophrenia: SMR: 2.49 [95% CI: 2.43-2.55]; ONAP: 2.00 [1.92-2.09]), natural-cause (1.80 [1.74-1.85]; 1.47 [1.40-1.54]), and unnatural-cause (6.97 [6.47-7.49]; 8.53 [7.61-9.52]) mortality rates than general population. Respiratory diseases, cardiovascular diseases, and cancers accounted for the majority of deaths in patient cohorts. Men and women with schizophrenia had 9.53 years and 8.07 years of excess LYLs, respectively. For ONAP, excess LYLs was 8.18 years for men and 5.44 years for women. The overall mortality gap remained similar for both patient groups over time despite their improved longevity and declined unnatural-cause mortality rates. Taken together, schizophrenia and ONAP are associated with increased premature mortality and substantially reduced lifespan in a predominantly Chinese population, with excess deaths mainly attributed to a natural cause. Persistent mortality gap highlights an urgent need for targeted interventions to improve the physical health of patients with psychotic disorders.
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Affiliation(s)
- Nicholas Chak Lam Yung
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Joe Kwun Nam Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong,To whom correspondence should be addressed; Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong; tel: (852)-22554486, fax: (852)-28551345, e-mail:
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Cook JA, Burke-Miller JK, Jonikas JA, Aranda F, Santos A. Factors associated with 30-day readmissions following medical hospitalizations among Medicaid beneficiaries with schizophrenia, bipolar disorder, and major depressive disorder. Psychiatry Res 2020; 291:113168. [PMID: 32619823 DOI: 10.1016/j.psychres.2020.113168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 01/12/2023]
Abstract
While evidence suggests that adults with serious mental illness have an elevated rate of 30-day readmissions after medical hospitalizations, most studies are of patients who are privately insured or Medicare beneficiaries, and little is known about the differential experiences of people with schizophrenia, bipolar disorder, and major depression. We used the Truven Health Analytics MarketScan® Medicaid Multi-State Database to study 43,817 Medicaid enrollees from 11 states, age 18-64, who were discharged from medical hospitalizations in 2011. Our outcome was unplanned all-cause readmissions within 30 days of discharge. In a multivariable analysis, compared to those with no SMI, people with schizophrenia had the highest odds of 30-day readmission (aOR: 1.46, 95% CI: 1.33-1.59), followed by those with bipolar disorder (aOR: 1.25, 95% CI: 1.14-1.38), and those with major depressive disorder (aOR: 1.18, 95% CI: 1.06-1.30). Readmissions also were more likely among those with substance use disorders, males, those with Medicaid eligibility due to disability, patients with longer index hospitalizations, and those with 2 or more medical co-morbidities. This is the first large-scale study to demonstrate the elevated risk of hospital readmission among low-income, working-age adults with schizophrenia. Given their greater psychological, social, and economic vulnerability, our findings can be used to design transition interventions and service delivery systems that address their complex needs.
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Affiliation(s)
- Judith A Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jane K Burke-Miller
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica A Jonikas
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Frances Aranda
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Alberto Santos
- Department of Psychiatry, Fetter Health Care Network, Charleston, SC, USA
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Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Mol Psychiatry 2020; 25:1487-1499. [PMID: 31745237 DOI: 10.1038/s41380-019-0595-x] [Citation(s) in RCA: 291] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
The link between depression and anxiety status and cancer outcomes has been well-documented but remains unclear. We comprehensively quantified the association between depression and anxiety defined by symptom scales or clinical diagnosis and the risk of cancer incidence, cancer-specific mortality, and all-cause mortality in cancer patients. Pooled estimates of the relative risks (RRs) for cancer incidence and mortality were performed in a meta-analysis by random effects or fixed effects models as appropriate. Associations were tested in subgroups stratified by different study and participant characteristics. Fifty-one eligible cohort studies involving 2,611,907 participants with a mean follow-up period of 10.3 years were identified. Overall, depression and anxiety were associated with a significantly increased risk of cancer incidence (adjusted RR: 1.13, 95% CI: 1.06-1.19), cancer-specific mortality (1.21, 1.16-1.26), and all-cause mortality in cancer patients (1.24, 1.13-1.35). The estimated absolute risk increases (ARIs) associated with depression and anxiety were 34.3 events/100,000 person years (15.8-50.2) for cancer incidence and 28.2 events/100,000 person years (21.5-34.9) for cancer-specific mortality. Subgroup analyses demonstrated that clinically diagnosed depression and anxiety were related to higher cancer incidence, poorer cancer survival, and higher cancer-specific mortality. Psychological distress (symptoms of depression and anxiety) was related to higher cancer-specific mortality and poorer cancer survival but not to increased cancer incidence. Site-specific analyses indicated that overall, depression and anxiety were associated with an increased incidence risks for cancers of the lung, oral cavity, prostate and skin, a higher cancer-specific mortality risk for cancers of the lung, bladder, breast, colorectum, hematopoietic system, kidney and prostate, and an increased all-cause mortality risk in lung cancer patients. These analyses suggest that depression and anxiety may have an etiologic role and prognostic impact on cancer, although there is potential reverse causality; Furthermore, there was substantial heterogeneity among the included studies, and the results should be interpreted with caution. Early detection and effective intervention of depression and anxiety in cancer patients and the general population have public health and clinical importance.
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Targeted Intervention to Reduce Smoking among People with Severe Mental Illness: Implementation of a Smoking Cessation Intervention in an Inpatient Mental Health Setting. ACTA ACUST UNITED AC 2020; 56:medicina56040204. [PMID: 32344790 PMCID: PMC7231207 DOI: 10.3390/medicina56040204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Smoking and smoking-related harms are highly prevalent among people with severe mental illness. Targeted smoking cessation programs are much needed in this population. This pilot study aimed to assess the effectiveness of implementing smoking cessation system change interventions within an acute inpatient mental health unit. Materials and Methods: Design: Pre-post intervention study. System change interventions for smoking cessation were delivered over a three-month period (05 March 2018-04 June 2018) on an acute inpatient mental health unit. Participants (n = 214) were all individuals receiving care as inpatients during the three-month intervention. Outcomes assessed pre- and post-intervention were: (i) recording of patient smoking status in medical notes, (ii) number of inpatients offered smoking cessation medication, and iii) number of violent incidents reported. Results: Recording of smoking status significantly increased from 1.9% to 11.4% (X2 = 14.80; p ≤ 0.001). The proportion of inpatients offered smoking cessation treatment significantly increased from 11.0% to 26.8% (X2 = 16.01; p ≤ 0.001). The number of violent incidents decreased by half, which was not statistically significant. Conclusion: Evidence-based smoking cessation interventions can be successfully implemented on an inpatient mental health unit. Modest gains were made in routine screening for smoking and in smoking cessation treatment prescription. Future studies should prioritize effective participatory collaboration with staff to optimize effectiveness of interventions and should include additional strategies such as brief intervention training and smoking cessation treatments such as varenicline and buproprion in addition to nicotine replacement therapy (NRT).
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Cameron CM, Cumsille Nazar J, Ehrlich C, Kendall E, Crompton D, Liddy AM, Kisely S. General practitioner management of chronic diseases in adults with severe mental illness: a community intervention trial. AUST HEALTH REV 2019; 41:665-671. [PMID: 27977388 DOI: 10.1071/ah16151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to assess the effects of a community intervention aimed at general practitioners (GPs) by comparing Medicare claims data from patients with severe mental illness (SMI) of GPs exposed to the intervention and controls that were not. Methods A comparison was made of primary care consultation and pathology data of people with SMI from intervention and control areas. Negative binomial regression models were used to compare the frequency and length of GP consultations, as well as the number and type of pathology examinations. Results Records of 103 people from intervention area and 98 controls were obtained. Intervention and control areas were not different at baseline in terms of age and claims data, but females had higher consultation rates. After adjusting for gender, people from intervention areas had more GP consultations, especially long consultations (adjusted incidence rate ratio 1.56; 95% confidence interval 1.28-1.91). They also had more pathology screening for chronic diseases, in accordance with implemented guideline recommendations. These benefits persisted after the end of the intervention. Conclusion These findings suggest that the ACTIVATE program aimed at training GPs to screen and better manage chronic diseases in adults with SMI had a positive effect up to 6 months after the trial, with demonstrated desired changes in medical management practices by GPs in the intervention area during that time. What is known about the topic? People with an SMI have higher mortality and poorer physical health than the general population. What does this paper add? The community intervention had a significant and sustained effect, with demonstrated desired changes in screening and medical management by GPs for adults with SMI in the intervention area. What are the implications for practitioners? GPs are ideally placed to assist in the prevention and better management of health conditions, thereby reducing avoidable illness and deaths in vulnerable populations, such as adults with SMI. Ongoing professional training and dissemination of clinical guidelines are critical for raising awareness about the physical and oral health care needs of people with SMI.
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Affiliation(s)
- Cate M Cameron
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia.
| | - Jose Cumsille Nazar
- School of Health Services and Social Work, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Carolyn Ehrlich
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia.
| | - Elizabeth Kendall
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia.
| | - David Crompton
- School of Health Services and Social Work, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Ann Maree Liddy
- General Practice Queensland t/a CheckUP Australia, PO Box 3205, South Brisbane, Qld 4101, Australia. Email
| | - Steve Kisely
- School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia. Email
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Das-Munshi J, Schofield P, Bhavsar V, Chang CK, Dewey ME, Morgan C, Stewart R, Thornicroft G, Prince MJ. Ethnic density and other neighbourhood associations for mortality in severe mental illness: a retrospective cohort study with multi-level analysis from an urbanised and ethnically diverse location in the UK. Lancet Psychiatry 2019; 6:506-517. [PMID: 31097399 PMCID: PMC6551347 DOI: 10.1016/s2215-0366(19)30126-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neighbourhood social context might play a role in modifying mortality outcomes in severe mental illness, but has received little attention to date. Therefore, we aimed to assess in an ethnically diverse and urban location the association of neighbourhood-level characteristics and individual-level factors for all-cause, natural-cause, and unnatural-cause mortality in those with severe mental illness. METHODS We did a retrospective cohort study using a case-registry from a large secondary mental health-care Trust in an ethnically diverse and urban location in south London, UK. Linked data for deaths and areas of residence were identified from the case-registry. We included all individuals aged 15 years or more at the time of diagnosis for a severe mental illness from Jan 1, 2007, to Dec 31, 2014. We used individual-level information in our analyses, such as gender, marital status, and the presence of current or previous substance use disorders. We assessed neighbourhood or area-level indicators at the Lower Super Output Area level. Association of neighbourhood-level characteristics, which included the interaction between ethnicity and own ethnic density, deprivation, urbanicity, and social fragmentation, alongside individual-level factors for all-cause, natural-cause, and unnatural-cause mortality in those with severe mental illness was assessed. FINDINGS A total of 18 201 individuals were included in this cohort for analyses, with a median follow-up of 6·36 years. There were 1767 (9·7%) deaths from all causes, 1417 (7·8%) from natural causes, and 192 (1·1%) from unnatural causes. In the least ethnically dense areas, the adjusted rate ratio (aRR) for all-cause mortality in ethnic minority groups with severe mental illness compared with white British people with severe mental illness were similar (aRR 0·96, 95% CI 0·71-1·29); however in the highest ethnic density areas, ethnic minority groups with severe mental illness had a lower risk of death (aRR 0·52, 95% CI 0·38-0·71; p<0·0001), with similar trends for natural-cause mortality (p=0·071 for statistical interaction). In the cohort with severe mental illness, residency in deprived, urban, and socially fragmented neighbourhoods was not associated with higher mortality rates. Compared with the general population, age-standardised and gender-standardised mortality ratios were elevated in the cohort with severe mental illness across all neighbourhood-level characteristics assessed. INTERPRETATION For ethnic minority groups with severe mental illness, residency in areas of higher own-group ethnic density is associated with lower mortality compared to white British groups with severe mental illness. FUNDING Health Foundation, National Institute for Health Research, EU Seventh Framework, and National Institute of Mental Health.
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Affiliation(s)
- Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, London, UK.
| | - Peter Schofield
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Vishal Bhavsar
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Chin-Kuo Chang
- Department of Health and Welfare, University of Taipei, Taipei City, Taiwan
| | - Michael E Dewey
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Graham Thornicroft
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Martin J Prince
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
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Oakley P, Kisely S, Baxter A, Harris M, Desoe J, Dziouba A, Siskind D. Increased mortality among people with schizophrenia and other non-affective psychotic disorders in the community: A systematic review and meta-analysis. J Psychiatr Res 2018; 102:245-253. [PMID: 29723811 DOI: 10.1016/j.jpsychires.2018.04.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is increasing evidence of excess mortality in schizophrenia but less information on other non-affective psychoses. We therefore generated standardised mortality ratios (SMRs) for community-dwelling people with schizophrenia and other non-affective psychoses, relative to the general population, and examined changes to the SMR over time. METHODS We conducted a systematic review in which Pubmed, CINAHL, EMBASE, Google Scholar and PsycINFO were searched for publications that reported SMRs for all-cause mortality among community-dwelling people with schizophrenia and psychotic disorders. Meta-analyses of SMRs were conducted, pooled across genders and then separately by gender. Sub-group analyses were conducted for diagnostic group, global region, decade and risk of study bias. RESULTS We were able to include 34 studies covering 1,724,906 participants. The gender pooled SMR for schizophrenia and psychotic disorders was 3.08 (95%CI 2.88-3.31). Schizophrenia and broader psychotic disorders had similar SMRs. Stratification by decade of observation suggests that the difference in SMR is not declining and may possibly be widening. Analyses showed high levels of heterogeneity. CONCLUSIONS The appearance of a static or widening mortality gap over time between people with schizophrenia and psychotic disorders and the general population is of concern. However, whether it is an increase over time is unclear, as there are insufficient studies to confirm this.
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Affiliation(s)
- Padraig Oakley
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Steve Kisely
- Metro South Addiction and Mental Health Service, Brisbane, Australia; University of Queensland School of Medicine, Brisbane, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - Amanda Baxter
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Meredith Harris
- Queensland Centre for Mental Health Research, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Jocelyne Desoe
- University of Queensland School of Medicine, Brisbane, Australia
| | - Alyona Dziouba
- University of Queensland School of Medicine, Brisbane, Australia
| | - Dan Siskind
- Queensland Centre for Mental Health Research, Brisbane, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia; University of Queensland School of Medicine, Brisbane, Australia.
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Manuel J, Crowe M, Inder M, Henaghan M. Suicide prevention in mental health services: A qualitative analysis of coroners' reports. Int J Ment Health Nurs 2018; 27:642-651. [PMID: 28493403 DOI: 10.1111/inm.12349] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 11/29/2022]
Abstract
Suicide is a major concern for mental health nurses because of its clear correlation with mental illness. In New Zealand, coroners investigate all deaths that appear to be a result of suicide, and provide reports to mental health services (MHS). The aim of the present study was to investigate coronial recommendations to MHS in relation to suicide prevention and to examine clinical and family responses to these. The present study was a three-phase design: (i) analysis of coroners' recommendations related to suicide in MHS; (ii) interviews with clinicians for their response to the recommendations; and (iii) interviews with individuals working with families of consumers of MHS for their responses in relation to family-related recommendations. A qualitative content analysis was conducted on the recommendations from coroners, the interviews with clinical leaders, and the focus group for family workers. Coroners recommended that MHS should implement suicide-prevention strategies that would facilitate improved communication, risk containment, service delivery, and family involvement. Clinicians agreed with most recommendations, apart from those related to risk containment. Family workers endorsed the coronial perspective that family inclusion in MHS was suboptimal. Coroners, MHS, and mental health nurses need to consider the latest clinical evidence for suicide prevention. However, given the complexity of factors that influence suicide, it is important to be realistic about MHS role in preventing suicide, but ensure that MHS provide interventions for which there is evidence, including facilitating family participation and providing access to psychotherapies.
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Affiliation(s)
- Jenni Manuel
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Mark Henaghan
- School of Law, University of Otago, Dunedin, New Zealand
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Henriksson M, Nyberg J, Schiöler L, Hensing G, Kuhn GH, Söderberg M, Torén K, Löve J, Waern M, Åberg M. Cause-specific mortality in Swedish males diagnosed with non-psychotic mental disorders in late adolescence: a prospective population-based study. J Epidemiol Community Health 2018; 72:582-588. [PMID: 29581226 DOI: 10.1136/jech-2018-210461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/06/2018] [Accepted: 03/10/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND While risk of premature death is most pronounced among persons with severe mental illness, also milder conditions are associated with increased all-cause mortality. We examined non-psychotic mental (NPM) disorders and specific causes of natural death in a cohort of late adolescent men followed for up to 46 years. METHODS Prospective cohort study of Swedish males (n=1 784 626) who took part in structured conscription interviews 1968-2005. 74 525 men were diagnosed with NPM disorders at or prior to conscription. Median follow-up time was 26 years. HRs for cause-specific mortality were calculated using Cox proportional hazards models. RESULTS Risks in fully adjusted models were particularly elevated for death by infectious diseases (depressive and neurotic/adjustment disorders (HR 2.07; 95% CI 1.60 to 2.67), personality disorders (HR 2.90; 95% CI 1.96 to 4.28) and alcohol-related and other substance use disorders (HR 9.02; 95% CI 6.63 to 12.27)) as well as by gastrointestinal causes (depressive and neurotic/adjustment disorders (HR 1.64; 95% CI 1.42 to 1.89), personality disorders (HR 2.77; 95% CI 2.27 to 3.38) and alcohol-related/substance use disorders (HR 4.41; 95% CI 3.59 to 5.42)). CONCLUSION Young men diagnosed with NPM disorders had a long-term increased mortality risk, in particular due to infectious and gastrointestinal conditions. These findings highlight the importance of early preventive actions for adolescents with mental illness.
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Affiliation(s)
- Malin Henriksson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Nyberg
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- Section for Social Medicine and Epidemiology, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Georg H Kuhn
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
| | - Mia Söderberg
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kjell Torén
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jesper Löve
- Section for Social Medicine and Epidemiology, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Starace F, Mungai F, Baccari F, Galeazzi GM. Excess mortality in people with mental illness: findings from a Northern Italy psychiatric case register. Soc Psychiatry Psychiatr Epidemiol 2018; 53:249-257. [PMID: 29273912 DOI: 10.1007/s00127-017-1468-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/03/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE People with mental disorders show mortality rates up to 22.2 times higher than that of the general population. In spite of progressive increase in life expectancy observed in the general population, the mortality gap of people suffering from mental health problems has gradually widened. The aim of this paper was to study mortality rates in people suffering from mental illness in a cohort of people (16,981 subjects) in the local mental health register of the province of Modena during the decade 2006-2015. METHODS Standardized Mortality Ratios (SMRs) were calculated to compare the mortality of people with mental disorders to the mortality of people living in the province of Modena and the excess of mortality was studied in relation to the following variables: gender, age group, diagnosis and causes of death. In addition, Poisson regression analysis was performed to study the association between patient characteristics and mortality. RESULTS An overall excess mortality of 80% was found in subjects under the care of mental health services as compared to the reference population (SMR = 1.8, 95% CI 1.7-1.9). Subjects in the 15-44 year group presented the highest SMR (9.2, 95% CI 6.9-11.4). The most prevalent cause of death was cancer (28.1% of deaths). At the Poisson regression, the diagnosis "Substance abuse and dependence" showed the highest relative risk (RR) (4.00). Moreover, being male, single, unemployed and with a lower qualification was associated with higher RRs. CONCLUSIONS Our study confirms that subjects with mental illness have higher SMR. Noteworthy, the overall higher risk of mortality was observed in the younger age group.
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Affiliation(s)
- Fabrizio Starace
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Francesco Mungai
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy.
| | - Flavia Baccari
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Gian Maria Galeazzi
- Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
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Alsubaie M, Abbott R, Dunn B, Dickens C, Keil TF, Henley W, Kuyken W. Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clin Psychol Rev 2017; 55:74-91. [DOI: 10.1016/j.cpr.2017.04.008] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/18/2016] [Accepted: 04/21/2017] [Indexed: 02/07/2023]
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Kisely S. On Adjusting for Life's Confounding. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:182-185. [PMID: 27432824 PMCID: PMC5317017 DOI: 10.1177/0706743716660710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Steve Kisely
- 1 Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada.,2 School of Medicine, University of Queensland, Queensland, Australia
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Sajatovic M, Ng-Mak D, Solem CT, Lin FJ, Rajagopalan K, Loebel A. Dosing patterns and medication adherence in bipolar disorder patients treated with lurasidone: a US retrospective claims database analysis. Ther Adv Psychopharmacol 2016; 6:355-368. [PMID: 28008349 PMCID: PMC5167084 DOI: 10.1177/2045125316672135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to describe dosing patterns and medication adherence among bipolar patients who initiated lurasidone in a real-world setting. METHODS Adult bipolar patients who initiated lurasidone between 1 November 2010 and 31 December 2012 (index period) with 6-month pre- and post-index continuous enrollment were identified from the IMS RWD Adjudicated Claims US database. Patients were grouped by starting lurasidone daily dose: 20 mg (7.1%), 40 mg (62.2%), 60-80 mg (28.7%), and 120-160 mg (2.1%). Patient characteristics were compared across doses using Cochran-Armitage trend tests. Multivariable ordinal logistic regression assessed the association between initial lurasidone dose and patient characteristics. Medication adherence was measured using medication possession ratio (MPR). RESULTS Of 1114 adult bipolar patients (mean age 40.6 years, 70.6% female), 90% initiated lurasidone at 40 mg or 80 mg/day (mean 51.9 mg/day). Of these, 16.2% initiated lurasidone as monotherapy. Mean lurasidone maintenance dose was 55.2 mg/day and mean MPR was 0.53 [standard deviation (SD) = 0.34] over the 6-month follow up. Substance use, hyperglycemia, obesity, and prior antipsychotic use were associated with higher initial lurasidone doses (p < 0.05). Odds of a 20 mg/day increase in initial lurasidone dose was 1.6-times higher for patients with substance use [95% confidence interval (CI): 1.16-2.24], 2.6-times higher with hyperglycemia problems (95% CI: 1.15-5.83), 1.7-times higher with obesity (95% CI: 1.05-2.60), and 1.3 (95% CI: 1.01-1.78) and 1.8-times higher (95% CI: 1.17-2.86) with prior use of second- and first-generation antipsychotics, respectively. CONCLUSIONS This real-world analysis of bipolar patients indicated that 40 mg or 80 mg/day were the most common starting doses of lurasidone. A majority of patients used concomitant psychiatric medications (polypharmacy). Higher doses of lurasidone were prescribed to patients with comorbidities or prior antipsychotic use. Adherence to lurasidone was comparable to or better than antipsychotic adherence reported in bipolar disorder literature.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Daisy Ng-Mak
- Sunovion Pharmaceuticals Inc., Global Health Economics & Health Outcomes Research, 84 Waterford Drive, Marlborough, MA 01752, USA
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Abstract
Individuals with serious mental illnesses such as psychosis still experience higher mortality rates than the general population, decades after data have linked the gap to increased rates of physical illness, delayed diagnosis, low treatment rates and worse outcomes from treatment received. The nature of the relationship between psychosis and comorbid physical illness is complex. Multiple strategies directed at different levels of disease process, health care systems and stakeholder culture are likely required to make sustained progress in reducing the mortality gap. Evidence for strategies that effectively reduce the burden of physical co-morbidity and lead to improved health outcomes are still in their infancy but growing at a reassuringly fast rate. This editorial considers the existing evidence base and makes suggestions for the development and future direction of this urgent research agenda and how this knowledge can be implemented in clinical practice.
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Affiliation(s)
- M. Docherty
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - B. Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - F. Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
- Collaborative Leadership in Applied Heath Research Centre and Care, South London, UK
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Kisely S, Forsyth S, Lawrence D. Why do psychiatric patients have higher cancer mortality rates when cancer incidence is the same or lower? Aust N Z J Psychiatry 2016; 50:254-63. [PMID: 25829481 DOI: 10.1177/0004867415577979] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Studies of overall cancer incidence and mortality in psychiatric patients have had mixed results. Some have reported lower than expected cancer incidence or mortality, while others have found no association or an increased risk depending on sample, psychiatric diagnosis, cancer site and methodology. Few studies have compared cancer incidence and mortality using the same population and methodology. METHOD A population-based record-linkage analysis to compare cancer incidence and mortality in psychiatric patients with that for the general Queensland population, using an historical cohort to calculate age- and sex-standardised rate ratios and hazard ratios. Mental health records were linked with cancer registrations and death records from 2002 to 2007. RESULTS There were 89,992 new cancer cases, of which 3349 occurred in people with mental illness. Cancer incidence was the same as the general population for most psychiatric disorders. Rates were actually lower for dementia (hazard ratio = 0.77; 95% confidence interval = [0.67, 0.88]) and schizophrenia (hazard ratio = 0.84; 95% confidence interval = [0.72, 0.98]). By contrast, mortality was increased in psychiatric patients (hazard ratio = 2.27; 95% confidence interval = [2.15, 2.39]) with elevated hazard ratios for all the main psychiatric diagnoses. CONCLUSIONS Lifestyle, such as alcohol or tobacco use, would not explain our findings that people with mental illness are no more likely than the general population to develop cancer but more likely to die of it. Other factors may be the difficulty in differentiating medically explained and unexplained symptoms, greater case fatality or inequity in access to specialist procedures. The study highlights the need for improved cancer screening, detection and intervention in this population.
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Affiliation(s)
- Steve Kisely
- Discipline of Psychiatry, The School of Medicine, The University of Queensland, Herston, QLD, Australia Diamantina Health Partners, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Simon Forsyth
- School of Population Health, The University of Queensland, Herston, QLD, Australia
| | - David Lawrence
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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Scott KM, Lim C, Al-Hamzawi A, Alonso J, Bruffaerts R, Caldas-de-Almeida JM, Florescu S, de Girolamo G, Hu C, de Jonge P, Kawakami N, Medina-Mora ME, Moskalewicz J, Navarro-Mateu F, O’Neill S, Piazza M, Posada-Villa J, Torres Y, Kessler RC. Association of Mental Disorders With Subsequent Chronic Physical Conditions: World Mental Health Surveys From 17 Countries. JAMA Psychiatry 2016; 73:150-8. [PMID: 26719969 PMCID: PMC5333921 DOI: 10.1001/jamapsychiatry.2015.2688] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease. OBJECTIVE To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions. DESIGN, SETTING, AND PARTICIPANTS Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47,609 individuals; 2,032,942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV-identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015. MAIN OUTCOMES AND MEASURES Lifetime history of physical conditions was ascertained via self-report of physician's diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions. RESULTS Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0-1.5) to 3.6 (2.0-6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1-1.3] to 2.0 [1.4-2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1-1.6) to 1.8 (1.4-2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4-2.7) to 4.0 (2.5-6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets. CONCLUSIONS AND RELEVANCE These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course.
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Affiliation(s)
- Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Carmen Lim
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania Governorate, Iraq
| | - Jordi Alonso
- Hospital del Mar Research Institute, Par de Salut Mar, Barcelona, Spain4Pompeu Fabra University, and Centro de Investigación Biomedica en Red en Epidemiología y Salud Pública, Barcelona, Spain
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum–Katholieke Universiteit Leuven, Campus Gasthuisberg, Gasthuisberg, Belgium
| | - José Miguel Caldas-de-Almeida
- Chronic Diseases Research Center and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Giovanni de Girolamo
- St John of God Clinical Research Centre, and IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kanging Hospital, Shenzhen, China
| | - Peter de Jonge
- University of Groningen, University Medical Center, Groningen Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation, Groningen, the Netherlands
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, University of Tokyo, Tokyo, Japan
| | | | | | - Fernando Navarro-Mateu
- Institut Hospital del Mar d’Investigacio Medica–Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain
| | - Siobhan O’Neill
- School of Psychology, University of Ulster, Ulster, Northern Ireland
| | | | | | - Yolanda Torres
- Center for Excellence on Research in Mental Health Medellin, Colombia
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard University Medical School, Boston, Massachusetts
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Lesage A, Rochette L, Émond V, Pelletier É, St-Laurent D, Diallo FB, Kisely S. A Surveillance System to Monitor Excess Mortality of People With Mental Illness in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:571-9. [PMID: 26720826 PMCID: PMC4679166 DOI: 10.1177/070674371506001208] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Outcome measures are rarely available for surveillance and system performance monitoring for mental disorders and addictions. Our study aims to demonstrate the feasibility and face validity of routinely measuring the mortality gap in the Canadian context at the provincial and regional levels using the methods and data available to the Canadian Chronic Disease Surveillance System (CCDSS) of the Public Health Agency of Canada. METHODS We used longitudinal data from the Quebec Integrated Chronic Disease Surveillance System, which also provides aggregated data to the CCDSS. This includes data from the health insurance registry physician claims and the hospital discharge abstract for all mental disorder diagnoses (International Classification of Diseases [ICD]-9 290-319 or ICD-10 F00-F99). Patients were defined as having had received a mental disorder diagnosis at least once during the year. Life expectancy was measured using Chiang's method for abridged life tables, complemented by the Hsieh method for adjustment of the last age interval. RESULTS We found a lower life expectancy among psychiatric patients of 8 years for men and 5 years for women. For patients with schizophrenia, life expectancy was lowered by 12 years for men and 8 years for women. Cardiovascular disease and cancer were the most common causes of premature death. Findings were consistent across time and regions of the province. Lower estimates of the mortality gap, compared with literature, could be explained by the inclusion of primary care patients and methods. CONCLUSIONS Our study demonstrates the feasibility of using administrative data to measure the impact of current and future mental health plans in Canada provided the techniques can be replicated in other Canadian provinces.
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Affiliation(s)
- Alain Lesage
- Professor, Department of Psychiatry, University of Montreal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec; Invited Psychiatric Expert, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Louis Rochette
- Statistician, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Valérie Émond
- Head, Chronic Disease Surveillance Unit, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Éric Pelletier
- Epidemiologist, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Danielle St-Laurent
- Scientific Director, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Fatoumata Binta Diallo
- Research Coordinator, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec
| | - Stephen Kisely
- Professor, Queensland Centre for Health Data Services, University of Queensland, Brisbane, Australia
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Kisely S, Ehrlich C, Kendall E, Lawrence D. Using Avoidable Admissions to Measure Quality of Care for Cardiometabolic and Other Physical Comorbidities of Psychiatric Disorders: A Population-Based, Record-Linkage Analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:497-506. [PMID: 26720507 PMCID: PMC4679130 DOI: 10.1177/070674371506001105] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/01/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Quality of care for comorbid physical disorders in psychiatric patients can be assessed by the number of avoidable admissions for ambulatory care sensitive (ACS) conditions. These are admissions for physical conditions that, with appropriate primary care, should not require inpatient treatment. Avoidable admissions for ACS conditions feature prominently in Australia's National Health Performance Framework and have been used to assess health care provision for marginalized groups, such as Indigenous patients or those of lower socioeconomic status. They have not been applied to people with mental illness. METHODS A population-based, record-linkage analysis was used to measure ACS admissions for physical disorder in psychiatric patients of state-based facilities in Queensland, Australia, during 5 years. RESULTS There were 77 435 males (48.0%) and 83 783 females (52%) (total n = 161 218). Among these, 13 219 psychiatric patients (8.2%) had at least 1 ACS admission, the most common being for diabetes (n = 6086) and angina (n = 2620). Age-standardized rates were double those of the general population. Within the psychiatric group, and after adjusting for confounders, those who had ever been psychiatric inpatients experienced the highest rates of ACS admissions, especially for diabetes. CONCLUSIONS In common with other marginalized groups, psychiatric patients have increased ACS admissions. Therefore, this measure could be used as an indicator of difficulties in access to appropriate primary care in Canada, given the availability of similar administrative data.
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Affiliation(s)
- Steve Kisely
- Professor, Departments of Psychiatry and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Professor, The University of Queensland School of Medicine, Queensland, Australia
| | - Carolyn Ehrlich
- Research Fellow, Population and Social Health Research Program, Griffith University, Queensland, Australia
| | - Elizabeth Kendall
- Professor, Population and Social Health Research Program, Griffith University, Queensland, Australia
| | - David Lawrence
- Professor, Centre for Child Health Research, The University of Western Australia, Perth, Australia
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Wu SI, Chen SC, Liu SI, Sun FJ, Juang JJM, Lee HC, Kao KL, Dewey ME, Prince M, Stewart R. Relative Risk of Acute Myocardial Infarction in People with Schizophrenia and Bipolar Disorder: A Population-Based Cohort Study. PLoS One 2015; 10:e0134763. [PMID: 26270347 PMCID: PMC4536090 DOI: 10.1371/journal.pone.0134763] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/13/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample. METHOD Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates. RESULTS A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01~1.32) for schizophrenia and 1.37 (1.08~1.73)for bipolar disorder, and in women, 1.85 (1.58~2.18) and 1.88(1.47~2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder. CONCLUSIONS In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.
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Affiliation(s)
- Shu-I Wu
- Mackay Memorial Hospital, Department of Psychiatry, Taipei, Taiwan
- Mackay Medical College, Department of Audiology and Speech Language Pathology, Taipei, Taiwan
| | - Su-Chiu Chen
- National Taipei University of Nursing and Health Sciences, Department of Health Care Management, Taipei, Taiwan
| | - Shen-Ing Liu
- Mackay Memorial Hospital, Department of Psychiatry, Taipei, Taiwan
- Mackay Junior College of Nursing, Taipei, Taiwan
- Mackay Memorial Hospital, Department of Medical Research, Taipei, Taiwan
| | - Fang-Ju Sun
- Mackay Junior College of Nursing, Taipei, Taiwan
- Mackay Memorial Hospital, Department of Medical Research, Taipei, Taiwan
| | - Jimmy J. M. Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kai-Liang Kao
- Far Eastern Memorial Hospital, Department of Pediatrics, Taipei, Taiwan
- * E-mail:
| | - Michael E. Dewey
- King’s College London, (Institute of Psychiatry, Psychology & Neuroscience), Health Service and Population Research Department, London, United Kingdom
| | - Martin Prince
- King’s College London, (Institute of Psychiatry, Psychology & Neuroscience), Health Service and Population Research Department, London, United Kingdom
| | - Robert Stewart
- King’s College London, (Institute of Psychiatry, Psychology & Neuroscience), Health Service and Population Research Department, London, United Kingdom
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Auxier AM, Hopkins BD, Reins AE. Under Construction: One State's Approach to Creating Health Homes for Individuals with Serious Mental Illness. AIMS Public Health 2015; 2:163-182. [PMID: 29546102 PMCID: PMC5690274 DOI: 10.3934/publichealth.2015.2.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/15/2015] [Indexed: 11/18/2022] Open
Abstract
Changes to the health care market associated with the Patient Protection and Affordable Care Act (ACA) are creating both need and opportunity for states, health plans, and providers to improve quality, outcomes, and satisfaction through better integration of traditionally separate health care delivery systems. Applications of the term "integrated care" vary widely and include, but are not limited to, the integration of care for Medicare-Medicaid dually enrolled beneficiaries, the integration of mental health and substance abuse (also known as behavioral health), and the integration of mental health and substance abuse with medical care, most commonly primary care. In this article, integrated care refers to well-coordinated physical health and behavioral health care. Medicaid Health Homes are emerging as a promising practice, with sixteen states having adopted the Health Home model through approved State Plan Amendments. This article describes one state's journey towards establishing Health Homes with a behavioral health focus. We discuss a partnership model between the relevant state organizations, the contracted providers, and the behavioral health managed care organization responsible for many of the supportive administrative functions. We highlight successes and operational challenges and offer recommendations for future Health Home development efforts.
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Affiliation(s)
- Andrea M. Auxier
- Beacon Health Options, 200 State Street, Suite 302, Boston, MA 02109, USA
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Paraschakis A, Michopoulos I, Christodoulou C, Koutsaftis F, Lykouras L, Douzenis A. A 2-year psychological autopsy study of completed suicides in the athens greater area, Greece. Psychiatry Investig 2015; 12:212-7. [PMID: 25866522 PMCID: PMC4390592 DOI: 10.4306/pi.2015.12.2.212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/16/2014] [Accepted: 06/16/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To study the characteristics of a sample of suicide victims from the Athens Greater Area using the psychological autopsy method for the first time in Greece. METHODS We studied all recorded cases of completed suicide for the 2-year time period November 2007-October 2009 collecting data from the victims' forensic records as well as from the completion of a psychological autopsy questionnaire. RESULTS 335 persons were recorded as suicide victims. We contacted relatives of 256 victims interviewing those of 248 of them (96.9%). The differences regarding sex, marital and employment status between our sample and the general population were statistically significant (p<0.001). The male/female ratio was 3:1. Comparatively more victims were divorced, separated or single and a greater proportion were pensioners or unemployed. 26.0% of the victims had history of prior attempts (64.4% once, 20.3% twice and 15.3% more times). 42.6% were taking psychiatric medication-significantly more women than men according to blood tests; 14.2% had been hospitalized in a psychiatric clinic the year prior to their death. 84.8% have deceased at the place of suicide and 15.2% died in the hospital; 80.3% died indoors and 19.7% outdoors. Men died primarily by hanging or shooting by a firearm while women preferred jumping from height instead (p<0.001). As many as 48.8% had expressed their intention to die to their relatives; 26.6% left a suicide note. CONCLUSION Our study has shown that the psychological autopsy method is applicable and widely accepted yielding results comparable to the international literature. Specific parameters associated with suicide have been studied for the first time in Greece.
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Affiliation(s)
| | - Ioannis Michopoulos
- 2nd Department of Psychiatry, Athens University Medical School, "Attikon" General Hospital, Athens, Greece
| | - Christos Christodoulou
- 2nd Department of Psychiatry, Athens University Medical School, "Attikon" General Hospital, Athens, Greece
| | | | - Lefteris Lykouras
- 2nd Department of Psychiatry, Athens University Medical School, "Attikon" General Hospital, Athens, Greece
| | - Athanassios Douzenis
- 2nd Department of Psychiatry, Athens University Medical School, "Attikon" General Hospital, Athens, Greece
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Krivoy A, Balicer RD, Feldman B, Hoshen M, Zalsman G, Weizman A, Shoval G. Adherence to antidepressant therapy and mortality rates in ischaemic heart disease: cohort study. Br J Psychiatry 2015; 206:297-301. [PMID: 25657353 DOI: 10.1192/bjp.bp.114.155820] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/15/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of antidepressant drugs in patients with ischaemic heart disease (IHD) has been debated owing to scarcity of data and conflicting results regarding the effect of these drugs on mortality. AIMS To evaluate the association between adherence to antidepressant therapy and all-cause mortality in a population-based cohort of patients with IHD. METHOD A total of 63 437 patients with IHD who purchased antidepressants at least once during the years 2008-2011 were retrospectively followed for all-cause mortality over 4 years. Adherence was measured as a ratio between claimed and prescribed durations of medication and modelled as non-adherence (<20%), poor (20-50%), moderate (50-80%) and good (>80%). We used multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality. RESULTS The moderate and good adherence groups had significantly reduced adjusted mortality hazard ratios of 0.83 (95% CI 0.78-0.88) and 0.86 (95% CI 0.82-0.90) respectively, compared with the non-adherence group. CONCLUSIONS Adherence to antidepressant pharmacotherapy is associated with reduced all-cause mortality in a population-based large sample cohort of patients with IHD. Physicians and health policy decision-makers should step up their efforts to sustain and enhance these patients' adherence to their antidepressant regimen.
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Affiliation(s)
- Amir Krivoy
- Amir Krivoy, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Ran D. Balicer, MD, PhD, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva; Becca Feldman, PhD, Moshe Hoshen, PhD, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, MD, MHA, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, MD, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran D Balicer
- Amir Krivoy, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Ran D. Balicer, MD, PhD, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva; Becca Feldman, PhD, Moshe Hoshen, PhD, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, MD, MHA, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, MD, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Becca Feldman
- Amir Krivoy, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Ran D. Balicer, MD, PhD, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva; Becca Feldman, PhD, Moshe Hoshen, PhD, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, MD, MHA, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, MD, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Hoshen
- Amir Krivoy, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Ran D. Balicer, MD, PhD, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva; Becca Feldman, PhD, Moshe Hoshen, PhD, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, MD, MHA, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, MD, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Zalsman
- Amir Krivoy, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Ran D. Balicer, MD, PhD, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva; Becca Feldman, PhD, Moshe Hoshen, PhD, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, MD, MHA, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, MD, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Amir Krivoy, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Ran D. Balicer, MD, PhD, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva; Becca Feldman, PhD, Moshe Hoshen, PhD, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, MD, MHA, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, MD, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Shoval
- Amir Krivoy, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Ran D. Balicer, MD, PhD, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva; Becca Feldman, PhD, Moshe Hoshen, PhD, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, MD, MHA, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, MD, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wu SI, Kao KL, Chen SC, Juang JJM, Lin CJ, Fang CK, Wu CS, Dewey M, Prince MJ, Stewart R. Antipsychotic exposure prior to acute myocardial infarction in patients with serious mental illness. Acta Psychiatr Scand 2015; 131:213-22. [PMID: 25311084 DOI: 10.1111/acps.12345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the association between acute myocardial infarction (AMI) and recent exposure to antipsychotic agents in people with serious mental illness (SMI), and modifying influences. METHOD A case-crossover design was applied using the Taiwan National Health Insurance Research Database (NHIRD) to compare the exposure frequency of antipsychotic agents within individuals of schizophrenia or bipolar disorder between 60-day case and control periods prior to their first AMI episode during 1996-2007. RESULTS A sample of 834 patients with incident AMI was analysed. AMI was significantly associated with more recent antipsychotic exposure in schizophrenia after adjustment (OR 1.87, 95% confidence interval 1.15-3.03) bipolar disorder (OR 1.06, 0.51-2.21). This association in schizophrenia was significantly stronger in men and in patients without previous diagnoses of cardiovascular risk factors. CONCLUSION These findings are consistent with a short-term risk effect of antipsychotic exposure on risk of AMI and identify potentially vulnerable groups. Further research is required to clarify underlying biological mechanisms.
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Affiliation(s)
- S-I Wu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech Language Pathology, Mackay Medical College, Taipei, Taiwan
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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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Pettipher A, Ovens R. The psychiatric inpatient physical health assessment sheet (PIPHAS): a useful tool to improve the speed, efficiency, and documentation of physical examination in new psychiatric inpatients. BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:bmjquality_uu206294.w2558. [PMID: 26734362 PMCID: PMC4645913 DOI: 10.1136/bmjquality.u206294.w2558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/31/2014] [Indexed: 11/06/2022]
Abstract
There is increased morbidity and mortality among patients suffering from mental illness. This is believed to be multi-factorial. Poor access to healthcare, the stigma of mental illness, reduced clinic attendance, lifestyle factors, and side effects of medications are cited as possible contributing factors. It is therefore vital to perform a physical examination to identify previously undiagnosed conditions during the admission of a psychiatric inpatient. The Royal College of Psychiatrists recommends that all patients admitted to a psychiatric hospital should receive a full physical examination on admission, or within twenty-four hours of admission. A snapshot audit was carried out at Prospect Park Hospital in Reading, which highlighted that The Royal College of Psychiatrist's recommendation, along with Trust guidelines regarding physical examination were not being met, with only 78 out of 111 patients (70.3%) undergoing an examination during their admission. In addition to this, examinations were often poorly documented and not covering all examination domains. A psychiatric inpatient physical health assessment sheet (PIPHAS) was designed and introduced, providing a quick and standardised approach to the documentation of a physical examination. After the intervention was put into practice, its impact was assessed by performing a retrospective review of the admission clerking notes of the next 100 admissions to Prospect Park Hospital. Following the introduction of the PIPHAS form there was an increase in the number of patients undergoing physical examination on admission to hospital (75 out of 100 patients, 75%). There was also an increase in the thorough documentation of all examination domains (e.g. respiratory examination) for patients that had a completed PIPHAS form scanned within their medical records. This quality improvement project demonstrates that the PIPHAS form is a useful tool to improve the speed, efficiency, and documentation of a thorough physical examination in new psychiatric inpatients.
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Koroukian SM, Bakaki PM, Golchin N, Tyler CV, Owusu C, Loue S. Breast Cancer Stage and Treatment Among Ohio Medicaid Beneficiaries With and Without Mental Illness. J Oncol Pract 2014; 11:e50-8. [PMID: 25466705 DOI: 10.1200/jop.2014.000034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is a dearth of studies on cancer outcomes in individuals with mental illness. We compared breast cancer outcomes in Medicaid beneficiaries with and without mental illness. METHODS Using records from the 1996 to 2005 Ohio Cancer Incidence Surveillance System (OCISS) and Medicaid files, we identified fee-for-service women age < 65 years diagnosed with incident invasive breast cancer who had enrolled in Medicaid ≥ 3 months before cancer diagnosis (n = 2,177). We retrieved cancer stage, patient demographics, and county of residence from the OCISS. From Medicaid claims data, we identified breast cancer treatment based on procedure codes and mental illness status based on diagnosis codes, prescription drugs dispensed, and service codes. We developed logistic regression models to examine the association between mental illness, cancer stage, and treatment for locoregional disease, adjusting for potential confounders. RESULTS Women with mental illness represented 60.2% of the study population. Adjusting for potential confounders, women with mental illness were less likely than those without mental illness to have unstaged or unknown-stage cancer (adjusted odds ratio [OR], 0.61; 95% CI, 0.44 to 0.86; P = .005) or to be diagnosed with distant-stage cancer (adjusted OR, 0.59; 95% CI, 0.40 to 0.85; P = .005). We observed no difference by mental illness status in receipt of definitive treatment (adjusted OR, 1.04; 95% CI, 0.84 to 1.29; P = .08). CONCLUSION Among Ohio Medicaid beneficiaries, women with mental illness did not experience disparities in breast cancer stage or treatment of locoregional disease. These findings may reflect the equalizing effects of Medicaid through vulnerable individuals' improved access to both physical and mental health care.
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Affiliation(s)
- Siran M Koroukian
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Paul M Bakaki
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Negar Golchin
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Carl V Tyler
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Cynthia Owusu
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
| | - Sana Loue
- Case Western Reserve University School of Medicine; Case Comprehensive Cancer Center; Cleveland Clinic Foundation; and University Hospitals of Cleveland, Cleveland, OH
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van Boekel LC, Brouwers EPM, van Weeghel J, Garretsen HFL. Inequalities in healthcare provision for individuals with substance use disorders: perspectives from healthcare professionals and clients. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.980860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maujean A, Kendall E, Ehrlich C, Kisely S. The capacity for health promotion survey. Gen Hosp Psychiatry 2014; 36:594-8. [PMID: 25204778 DOI: 10.1016/j.genhosppsych.2014.08.007] [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: 01/22/2014] [Revised: 07/14/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective was to develop and examine the psychometric properties of the Capacity for Health Promotion Survey designed to assess the practice of health promotion in the area of severe mental illness. METHOD Seven hundred and eighty-five health professionals in Queensland, Australia, completed the survey. A principal component analysis was used to assess the factor structure of the scale and investigations of internal consistency, interitem correlation and item-discriminant validity were conducted to establish the reliability and validity of the survey. RESULTS The final survey is a 22-item scale comprising five subscales: Beliefs about Behavior Change, Intention to Promote Health, Health Promotion Skills, Effectiveness of Health Promotion and Health Promoting Norms. The survey demonstrated satisfactory internal consistency for the five subscales. Items were more strongly correlated within their own subscales than with other subscales, providing evidence of discriminant validity. CONCLUSION The Capacity for Health Promotion Survey is a psychometrically sound measure to assess the practice of health promotion in the area of severe mental illness.
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Affiliation(s)
- Annick Maujean
- Centre for National Research on Disability and Rehabilitation Medicine (CONROD), Griffith Health Institute, Griffith University, Meadowbrook, Australia.
| | - Elizabeth Kendall
- Centre for National Research on Disability and Rehabilitation Medicine (CONROD), Griffith Health Institute, Griffith University, Meadowbrook, Australia
| | - Carolyn Ehrlich
- Centre for National Research on Disability and Rehabilitation Medicine (CONROD), Griffith Health Institute, Griffith University, Meadowbrook, Australia
| | - Steve Kisely
- School of Population Health, University of Queensland, Herston, QLD, Australia
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Perini G, Grigoletti L, Hanife B, Biggeri A, Tansella M, Amaddeo F. Cancer mortality among psychiatric patients treated in a community-based system of care: a 25-year case register study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:693-701. [PMID: 24092521 DOI: 10.1007/s00127-013-0765-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 09/17/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE Cancer mortality data allow assessing, at the same time, the risk of developing the disease and the quality of care provided to patients after the oncologic diagnosis. This study explores the risk of death caused by a single tumor site in a psychiatric population treated in a community-based psychiatric service. METHODS All patients with an ICD-10 psychiatric diagnosis, seeking care in 1982-2006 (25 years), were included. Data were drawn from the South Verona Psychiatric Case Register (PCR). Mortality and cause of death were ascertained using different procedures and sources. Standardized mortality ratios (SMRs) were used to compare the observed number of deaths with the expected number using as reference a population in the Veneto region. RESULTS Having been admitted to the hospital (SMR = 1.32), having a short interval from registration (1.52), having a diagnosis of alcoholism (2.03), and being a middle-aged male (1.83) were factors showing an increased risk of death from cancer. Increased SMRs were found for cancer of the oral cavity (22.93), lymphoma, leukemias, Hodgkin's lymphoma (8.01), and central nervous system (CNS) and cranial nerve tumors (4.75). The SMR decreased for stomach tumors (0.49). Patients with alcoholism (5.90 for larynx), affective disorders (20.00 for lymphomas), and personality disorders (28.00 for SNC) were found to be exposed to a high risk of cancer death in specific sites. CONCLUSIONS Psychiatric patients showed different patterns of site-specific cancer mortality when compared with the general population. The 20-fold higher risk of dying from hematological neoplasms needs further investigation. Chronic use of phenothiazines could be involved in the relative protection from stomach and prostate cancer found in psychiatric patients.
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Affiliation(s)
- Giovanni Perini
- Section of Psychiatry and Section of Clinical Psychology, Department of Public Health and Community Medicine, Policlinico GB Rossi, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
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Burke RE, Donzé J, Schnipper JL. Contribution of psychiatric illness and substance abuse to 30-day readmission risk. J Hosp Med 2013; 8:450-5. [PMID: 23589474 DOI: 10.1002/jhm.2044] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 02/27/2013] [Accepted: 03/07/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Little is known about the contribution of psychiatric illness to medical 30-day readmission risk. OBJECTIVE To determine the independent contribution of psychiatric illness and substance abuse to all-cause and potentially avoidable 30-day readmissions in medical patients. DESIGN Retrospective cohort study. SETTING Patients discharged from the medicine services at a large teaching hospital from July 1, 2009 to June 30, 2010. MEASUREMENTS The main outcome of interest was 30-day all-cause and potentially avoidable readmissions; the latter determined by a validated algorithm (SQLape) in both bivariate and multivariate analysis. Readmissions were captured at 3 hospitals where the majority of these patients are readmitted. RESULTS Of 6987 discharged patients, 1260 were readmitted within 30 days (18.0%); 388 readmissions were potentially avoidable (5.6%). In multivariate analysis, 2 or more prescribed outpatient psychiatric medications (odds ratio [OR]: 1.1, 95% confidence interval [CI]: 1.01-1.20) or any prescription of anxiolytics (OR: 1.16, 95% CI: 1.00-1.35) were associated with increased all-cause readmissions, whereas discharge diagnoses of anxiety (OR: 0.82, 95% CI: 0.68-0.99) or substance abuse (OR: 0.80, 96% CI: 0.65-0.99) were associated with fewer all-cause readmissions. These findings were not replicated as predictors of potentially avoidable readmissions; rather, patients with discharge diagnoses of depression (OR: 1.49, 95% CI: 1.09-2.04) and schizophrenia (OR: 2.63, 95% CI: 1.13-6.13) were at highest risk. CONCLUSIONS Our data suggest that patients treated during a hospitalization for depression and for schizophrenia are at higher risk for potentially avoidable 30-day readmissions, whereas those prescribed more psychiatric medications as outpatients are at increased risk for all-cause readmissions. These populations may represent fruitful targets for interventions to reduce readmission risk.
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Affiliation(s)
- Robert E Burke
- Hospital Medicine Section, Department of Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO 80220, USA.
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Murphy AL, Gardner DM, Cooke C, Kisely S, Hughes J, Kutcher SP. Prescribing trends of antipsychotics in youth receiving income assistance: results from a retrospective population database study. BMC Psychiatry 2013; 13:198. [PMID: 23890157 PMCID: PMC3737046 DOI: 10.1186/1471-244x-13-198] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 07/25/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Prescribing of antipsychotics (AP) to young people has increased in the last decade internationally. We aimed to characterize AP prescribing in a population of low-income youth in Nova Scotia, Canada. METHODS We conducted a population database study of AP prescription claims and health services utilization by young people aged 25 years and younger receiving drug benefits through the publicly funded Pharmacare program between October 1, 2000 to September 30, 2007. RESULTS Four percent (1715/43888) of youth receiving Pharmacare benefits filled AP prescriptions. The use of second generation antipsychotics (SGAs) significantly increased (p < 0.0001) in all age groups except 0-5 year olds, whereas first generation antipsychotic use significantly decreased. Pharmacare beneficiaries aged 21-25 years represented 45.2% of AP users. The majority (66%) of youth filling AP prescriptions had 2 or more psychiatric diagnoses. Most youth (76%) filled prescriptions for only one type of AP during the study period. Psychotic disorders were the most common indication for AP use except with risperidone, in which ADHD was the most likely reason for use. Co-prescribing of psychotropics was prevalent with antidepressants and mood stabilizers prescribed in 42% and 27% of AP users, respectively. General practitioners (GPs) prescribed incident APs most often (72%) followed by psychiatrists (16%). The age- and gender-adjusted rate of death was higher in AP users as compared to the age-matched general population of Nova Scotia. CONCLUSIONS SGA use increased significantly over seven years in a cohort of 0 to 25 years olds receiving Pharmacare benefits. Off-label use of APs was prevalent with ADHD and other non-psychotic disorders being common reasons for AP use. GPs initiated most AP prescriptions. Co-prescribing of other psychotropics, especially antidepressants and mood stabilizers, was prevalent even in younger age strata. This study raises further questions about AP prescribing in those 25 years of age and under, especially given the range of diagnoses and psychotropic co-prescribing.
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Nordentoft M, Wahlbeck K, Hällgren J, Westman J, Osby U, Alinaghizadeh H, Gissler M, Laursen TM. Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. PLoS One 2013; 8:e55176. [PMID: 23372832 PMCID: PMC3555866 DOI: 10.1371/journal.pone.0055176] [Citation(s) in RCA: 423] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 12/19/2012] [Indexed: 12/17/2022] Open
Abstract
Background Excess mortality among patients with severe mental disorders has not previously been investigated in detail in large complete national populations. Objective To investigate the excess mortality in different diagnostic categories due to suicide and other external causes of death, and due to specific causes in connection with diseases and medical conditions. Methods In longitudinal national psychiatric case registers from Denmark, Finland, and Sweden, a cohort of 270,770 recent-onset patients, who at least once during the period 2000 to 2006 were admitted due to a psychiatric disorder, were followed until death or the end of 2006. They were followed for 912,279 person years, and 28,088 deaths were analyzed. Life expectancy and standardized cause-specific mortality rates were estimated in each diagnostic group in all three countries. Results The life expectancy was generally approximately 15 years shorter for women and 20 years shorter for men, compared to the general population. Mortality due to diseases and medical conditions was increased two- to three-fold, while excess mortality from external causes ranged from three- to 77-fold. Mortality due to diseases and medical conditions was generally lowest in patients with affective disorders and highest in patients with substance abuse and personality disorders, while mortality due to suicide was highest in patients with affective disorders and personality disorders, and mortality due to other external causes was highest in patients with substance abuse. Conclusions These alarming figures call for action in order to prevent the high mortality.
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Affiliation(s)
- Merete Nordentoft
- Psychiatric Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark.
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Ehrlich C, Kisely S, Kendall E, Crompton D, Crowe E, Liddy AM. Active steps towards a healthier life for people with severe mental illness: a qualitative approach to understanding the potential for implementing change. AUST HEALTH REV 2013; 37:423-9. [DOI: 10.1071/ah13062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 06/10/2013] [Indexed: 11/23/2022]
Abstract
Objective.
Our health systems are failing to provide optimal physical care for people with severe mental illness. To address this gap, Queensland Health and General Practice Queensland in partnership developed a comprehensive package of guidelines and health messages. However, guidelines alone are likely to be inadequate motivators of change. The objective of this research was to qualitatively explore key stakeholders’ expectations about the implementation of guidelines, with the purpose of identifying potential interventions to support practice change.
Method.
Participants were recruited from the partnership governance committee. A semistructured interview guide was used to gather data. Using grounded-theory techniques, the data were analysed to identify key themes.
Results.
All stakeholders agreed that the purpose of developing comprehensive guidelines and health messages was to achieve change through innovation and the promotion of early intervention, reduction of avoidable admissions and sectoral integration. However, existing structures within the system were considered to be insurmountable barriers.
Conclusion.
Key stakeholders sought broader change than just guidelines and health messages developed by the partnership focussed specifically on awareness-raising about the physical care of people with severe mental illness. However, there was no clear consensus as to what that change should be. This mismatch between the goals and actions of such a large-scale initiative is problematic. Suggestions are made about how to address change.
What is known about the topic?
The physical and oral health of people with severe mental illness is poor. One response that is frequently used to improve the health of this population is to develop and implement guidelines for practice. However, oral healthcare is frequently omitted from guidelines for care. Moreover, guidelines are not always adopted in everyday practice.
What does this paper add?
This paper outlines a process of guideline development and includes investigation of the short- and long-term goals that a governing committee held for the implementation of guidelines for both the physical and oral healthcare of people with severe mental illness. Additionally, we explore gaps between a short-term focus for guideline implementation and the longer-term goals of achieving improved healthcare.
What are the implications for practitioners?
Cultural change is required if the physical and oral health of people with severe mental illness is to be improved. However, a mismatch between the goals and actions of large-scale initiatives is problematic. Thus, clearly identified avenues for realising long-term culture change are required if new practices are to be embedded in everyday routines.
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Diagnostic procedures, revascularization, and inpatient mortality after acute myocardial infarction in patients with schizophrenia and bipolar disorder. Psychosom Med 2013; 75:52-9. [PMID: 23213265 DOI: 10.1097/psy.0b013e31827612a6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate inpatient mortality and the use of invasive diagnostic and revascularization procedures after acute myocardial infarction (AMI) in people with schizophrenia and bipolar disorder. METHODS A case-control study was nested within the first AMI episodes between 1996 and 2007 using nationwide data. Participants with schizophrenia or bipolar disorder were compared with a random sample of all other adults without severe mental illness. Inpatient mortality and receipt of cardiac catheterization, coronary arteriography, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft were compared in logistic regression models after adjusting for demographic and health status, hospital type, and AMI complications. RESULTS A total of 3361 adult patients who had incident AMI between 1996 and 2007 were identified. Patients with schizophrenia and bipolar disorder (n = 834; 24.8%) had a significantly decreased likelihood of catheterization (12.2% and 14.0%, respectively) and revascularization (9.0% and 12.8%, respectively) during the index AMI episode compared with controls (27.9% of whom received catheterization and 23.9% of whom received revascularizations). Inpatient mortality remained 2.68 times the rate in patients with schizophrenia (95% confidence interval = 1.73-4.15; p < .001) compared with controls after adjusting for intervention receipt among other covariates, but mortality was not significantly raised in patients with bipolar disorder. CONCLUSIONS In a large national sample and in the context of a comprehensive free health service, patients with schizophrenia and bipolar disorder were substantially disadvantaged, being half as likely to receive catheterization or revascularization procedures after AMI. Further research is required to clarify the reasons for this.
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Westman J, Hällgren J, Wahlbeck K, Erlinge D, Alfredsson L, Ösby U. Cardiovascular mortality in bipolar disorder: a population-based cohort study in Sweden. BMJ Open 2013; 3:bmjopen-2012-002373. [PMID: 23604348 PMCID: PMC3641504 DOI: 10.1136/bmjopen-2012-002373] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To estimate the cardiovascular mortality among persons with bipolar disorder in Sweden compared to the general population. DESIGN Population register-based cohort study with a 20-year follow-up. SETTING Sweden. PARTICIPANTS The entire population of Sweden (n=10.6 million) of whom 17 101 persons were diagnosed with bipolar disorder between 1987 and 2006. MAIN OUTCOME MEASURES Mortality rate ratios (MRR), excess mortality (excess deaths), cardiovascular disorder (CVD) and specifically cerebrovascular disease, coronary heart disease, acute myocardial infarction, sudden cardiac deaths and hospital admission rate ratio (ARR). RESULTS Persons with bipolar disorder died of CVD approximately 10 years earlier than the general population. One third (38%) of all deaths in persons with bipolar disorder were caused by CVD and almost half (44%) by other somatic diseases, whereas suicide and other external causes accounted for less than a fifth of all deaths (18%). Excess mortality of both CVD (n=824) and other somatic diseases (n=988) was higher than that of suicide and other external causes (n=675 deaths). MRRs for cerebrovascular disease, coronary heart disease and acute myocardial infarction were twice as high in persons with bipolar disorder compared to the general population. Despite the increased mortality of CVD, hospital admissions (ARR) for CVD treatment were only slightly increased in persons with bipolar disorder when compared to the general population. CONCLUSIONS The increased cardiovascular mortality in persons with bipolar disorder calls for renewed efforts to prevent and treat somatic diseases in this group. Specifically, our findings further imply that it would be critical to ensure that persons with bipolar disorder receive the same quality care for CVD as persons without bipolar disorder.
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Affiliation(s)
- Jeanette Westman
- Department of Neurobiology, Care Sciences, and Society, Centre for Family Medicine (CeFAM), Karolinska Institutet, Stockholm, Sweden
| | - Jonas Hällgren
- Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden
| | - Kristian Wahlbeck
- Department of Mental Health and Substance Abuse Services, THL, National Institute for Health and Welfare, Helsinki, Finland
| | - David Erlinge
- Department of Cardiology, Lunds Universitet, Lund, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Urban Ösby
- Department of Neurobiology, Care Sciences, and Society, Centre for Family Medicine (CeFAM), Karolinska Institutet, Stockholm, Sweden
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Kisely S, Preston N, Xiao J, Lawrence D, Louise S, Crowe E. Reducing all-cause mortality among patients with psychiatric disorders: a population-based study. CMAJ 2012; 185:E50-6. [PMID: 23148054 DOI: 10.1503/cmaj.121077] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Among patients with psychiatric disorders, there are 10 times as many preventable deaths from physical disorders as there are from suicide. We investigated whether compulsory community treatment, such as community treatment orders, could reduce all-cause mortality among patients with psychiatric disorders. METHODS We conducted a population-based survival analysis of an inception cohort using record linking. The study period extended from November 1997 to December 2008. The cohort included patients from all community-based and inpatient psychiatric services in Western Australia (state population 1.8 million). We used a 2-stage design of matching and Cox regression to adjust for demographic characteristics, previous use of health services, diagnosis and length of psychiatric history. We collected data on successive cohorts for each year for which community treatment orders were used to measure changes in numbers of patients, their characteristics and outcomes. Our primary outcome was 2-year all-cause mortality. Our secondary outcomes were 1-and 3-year all-cause mortality. RESULTS The study population included 2958 patients with community treatment orders (cases) and 2958 matched controls (i.e., patients with psychiatric disorders who had not received a community treatment order). The average age for cases and controls was 36.7 years, and 63.7% (3771) of participants were men. Schizophrenia and other nonaffective psychoses were the most common diagnoses (73.4%) among participants. A total of 492 patients (8.3%) died during the study. Cox regression showed that, compared with controls, patients with community treatment orders had significantly lower all-cause mortality at 1, 2 and 3 years, with an adjusted hazard ratio of 0.62 (95% confidence interval 0.45-0.86) at 2 years. The greatest effect was on death from physical illnesses such as cancer, cardiovascular disease or diseases of the central nervous system. This association disappeared when we adjusted for increased outpatient and community contacts with psychiatric services. INTERPRETATION Community treatment orders might reduce mortality among patients with psychiatric disorders. This may be partly explained by increased contact with health services in the community. However, the effects of uncontrolled confounders cannot be excluded.
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Affiliation(s)
- Steve Kisely
- Department of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Australia.
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Fok MLY, Hayes RD, Chang CK, Stewart R, Callard FJ, Moran P. Life expectancy at birth and all-cause mortality among people with personality disorder. J Psychosom Res 2012; 73:104-7. [PMID: 22789412 DOI: 10.1016/j.jpsychores.2012.05.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 05/03/2012] [Accepted: 05/03/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE It is well established that serious mental illness is associated with raised mortality, yet few studies have looked at the life expectancy of people with personality disorder (PD). This study aims to examine the life expectancy and relative mortality in people with PD within secondary mental health care. METHODS We set out to examine this using a large psychiatric case register in southeast London, UK. Mortality was obtained through national mortality tracing procedures. In a cohort of patients with a primary diagnosis of PD (n=1836), standardised mortality ratios (SMRs) and life expectancies at birth were calculated, using general population mortality statistics as the comparator. RESULTS Life expectancy at birth was 63.3 years for women and 59.1 years for men with PD-18.7 years and 17.7 years shorter than females and males respectively in the general population in England and Wales. The SMR was 4.2 (95% CI: 3.03-5.64) overall; 5.0 (95% CI: 3.15-7.45) for females and 3.5 (95% CI: 2.17-5.47) for males. The highest SMRs were found in the younger age groups for both genders. CONCLUSION People with PD using mental health services have a substantially reduced life expectancy, highlighting the significant public health burden of the disorder.
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Affiliation(s)
- Marcella Lei-Yee Fok
- King's College London, King's Health Partners, Dept of Health Service and Population Research, Institute of Psychiatry, London, UK
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Park S, Kim SY, Hong JP. Cause-specific mortality of psychiatric inpatients and outpatients in a general hospital in Korea. Asia Pac J Public Health 2012; 27:164-75. [PMID: 22815305 DOI: 10.1177/1010539512452755] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study aimed to examine the cause-specific excess mortality of psychiatric patients in a general hospital in Korea. Between January 1995 and December 2006, 29 986 patients presented to the outpatient clinic of a general hospital in Seoul, Korea, or were admitted to that hospital for psychiatric disorders. Their cause-specific mortality risk was compared with that of age-matched patients from the general Korean population. The mortality risk of psychiatric patients was 1.6 times higher than that of the general population. Inpatients, younger adults, and patients with alcohol use disorders or schizophrenia had the highest standardized mortality rates (SMRs). Alcohol use disorder was associated with extremely high SMRs of more than 20 for hematological disease and digestive system disease. Effective preventive measures are required to reduce the excess mortality of psychiatric patients, particularly alcohol-dependent patients and younger patients who have been admitted for general psychiatric care.
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Affiliation(s)
- Subin Park
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Yoon Kim
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Pyo Hong
- University of Ulsan College of Medicine, Seoul, Republic of Korea
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Koroukian SM, Bakaki PM, Golchin N, Tyler C, Loue S. Mental illness and use of screening mammography among Medicaid beneficiaries. Am J Prev Med 2012; 42:606-9. [PMID: 22608377 PMCID: PMC3631560 DOI: 10.1016/j.amepre.2012.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 03/04/2012] [Accepted: 03/09/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Disparities in receipt of preventive services by people with mental illness have been documented previously. However, whether these disparities extend to screening mammography among individuals experiencing comparable barriers to accessing care has not been examined fully. PURPOSE To determine whether disparities exist in receipt of screening mammography between women with and without mental illness enrolled in Medicaid, a program with documented potential to reduce healthcare disparities. METHODS Receipt of screening mammography was examined among women aged 50-64 years enrolled in Ohio's Medicaid program during the years 2002-2008 (n=130,088). Receipt of annual screening mammography was examined among those with at least one screening mammography during the study period. Mental illness was identified through diagnostic, service, and pharmacotherapy codes (n=61,661). RESULTS Compared to women without mental illness, more women with mental illness received at least one screening mammography during the study period (31.7% vs 38.1%, p<0.001). However, after adjusting for potential confounders, including the presence of comorbid conditions and length of enrollment in Medicaid, women with mental illness were 32% less likely to undergo at least one screening mammography (AOR=0.68, 95% CI=0.66, 0.70). Among those who received at least one screening mammography, fewer women with mental illness received screening mammography on an annual basis (5.9% vs 12.7%, p<0.001; AOR=0.53, 95% CI=0.49, 0.56). For all beneficiaries, each year of enrollment in Medicaid increased the likelihood of screening mammography use by at least 50%. CONCLUSIONS Medicaid beneficiaries with mental illness constitute a particularly vulnerable population for suboptimal breast cancer screening.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland OH 44106-4945, USA.
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Choi JW, Park S, Yi KK, Hong JP. Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients, and admitted nonsuicidal psychiatric patients. Suicide Life Threat Behav 2012; 42:235-43. [PMID: 22380459 DOI: 10.1111/j.1943-278x.2012.00085.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric inpatients admitted for other reasons were examined. The records of 3,897 patients who were treated at a general hospital in Seoul, Korea, from July 2003 to December 2006 were reviewed. Forty-three of the 3,897 subjects died by suicide during the 2.5-year observation period. Compared to the general Korean population, the suicide mortality rate was 82-fold higher for suicide attempt patients, admitted; 54-fold higher for suicide attempt patients, discharged; 21-fold higher for nonsuicidal patients, admitted; and 11-fold higher for nonsuicidal patients, discharged. In all four groups, diagnosis of a depressive disorder and suicide attempt at presentation were each significant independent risk factors for suicide completion. These results highlight the need for suicide prevention strategies for depressed patients who present to the ER or are admitted to a psychiatric ward after a suicide attempt.
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Affiliation(s)
- Jae W Choi
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
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