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Na EJ, Lee J, Sohn JH, Yang M, Park Y, Sim HB, Lee H. Characteristics of Comorbid Physical Disease in Patients With Severe Mental Illness in South Korea: A Nationwide Population-Based Study (2014-2019). Psychiatry Investig 2024; 21:361-370. [PMID: 38695043 PMCID: PMC11065528 DOI: 10.30773/pi.2023.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/29/2023] [Accepted: 12/08/2023] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE The purpose of this study was to identify the associations of chronic physical disease between patients with severe mental illness (SMI) and the general population of South Korea. METHODS This study was conducted with National Health Insurance Corporation data from 2014 to 2019. A total of 848,058 people were diagnosed with SMI in this period, and the same number of controls were established by matching by sex and age. A descriptive analysis was conducted on the sociodemographic characteristics of patients with SMI. Conditional logistic regression analysis was performed to identify the associations between comorbid physical disease in patients with SMI and those of the general population. SAS Enterprise Guide 7.1 (SAS Inc, Cary, NC, USA) were used to perform all statistical tests. RESULTS The analysis revealed significant differences in medical insurance, income level, and Charlson Comorbidity Index weighted by chronic physical disease, between patients with SMI and the general population. Conditional logistic regression analysis between the two groups also revealed significant differences in eight chronic physical diseases except hypertensive disease. CONCLUSION This study confirmed the vulnerability of patients with SMI to chronic physical diseases and we were able to identify chronic physical disease that were highly related to patients with SMI.
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Affiliation(s)
- Eun Jin Na
- Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
| | - Jungsun Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jee Hoon Sohn
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mi Yang
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
| | - Yoomi Park
- Seoul Metropolitan Government, Seoul, Republic of Korea
| | - Hyun-Bo Sim
- Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
| | - Haewoo Lee
- Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
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Halstead S, Siskind D, Warren N. Making meaning of multimorbidity and severe mental illness: A viewpoint. Aust N Z J Psychiatry 2024; 58:12-20. [PMID: 37655619 PMCID: PMC10756013 DOI: 10.1177/00048674231195560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
People living with severe mental illness, such as schizophrenia and bipolar affective disorder, frequently experience poorer physical health compared to those without mental illness. This issue has hitherto been approached through the disease-centred construct of comorbidity, where subsequent conditions are viewed as secondary to an 'index condition'. In contrast, this Viewpoint sets out to explain why multimorbidity, a patient-centred concept that instead refers to the coexistence of multiple chronic illnesses, is a more versatile and robust framework for tackling the issue of poor physical health in people with severe mental illness. In establishing this argument, this Viewpoint has sought to address three key areas. First, this article will discuss the epidemiology of both physical and psychiatric multimorbidity, with respect to how they manifest at greater frequency and at younger ages in people with severe mental illness. Second, the profound consequences of this multimorbidity burden will be explored, with respect to the 'three D's' of death (premature mortality), disability (functional impacts) and deficit (health-economic impacts). Finally, the utility of multimorbidity as a framework will be illustrated through a proposal for a three-dimensional multimorbidity construct composed of (1) quantity, (2) severity and (3) duration of an individual's chronic illnesses. Consequently, this Viewpoint aims to capture why it is necessary for modern psychiatry to grasp the concept of multimorbidity to facilitate holistic healthcare for people living with severe mental illness.
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Affiliation(s)
- Sean Halstead
- The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia
- Logan Hospital, Metro South Health, Meadowbrook, QLD, Australia
| | - Dan Siskind
- The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Nicola Warren
- The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
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Pizzol D, Trott M, Butler L, Barnett Y, Ford T, Neufeld SA, Ragnhildstveit A, Parris CN, Underwood BR, López Sánchez GF, Fossey M, Brayne C, Fernandez-Egea E, Fond G, Boyer L, Shin JI, Pardhan S, Smith L. Relationship between severe mental illness and physical multimorbidity: a meta-analysis and call for action. BMJ Ment Health 2023; 26:e300870. [PMID: 37907331 PMCID: PMC10619039 DOI: 10.1136/bmjment-2023-300870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND People with severe mental illness (SMI) have a higher prevalence of several chronic physical health conditions, and the prevalence of physical multimorbidity is expected to rise. The aim of this study was to assess the strength of the association between SMI and physical multimorbidity. STUDY SELECTION AND ANALYSIS We systematically searched PubMed/Medline, Scopus, Embase, Web of Science, PsycINFO and the behavioural sciences collection databases, from inception to 31 January 2023, for studies that investigated the association between SMI and physical multimorbidity. Humans of any age either clinically diagnosed and/or currently receiving treatment for SMI, specified as schizophrenia (and related psychotic disorders), bipolar disorder and psychotic depression, were eligible. Data from studies selected for inclusion were converted into ORs, with a subsequent meta-analysis conducted. FINDINGS We included 19 studies with a total of 194 123 patients with SMI with different diagnoses and drawn from the general population. The pooled OR for physical multimorbidity in people with versus without SMI was 1.84 (95% CI 1.33 to 2.54), with the analysis indicating a high level of heterogeneity (98.38%). The other 15 studies included in the systematic review for which it was not possible to conduct a meta-analysis showed strong associations between SMI and physical multimorbidity. CONCLUSIONS The current evidence highlights the link between SMI and physical multimorbidity. A multidisciplinary approach is now urgent to develop the best models of services tailored to patients with SMI with physical multimorbidities to improve physical, mental and social outcomes. PROSPERO registration number CRD42023395165.
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Affiliation(s)
| | - Mike Trott
- Queensland Centre for Mental Health Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Laurie Butler
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Yvonne Barnett
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation trust, Cambridge, UK
| | | | | | - Christopher N Parris
- School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation trust, Cambridge, UK
| | | | - Matt Fossey
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, Cambridge, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation trust, Cambridge, UK
| | - Guillaume Fond
- CEReSS-Health Services Research and Quality of Life Center, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Services Research and Quality of Life Center, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Shahina Pardhan
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
- Centre for Inclusive Community Eye Health, Anglia Ruskin University, Caambridge, UK
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
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Lewis J, Weich S, O'Keeffe C, Stone T, Hulin J, Bell N, Doyle M, Lucock M, Mason S. Use of urgent, emergency and acute care by mental health service users: A record-level cohort study. PLoS One 2023; 18:e0281667. [PMID: 36780483 PMCID: PMC9925080 DOI: 10.1371/journal.pone.0281667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND People with serious mental illness experience worse physical health and greater mortality than the general population. Crude rates of A&E attendance and acute hospital admission are higher in people with serious mental illness than other hospital users. We aimed to further these findings by undertaking a standardised comparison of urgent and emergency care pathway use among users of mental health services and the general population. METHODS Retrospective cohort analysis using routine data from 2013-2016 from the CUREd dataset for urgent and emergency care contacts (NHS 111, ambulance, A&E and acute admissions) and linked mental health trust data for Sheffield, England. We compared annual age- and sex-standardised usage rates for each urgent and emergency care service between users of mental health services and those without a recent history of mental health service use. RESULTS We found marked differences in usage rates for all four urgent and emergency care services between the general population and users of mental health services. Usage rates and the proportion of users were 5-6 times and 3-4 times higher in users of mental health services, respectively, for all urgent and emergency care services. Users of mental health services were often more likely to experience the highest or lowest acuity usage characteristics. CONCLUSIONS Current users of mental health services were heavily over-represented among urgent and emergency care users, and they made more contacts per-person. Higher service use among users of mental health services could be addressed by improved community care, more integrated physical and mental health support, and more proactive primary care. A complex pattern of service use among users of mental health services suggests this will need careful targeting to reduce avoidable contacts and optimise patient outcomes.
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Affiliation(s)
- Jen Lewis
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, United Kingdom
| | - Colin O'Keeffe
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Tony Stone
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Joe Hulin
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Nicholas Bell
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, United Kingdom
| | - Mike Doyle
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
- University of Huddersfield, Huddersfield, United Kingdom
| | - Mike Lucock
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, United Kingdom
- University of Huddersfield, Huddersfield, United Kingdom
| | - Suzanne Mason
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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Boyer L, Fond G, Pauly V, Orléans V, Auquier P, Solmi M, Correll CU, Yon DK, Llorca PM, Baumstarck-Barrau K, Duclos A. Impact of the COVID-19 pandemic on non-COVID-19 hospital mortality in patients with schizophrenia: a nationwide population-based cohort study. Mol Psychiatry 2022; 27:5186-94. [PMID: 36207583 DOI: 10.1038/s41380-022-01803-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 01/14/2023]
Abstract
It remains unknown to what degree resource prioritization toward SARS-CoV-2 (2019-nCoV) coronavirus (COVID-19) cases had disrupted usual acute care for non-COVID-19 patients, especially in the most vulnerable populations such as patients with schizophrenia. The objective was to establish whether the impact of the COVID-19 pandemic on non-COVID-19 hospital mortality and access to hospital care differed between patients with schizophrenia versus without severe mental disorder. We conducted a nationwide population-based cohort study of all non-COVID-19 acute hospitalizations in the pre-COVID-19 (March 1, 2019 through December 31, 2019) and COVID-19 (March 1, 2020 through December 31, 2020) periods in France. We divided the population into patients with schizophrenia and age/sex-matched patients without severe mental disorder (1:10). Using a difference-in-differences approach, we performed multivariate patient-level logistic regression models (adjusted odds ratio, aOR) with adjustment for complementary health insurance, smoking, alcohol and substance addiction, Charlson comorbidity score, origin of the patient, category of care, intensive care unit (ICU) care, major diagnosis groups and hospital characteristics. A total of 198,186 patients with schizophrenia were matched with 1,981,860 controls. The 90-day hospital mortality in patients with schizophrenia increased significantly more versus controls (aOR = 1.18; p < 0.001). This increased mortality was found for poisoning and injury (aOR = 1.26; p = 0.033), respiratory diseases (aOR = 1.19; p = 0.008) and for both surgery (aOR = 1.26; p = 0.008) and medical care settings (aOR = 1.16; p = 0.001). Significant changes in the case mix were noted with reduced admission in the ICU and for several somatic diseases including cancer, circulatory and digestive diseases and stroke for patients with schizophrenia compared to controls. These results suggest a greater deterioration in access to, effectiveness and safety of non-COVID-19 acute care in patients with schizophrenia compared to patients without severe mental disorders. These findings question hospitals' resilience pertaining to patient safety and underline the importance of developing specific strategies for vulnerable patients in anticipation of future public health emergencies.
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