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Edwards J, Kurdyak P, Waddell C, Patten SB, Reid GJ, Campbell LA, Georgiades K. Surveillance of Child and Youth Mental Disorders and Associated Service Use in Canada. Can J Psychiatry 2023; 68:819-825. [PMID: 37357689 PMCID: PMC10590091 DOI: 10.1177/07067437231182059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Affiliation(s)
- Jordan Edwards
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Mental Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Scott B. Patten
- Cuthbertson & Fischer Chair in Pediatric Mental Health, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Graham J. Reid
- Departments of Psychology & Family Medicine, The University of Western Ontario, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Leslie Anne Campbell
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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Chan JKN, Correll CU, Wong CSM, Chu RST, Fung VSC, Wong GHS, Lei JHC, Chang WC. Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102294. [PMID: 37965432 PMCID: PMC10641487 DOI: 10.1016/j.eclinm.2023.102294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Mental disorders are associated with premature mortality. There is increasing research examining life expectancy and years-of-potential-life-lost (YPLL) to quantify the disease impact on survival in people with mental disorders. We aimed to systematically synthesize studies to estimate life expectancy and YPLL in people with any and specific mental disorders across a broad spectrum of diagnoses. Methods In this systematic review and meta-analysis, we searched Embase, MEDLINE, PsychINFO, WOS from inception to July 31, 2023, for published studies reporting life expectancy and/or YPLL for mental disorders. Criteria for study inclusion were: patients of all ages with any mental disorders; reported data on life expectancy and/or YPLL of a mental-disorder cohort relative to the general population or a comparison group without mental disorders; and cohort studies. We excluded non-cohort studies, publications containing non-peer-reviewed data or those restricted to population subgroups. Survival estimates, i.e., life expectancy and YPLL, were pooled (based on summary data extracted from the included studies) using random-effects models. Subgroup analyses and random-effects meta-regression analyses were performed to explore sources of heterogeneity. Risk-of-bias assessment was evaluated using the Newcastle-Ottawa Scale. This study is registered with PROSPERO (CRD42022321190). Findings Of 35,865 studies identified in our research, 109 studies from 24 countries or regions including 12,171,909 patients with mental disorders were eligible for analysis (54 for life expectancy and 109 for YPLL). Pooled life expectancy for mental disorders was 63.85 years (95% CI 62.63-65.06; I2 = 100.0%), and pooled YPLL was 14.66 years (95% CI 13.88-15.98; I2 = 100.0%). Disorder-stratified analyses revealed that substance-use disorders had the shortest life expectancy (57.07 years [95% CI 54.47-59.67]), while neurotic disorders had the longest lifespan (69.51 years [95% CI 67.26-71.76]). Substance-use disorders exhibited the greatest YPLL (20.38 years [95% CI 18.65-22.11]), followed by eating disorders (16.64 years [95% CI 7.45-25.82]), schizophrenia-spectrum disorders (15.37 years [95% CI 14.18-16.55]), and personality disorders (15.35 years [95% CI 12.80-17.89]). YPLLs attributable to natural and unnatural deaths in mental disorders were 4.38 years (95% CI 3.15-5.61) and 8.11 years (95% CI 6.10-10.13; suicide: 8.31 years [95% CI 6.43-10.19]), respectively. Stratified analyses by study period suggested that the longevity gap persisted over time. Significant cross-study heterogeneity was observed. Interpretation Mental disorders are associated with substantially reduced life expectancy, which is transdiagnostic in nature, encompassing a wide range of diagnoses. Implementation of comprehensive and multilevel intervention approaches is urgently needed to rectify lifespan inequalities for people with mental disorders. Funding None.
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Affiliation(s)
- Joe Kwun Nam Chan
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corine Sau Man Wong
- LKS Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ryan Sai Ting Chu
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Vivian Shi Cheng Fung
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Gabbie Hou Sem Wong
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Janet Hiu Ching Lei
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
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Natividad M, Seeman MV, Paolini JP, Balagué A, Román E, Bagué N, Izquierdo E, Salvador M, Vallet A, Pérez A, Monreal JA, González-Rodríguez A. Monitoring the Effectiveness of Treatment in Women with Schizophrenia: New Specialized Cooperative Approaches. Brain Sci 2023; 13:1238. [PMID: 37759839 PMCID: PMC10526759 DOI: 10.3390/brainsci13091238] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Women with schizophrenia have specific health needs that differ from those of men and that change through successive life stages. We aimed to review the biopsychosocial literature on schizophrenia that addresses clinically important questions related to the treatment of women, including somatic morbi-mortality, hyperprolactinemia, comorbid substance use disorders, social risk factors, and medication effectiveness/safety. Data search terms were as follows: (Morbidity AND mortality) OR hyperprolactinemia OR ("substance use disorders" OR addictions) OR ("social risk factors") OR ("drug safety" OR prescription) AND women AND schizophrenia. A secondary aim was to describe a method of monitoring and interdisciplinary staff strategies. Schizophrenia patients show an increased risk of premature death from cardiovascular/respiratory disease and cancer compared to the general population. The literature suggests that close liaisons with primary care and the introduction of physical exercise groups reduce comorbidity. Various strategies for lowering prolactin levels diminish the negative long-term effects of hyperprolactinemia. Abstinence programs reduce the risk of victimization and trauma in women. Stigma associated with women who have serious psychiatric illness is often linked to reproductive functions. The safety and effectiveness of antipsychotic drug choice and dose differ between men and women and change over a woman's life cycle. Monitoring needs to be multidisciplinary, knowledgeable, and regular.
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Affiliation(s)
- Mentxu Natividad
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Mary V. Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5P 3L6, Canada;
| | - Jennipher Paola Paolini
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Ariadna Balagué
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Eloïsa Román
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Noelia Bagué
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Eduard Izquierdo
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Mireia Salvador
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Anna Vallet
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Anabel Pérez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - José A. Monreal
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
- Institut de Neurociències, Universitat Autònoma de Barcelona (UAB), 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
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Patel R, Akahara PC, Musa MRO, Okereke OP, Puri C, Abera S, Okoronkwo OU, Iroro J, Dan-Eleberi AO, Okobi OE, Nwachukwu O. Association Between Depression and Anxiety Status With Uptake of Colorectal Cancer Screening Among US Adults: A Population-Level Study. Cureus 2023; 15:e42659. [PMID: 37644921 PMCID: PMC10462395 DOI: 10.7759/cureus.42659] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Individuals with different mental disorders tend to experience higher rates of colorectal cancer (CRC)-related mortality compared to the general population. Discrepancies in CRC screening behaviors have been suggested as a potential contributing factor to this difference in mortality. However, existing evidence on this topic has been inconclusive and conflicting. OBJECTIVE This study aims to explore the relationship between mental health status (specifically, depression and/or anxiety) and the uptake of CRC screening. To achieve this, a larger and nationally representative sample from the adult population of the United States was utilized. METHODS We employed a cross-sectional approach using data from the 2019-2020 edition of the Health Information National Trends Survey (HINTS). The study examined disparities in CRC screening between individuals with self-reported history of depression diagnosis and the general population. Chi-square tests were used for analysis. Multivariable logistic regression models were applied to adjust for variables such as gender, age, education level, race, comorbidities, healthcare access, smoking status, household income, geographical residence, and insurance status. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. RESULTS The findings of the study indicated that out of 5,398 eligible individuals, approximately 1,220 (weighted percentage: 22.8%) reported experiencing depression and/or anxiety, and approximately 4,154 (weighted percentage: 68.9%) reported adherence to colorectal cancer screening. In the bivariate analysis, there was no significant difference in participation in colorectal cancer screening between individuals with and without depression and/or anxiety (72.0% vs. 68.0%). Similarly, after adjusting for sociodemographic and health-related factors, the study found that the odds of participating in colorectal cancer screening did not vary based on an individual's depression status (OR 1.34, 95% CI 0.94-1.91, P = 0.05). CONCLUSION Individuals with depression participate in colorectal cancer screening at comparable rates to the general population. The findings of this study suggest that factors beyond CRC screening may play significant roles in the higher CRC-associated mortality rate. Therefore, further research is needed to uncover the various mechanisms contributing to the increased cancer-related mortality rates among susceptible populations.
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Affiliation(s)
- Radhey Patel
- Psychiatry and Behavioral Sciences, Avalon University School of Medicine, Willemstad, CUW
| | | | | | | | - Chander Puri
- Medical School, Gian Sagar Medical College and Hospital, Patiala, IND
| | - Saare Abera
- Internal Medicine, American University of Integrated Sciences, St. Michael, BRB
| | - Obiaku U Okoronkwo
- School of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
| | - Joy Iroro
- Internal Medicine, All Saints University School of Medicine, Dominica, DMA
| | | | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Ogechukwu Nwachukwu
- Internal Medicine, St. Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, GBR
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Wang J, Gholi Zadeh Kharrat F, Pelletier JF, Rochette L, Pelletier E, Lévesque P, Massamba V, Brousseau-Paradis C, Mohammed M, Gariépy G, Gagné C, Lesage A. A case-control study on predicting population risk of suicide using health administrative data: a research protocol. BMJ Open 2023; 13:e066423. [PMID: 36849211 PMCID: PMC9972456 DOI: 10.1136/bmjopen-2022-066423] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION Suicide has a complex aetiology and is a result of the interaction among the risk and protective factors at the individual, healthcare system and population levels. Therefore, policy and decision makers and mental health service planners can play an important role in suicide prevention. Although a number of suicide risk predictive tools have been developed, these tools were designed to be used by clinicians for assessing individual risk of suicide. There have been no risk predictive models to be used by policy and decision makers for predicting population risk of suicide at the national, provincial and regional levels. This paper aimed to describe the rationale and methodology for developing risk predictive models for population risk of suicide. METHODS AND ANALYSIS A case-control study design will be used to develop sex-specific risk predictive models for population risk of suicide, using statistical regression and machine learning techniques. Routinely collected health administrative data in Quebec, Canada, and community-level social deprivation and marginalisation data will be used. The developed models will be transformed into the models that can be readily used by policy and decision makers. Two rounds of qualitative interviews with end-users and other stakeholders were proposed to understand their views about the developed models and potential systematic, social and ethical issues for implementation; the first round of qualitative interviews has been completed. We included 9440 suicide cases (7234 males and 2206 females) and 661 780 controls for model development. Three hundred and forty-seven variables at individual, healthcare system and community levels have been identified and will be included in least absolute shrinkage and selection operator regression for feature selection. ETHICS AND DISSEMINATION This study is approved by the Health Research Ethnics Committee of Dalhousie University, Canada. This study takes an integrated knowledge translation approach, involving knowledge users from the beginning of the process.
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Affiliation(s)
- JianLi Wang
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Louis Rochette
- Institut national de sante publique du Quebec (INSPQ), Quebec City, Quebec, Canada
| | - Eric Pelletier
- Institut national de sante publique du Quebec (INSPQ), Quebec City, Quebec, Canada
| | - Pascale Lévesque
- Institut national de sante publique du Quebec (INSPQ), Quebec City, Quebec, Canada
| | - Victoria Massamba
- Institut national de sante publique du Quebec (INSPQ), Quebec City, Quebec, Canada
| | | | - Mada Mohammed
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Geneviève Gariépy
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
| | - Christian Gagné
- Department of Electrical Engineering and Computer Engineering, Laval University, Quebec, Quebec, Canada
| | - Alain Lesage
- Institut universitaire en sante mentale de Montreal, Montreal, Québec, Canada
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Reis da Silva DA, de Almeida LS, Correa LL, Pimentel RFW, Gomes AMT, Travassos AG, Viana AM, Cerqueira MMBDF, de Souza MC, de Sousa AR, Barbosa PJB, Coelho JMF, Magalhães LBNC, D’Oliveira Júnior A, Cavalcante Neto JL, Santos CS, França LCM, Brandão JDL, dos Santos LFDM, Gomes HF, Peres EM, Rossi TRA, Damasceno KSM, das Mercês MC, Fernandes SL, Soriano EDA, Maduro IPDNN, Brandão TS, Menezes AC, Santana AIC, das Merces MC. Prevalence and Factors Associated with Metabolic Syndrome in Patients at a Psychosocial Care Center: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:10203. [PMID: 36011835 PMCID: PMC9407874 DOI: 10.3390/ijerph191610203] [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] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Metabolic syndrome (MS) is associated with greater risk of morbimortality and it has high prevalence in people with mental illness. OBJECTIVE Estimate the prevalence of Metabolic Syndrome (MS) and its associated factors in the patients of a Psychosocial Care Center (CAPS in Brazilian Portuguese) in the city of Salvador, state of Bahia, Brazil. METHOD Cross-sectional study set at CAPS in the city of Salvador-Bahia between August 2019 and February 2020. MS was evaluated according to the National Cholesterol Education Program's Adult Treatment Panel III. In addition to descriptive statistics, gross and adjusted prevalence ratios were described. RESULTS MS was found in 100 (35.2%) individuals, 116 (40.9%) were obese and 165 (58.1%) had increased waist circumference. Polypharmacy was identified in 63 (22.3%) patients and 243 (85.9%) used antipsychotics. Under gross evaluation, women (PR = 1.88; 95%CI: 1.35-2.63) and those who used antidepressants (PR = 1.41; 95%CI: 1.05-1.88) showed an association with MS. After logistic regression, depression (PR = 1.86; 95%CI: 1.38-2.51), acanthosis (PR = 1.50; 95%CI: 1.18-1.90), use of antipsychotics (PR = 1.88; 95%CI: 1.13-2.75), and hypertriglyceridemic waist (PR = 3.33; 95%CI: 2.48-4.46) were associated with MS. CONCLUSION The prevalence of MS signals multimorbidity among individuals with mental disorders and suggests a need for clinical screening.
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Affiliation(s)
| | - Ludmila Santana de Almeida
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Bahia, Brazil
| | - Livia Lugarinho Correa
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE), Rio de Janeiro 22451-000, Rio de Janeiro, Brazil
| | - Rodrigo Fernandes Weyll Pimentel
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Bahia, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador 40026-010, Bahia, Brazil
- Hospital Universitário Professor Edgard Santos (HUPES/UFBA), Universidade Federal da Bahia, Salvador 40150-000, Bahia, Brazil
- Centro Universitário UnidomPedro, Salvador 40010-020, Bahia, Brazil
| | - Antonio Marcos Tosoli Gomes
- Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Rio de Janeiro, Brazil
| | - Ana Gabriela Travassos
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Bahia, Brazil
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Secretaria de Saúde do Estado da Bahia, Salvador 40100-160, Bahia, Brazil
| | - Adriana Mattos Viana
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Bahia, Brazil
| | - Monique Magnavita Borba da Fonseca Cerqueira
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Bahia, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador 40026-010, Bahia, Brazil
| | - Marcio Costa de Souza
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Bahia, Brazil
| | - Anderson Reis de Sousa
- Escola de Enfermagem, Universidade Federal da Bahia (UFBA), Salvador 40110-060, Bahia, Brazil
| | - Paulo José Bastos Barbosa
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Bahia, Brazil
| | - Julita Maria Freitas Coelho
- Centro Universitário UnidomPedro, Salvador 40010-020, Bahia, Brazil
- Instituto Federal da Bahia (IFBA), Simões Filho 43700-000, Bahia, Brazil
| | | | - Argemiro D’Oliveira Júnior
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador 40026-010, Bahia, Brazil
| | | | | | - Luiz Carlos Moraes França
- Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Rio de Janeiro, Brazil
| | - Juliana de Lima Brandão
- Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Rio de Janeiro, Brazil
| | | | - Helena Ferraz Gomes
- Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Rio de Janeiro, Brazil
| | - Ellen Marcia Peres
- Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro 20551-030, Rio de Janeiro, Brazil
| | - Thais Regis Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Bahia, Brazil
| | - Kairo Silvestre Meneses Damasceno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Bahia, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador 40026-010, Bahia, Brazil
| | | | | | | | | | - Tatiana Santos Brandão
- Hospital Universitário Professor Edgard Santos (HUPES/UFBA), Universidade Federal da Bahia, Salvador 40150-000, Bahia, Brazil
| | - Amanda Cardoso Menezes
- Centro Universitário UnidomPedro, Salvador 40010-020, Bahia, Brazil
- Hospital Ana Nery (HAN), Salvador 40301-155, Bahia, Brazil
| | - Amália Ivine Costa Santana
- Hospital Universitário Professor Edgard Santos (HUPES/UFBA), Universidade Federal da Bahia, Salvador 40150-000, Bahia, Brazil
| | - Magno Conceição das Merces
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Bahia, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador 40026-010, Bahia, Brazil
- Centro Universitário UnidomPedro, Salvador 40010-020, Bahia, Brazil
- Faculdade de Tecnologia e Ciências (UNIFTC), Salvador 41741-590, Bahia, Brazil
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Lambert AM, Parretti HM, Pearce E, Price MJ, Riley M, Ryan R, Tyldesley-Marshall N, Avşar TS, Matthewman G, Lee A, Ahmed K, Odland ML, Correll CU, Solmi M, Marshall T. Temporal trends in associations between severe mental illness and risk of cardiovascular disease: A systematic review and meta-analysis. PLoS Med 2022; 19:e1003960. [PMID: 35439243 PMCID: PMC9017899 DOI: 10.1371/journal.pmed.1003960] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/08/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI; schizophrenia, bipolar disorders (BDs), and other nonorganic psychoses) is associated with increased risk of cardiovascular disease (CVD) and CVD-related mortality. To date, no systematic review has investigated changes in population level CVD-related mortality over calendar time. It is unclear if this relationship has changed over time in higher-income countries with changing treatments. METHODS AND FINDINGS To address this gap, a systematic review was conducted, to assess the association between SMI and CVD including temporal change. Seven databases were searched (last: November 30, 2021) for cohort or case-control studies lasting ≥1 year, comparing frequency of CVD mortality or incidence in high-income countries between people with versus without SMI. No language restrictions were applied. Random effects meta-analyses were conducted to compute pooled hazard ratios (HRs) and rate ratios, pooled standardised mortality ratios (SMRs), pooled odds ratios (ORs), and pooled risk ratios (RRs) of CVD in those with versus without SMI. Temporal trends were explored by decade. Subgroup analyses by age, sex, setting, world region, and study quality (Newcastle-Ottawa scale (NOS) score) were conducted. The narrative synthesis included 108 studies, and the quantitative synthesis 59 mortality studies (with (≥1,841,356 cases and 29,321,409 controls) and 28 incidence studies (≥401,909 cases and 14,372,146 controls). The risk of CVD-related mortality for people with SMI was higher than controls across most comparisons, except for total CVD-related mortality for BD and cerebrovascular accident (CVA) for mixed SMI. Estimated risks were larger for schizophrenia than BD. Pooled results ranged from SMR = 1.55 (95% confidence interval (CI): 1.33 to 1.81, p < 0.001), for CVA in people with BD to HR/rate ratio = 2.40 (95% CI: 2.25 to 2.55, p < 0.001) for CVA in schizophrenia. For schizophrenia and BD, SMRs and pooled HRs/rate ratios for CHD and CVD mortality were larger in studies with outcomes occurring during the 1990s and 2000s than earlier decades (1980s: SMR = 1.14, 95% CI: 0.57 to 2.30, p = 0.71; 2000s: SMR = 2.59, 95% CI: 1.93 to 3.47, p < 0.001 for schizophrenia and CHD) and in studies including people with younger age. The incidence of CVA, CVD events, and heart failure in SMI was higher than controls. Estimated risks for schizophrenia ranged from HR/rate ratio 1.25 (95% CI: 1.04 to 1.51, p = 0.016) for total CVD events to rate ratio 3.82 (95% CI: 3.1 to 4.71, p < 0.001) for heart failure. Incidence of CHD was higher in BD versus controls. However, for schizophrenia, CHD was elevated in higher-quality studies only. The HR/rate ratios for CVA and CHD were larger in studies with outcomes occurring after the 1990s. Study limitations include the high risk of bias of some studies as they drew a comparison cohort from general population rates and the fact that it was difficult to exclude studies that had overlapping populations, although attempts were made to minimise this. CONCLUSIONS In this study, we found that SMI was associated with an approximate doubling in the rate ratio of CVD-related mortality, particularly since the 1990s, and in younger groups. SMI was also associated with increased incidence of CVA and CHD relative to control participants since the 1990s. More research is needed to clarify the association between SMI and CHD and ways to mitigate this risk.
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Affiliation(s)
- Amanda M Lambert
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Helen M Parretti
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Emma Pearce
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Malcolm J Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Mark Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ronan Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Tuba Saygın Avşar
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Gemma Matthewman
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Alexandra Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Khaled Ahmed
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi.,Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York, United States of America.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, United States of America.,Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada.,Department of Mental Health, The Ottawa Hospital, Ontario, Canada.,Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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8
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Lamoureux-Lamarche C, Berbiche D, Vasiliadis HM. Health care system and patient costs associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults. BMC Psychiatry 2022; 22:175. [PMID: 35272650 PMCID: PMC8908583 DOI: 10.1186/s12888-022-03759-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and anxiety disorders in older adults are associated with a great burden. Research has shown that less than 50% of adults receive adequate treatment in primary care settings for these disorders. Rare are the studies however assessing adequate treatment in older adults and associated costs from the societal perspective. Given the episodic nature of common mental disorders, this study aims to assess the three-year costs from a restricted societal perspective (including health system and patient perspectives) associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults consulting in primary care. METHODS This primary care cohort study included 358 older adults aged 65 years and older with either a self-reported or physician diagnosis of depression or an anxiety disorder covered under Quebec's public drug plan. Receipt of minimally adequate treatment was assessed according to Canadian guidelines and relevant reports. Outpatient and inpatient service use, medication costs and physician billing fees were obtained from provincial administrative databases. Unit costs were calculated using provincial financial and activity reports and relevant literature. A propensity score was created to estimate the probability of receiving minimally adequate treatment and the inverse probability was used as a weight in analyses. Generalized linear models, with gamma distribution and log link, were conducted to assess the association between receipt of minimally adequate treatment and costs. RESULTS Overall, receipt of minimally adequate treatment was associated with increased three-year costs averaging $5752, $536, $6266 for the health system, patient and societal perspectives, respectively, compared to those not receiving minimally adequate treatment. From the health system perspective, participants receiving minimally adequate treatment had higher costs related to emergency department (ED) (difference: $457, p = 0.001) and outpatient visits (difference: $620, p < 0.001), inpatient stays (difference: $2564, p = 0.025), drug prescriptions (difference: $1243, p = 0.002) and physician fees (difference: $1224, p < 0.001). From the patient perspective, receipt of minimally adequate treatment was associated with higher costs related to loss of productivity related to ED (difference: $213, p < 0.001) and outpatient visits (difference: $89, p < 0.001). CONCLUSIONS Older adults receiving minimally adequate treatment for depression and anxiety disorders incurred higher societal costs reaching $2089 annually compared to older adults not receiving minimally adequate treatment. The main cost drivers were attributable to hospitalizations and prescription drug costs.
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Affiliation(s)
- Catherine Lamoureux-Lamarche
- grid.86715.3d0000 0000 9064 6198Faculty of Medicine and Health Sciences, Campus de Longueuil – Université de Sherbrooke; Centre de recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Quebec J4K 0A8 Longueuil, Canada
| | - Djamal Berbiche
- grid.86715.3d0000 0000 9064 6198Faculty of Medicine and Health Sciences, Campus de Longueuil – Université de Sherbrooke; Centre de recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Quebec J4K 0A8 Longueuil, Canada
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, Campus de Longueuil - Université de Sherbrooke; Centre de recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Quebec, J4K 0A8, Longueuil, Canada.
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9
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Liu X, Wang D, Fan R, Wang R, Xiang H, Yang X, Liu Y. Life expectancy and potential years of life lost for schizophrenia in western China. Psychiatry Res 2022; 308:114330. [PMID: 34929521 DOI: 10.1016/j.psychres.2021.114330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/21/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022]
Abstract
Excess mortality in people with schizophrenia has been extensively reported. However, little is known about the life expectancy and potential years of life lost (PYLL) in western China. This study aimed to estimated life expectancy and PYLL for people with schizophrenia in western China. A total of 228,572 people with schizophrenia were included from National Information System for Psychosis in one province of western China. Life-expectancy was calculated by using Chiang's method. One-way ANOVA was used to compare the age-sex standardized PYLL for different causes of death among different demographic characteristics groups. Life expectancy for men and women with schizophrenia was 52.8 years and 59.0 years respectively. The overall PYLL of people with schizophrenia was 18.4 years, and suicide had the largest PYLL (31.2 years) among all causes of mortality. The PYLL due to suicide was significantly higher among men, high school and above, non-poverty, non-farmer and divorced people with schizophrenia. The PYLL due to diseases and medical conditions was higher among men, illiteracy, farmer and unmarried people with schizophrenia. Strategies to prevent causes of premature death in schizophrenia are urgently required in western China, particularly in the promotion of physical health and prevention of suicide.
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Affiliation(s)
- Xiang Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Dan Wang
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Ruoxin Fan
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Rongke Wang
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Hu Xiang
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Xianmei Yang
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China.
| | - Yuanyuan Liu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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10
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Huỳnh C, Kisely S, Rochette L, Pelletier É, Morrison KB, Li S, Hopkin G, Smith M, Burchill C, Lin E, Asbridge M, Jutras-Aswad D, Lesage A. Measuring Substance-Related Disorders Using Canadian Administrative Health Databanks: Interprovincial Comparisons of Recorded Diagnostic Rates, Incidence Proportions and Mortality Rate Ratios. Can J Psychiatry 2022; 67:117-129. [PMID: 34569874 PMCID: PMC8978214 DOI: 10.1177/07067437211043446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Assessing temporal changes in the recorded diagnostic rates, incidence proportions, and health outcomes of substance-related disorders (SRD) can inform public health policymakers in reducing harms associated with alcohol and other drugs. OBJECTIVE To report the annual and cumulative recorded diagnostic rates and incidence proportions of SRD, as well as mortality rate ratios (MRRs) by cause of death among this group in Canada, according to their province of residence. METHODS Analyses were performed on linked administrative health databases (AHD; physician claims, hospitalizations, and vital statistics) in five Canadian provinces (Alberta, Manitoba, Ontario, Québec, and Nova Scotia). Canadians 12 years and older and registered for their provincial healthcare coverage were included. The International Classification of Diseases (ICD-9 or ICD-10 codes) was used for case identification of SRD from April 2001 to March 2018. RESULTS During the study period, the annual recorded SRD diagnostic rates increased in Alberta (2001-2002: 8.0‰; 2017-2018: 12.8‰), Ontario (2001-2002: 11.5‰; 2017-2018: 14.4‰), and Nova Scotia (2001-2002: 6.4‰; 2017-2018: 12.7‰), but remained stable in Manitoba (2001-2002: 5.5‰; 2017-2018: 5.4‰) and Québec (2001-2002 and 2017-2018: 7.5‰). Cumulative recorded SRD diagnostic rates increased steadily for all provinces. Recorded incidence proportions increased significantly in Alberta (2001-2002: 4.5‰; 2017-2018: 5.0‰) and Nova Scotia (2001-2002: 3.3‰; 2017-2018: 3.8‰), but significantly decreased in Ontario (2001-2002: 6.2‰; 2017-2018: 4.7‰), Québec (2001-2002: 4.1‰; 2017-2018: 3.2‰) and Manitoba (2001-2002: 2.7‰; 2017-2018: 2.0‰). For almost all causes of death, a higher MRR was found among individuals with recorded SRD than in the general population. The causes of death in 2015-2016 with the highest MRR for SRD individuals were SRD, suicide, and non-suicide trauma in Alberta, Ontario, Manitoba, and Québec. DISCUSSION Linked AHD covering almost the entire population can be useful to monitor the medical service trends of SRD and, therefore, guide health services planning in Canadian provinces.
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Affiliation(s)
- Christophe Huỳnh
- University Institute on Addictions, 49987CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Québec.,Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.,School of Psychoeducation, University of Montréal, Montréal, Québec, Canada.,Recherche et Intervention sur les Substances Psychoactives - Québec, Trois-Rivières, Québec, Canada.,54470Institut National de Santé Publique du Québec, Québec, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, 12361Dalhousie University, Halifax, Nova Scotia, Canada.,School of Medicine, University of Queensland, Queensland, Australia
| | - Louis Rochette
- 54470Institut National de Santé Publique du Québec, Québec, Canada
| | - Éric Pelletier
- 54470Institut National de Santé Publique du Québec, Québec, Canada
| | | | - Shelley Li
- 151965Alberta Health, Edmonton, Alberta, Canada
| | - Gareth Hopkin
- Institute of Health Economics & University of Alberta, Edmonton, Alberta, Canada.,Health Technology Wales, 1029NHS Wales/GIG Cymru, Cardiff, Wales, UK
| | - Mark Smith
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, 50023University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles Burchill
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, 50023University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Lin
- 7978Centre for Addiction & Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, 12361Dalhousie University, Halifax, Nova Scotia, Canada
| | - Didier Jutras-Aswad
- University Institute on Addictions, 49987CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Québec.,Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.,Research Centre, 5622Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Alain Lesage
- University Institute on Addictions, 49987CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Québec.,Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.,54470Institut National de Santé Publique du Québec, Québec, Canada.,25443Research Centre of the Montréal Mental Health University Institute, Montréal, Québec, Canada
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11
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Al-Rawi S, Zolezzi M, Eltorki Y. Evaluation of cardiovascular risk in adult psychiatric outpatients in Qatar using two risk assessment tools. Qatar Med J 2021; 2021:27. [PMID: 34604012 PMCID: PMC8475158 DOI: 10.5339/qmj.2021.27] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/13/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Individuals with serious mental illness (SMI) experience premature death, likely due to increased rates of obesity and cardiovascular disease (CVD). This study was conducted to estimate the CVD risk in a cohort of individuals with SMI receiving outpatient psychiatric services in Qatar and to assess contributory CVD risk factors. Methods: This is a retrospective review of the electronic medical records of a cohort of outpatients with SMI attending a mental health clinic in Doha, Qatar. The CVD risk was estimated using two risk prediction tools: the American Heart Association and the American College of Cardiology (AHA/ACC) risk calculator and the World Health Organization/International Society of Hypertension (WHO/ISH) CVD risk prediction charts for the Eastern Mediterranean region. Descriptive and inferential statistics were used to analyze the demographic and clinical data. Data were analyzed using Statistical Package for the Social Sciences. Results: Of the 346 eligible patients, 28% (n = 97) had obtainable data for the estimation of their CVD risk using both tools. Approximately one-third of the cohort (33%) were classified as high risk using the AHA/ACC risk calculator, and 13.3% were classified as intermediate to high risk using the WHO/ISH CVD risk prediction charts. Based on the AHA/ACC risk scores, among those with a high CVD risk, almost two-thirds had CVD modifiable risk factors (i.e., smoking, diabetes, dyslipidemia, and hypertension). No statistically significant difference in the CVD risk estimates was observed among individuals with a body mass index of more or lower than 30 kg/m2 (p = 0.815). Conclusion: Based on the AHA/ACC risk calculator, approximately one-third of the study cohort had high CVD risk estimates. The WHO/ISH CVD risk prediction charts appeared to underestimate CVD risk, particularly for those identified as high risk using the AHA/ACC risk calculator. A closer alliance between psychiatrists and primary healthcare professionals to control modifiable cardiovascular risk factors among patients with SMI is necessary.
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Affiliation(s)
- Safa Al-Rawi
- Al Wakrah Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Yassin Eltorki
- Mental Health Hospital, Hamad Medical Corporation, Doha, Qatar
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12
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Affiliation(s)
| | - Mathias Lasgaard
- DEFACTUM-Public Health & Health Services Research, 69688Central Denmark Region, Aarhus, Denmark
| | - Zeina N Mneimneh
- Survey Research Center, Institute for Social Research, 1259University of Michigan, Ann Arbor, MI, USA
| | - John J McGrath
- National Centre for Register-based Research, 1006Aarhus University, Denmark.,Queensland Brain Institute, 1974University of Queensland, St Lucia, Queensland, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
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13
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Abstract
Hintergrund Psychisch Kranke haben ein erhöhtes kardiovaskuläres Mortalitätsrisiko. Zur Prophylaxe und Therapie von Herz-Kreislauf-Erkrankungen werden insbesondere Antihypertensiva eingesetzt. In Kombination mit Psychopharmaka resultiert ein Interaktionspotenzial, wodurch das Erreichen therapeutischer Ziele beeinträchtigt werden kann. Ziel Das Verordnungsverhalten bei Antihypertensiva in psychiatrischen Kliniken und Praxen im deutschsprachigen Raum sowie das Interaktionspotenzial mit Psychopharmaka soll untersucht werden. Methoden Es erfolgte eine Auswertung der AGATE-„Stichtags“-Datenbank, welche anonym die Patientendaten Alter, Geschlecht, psychiatrische Hauptdiagnose sowie die verordneten Handelspräparate enthält. Die Auswertung der möglichen Interaktionen erfolgte mit PSIAC. Ergebnisse Zwischen 01.01.2012 und 31.12.2016 wiesen 27 % aller 21.980 erfassten Patienten eine Verordnung für mindestens ein Antihypertensivum auf, wobei der Anteil mit dem Alter auf 72 % bei den über 80-Jährigen anstieg. 48 % der antihypertensiv Behandelten erhielten eine blutdrucksenkende Monotherapie. Mit dem Alter stieg die Bedeutung der antihypertensiven Kombinationstherapie. Insgesamt wurden den Patienten im Median 7 Wirkstoffe verordnet, wodurch mathematisch 21 Interaktionen resultieren. Durch eine gleichzeitige Gabe von Psychopharmaka und Blutdrucksenkern kann es vor allem zu einem erhöhten Risiko für Hypotonie, unzureichende Blutdrucksenkung oder QTc-Zeitverlängerung kommen. Diskussion Antihypertensiva haben einen hohen Stellenwert bei der Behandlung psychiatrischer Patienten. Eine Interaktionsprüfung sollte durchgeführt werden, wenn die Pharmakotherapie ergänzt oder verändert werden soll. Allenfalls sollten Maßnahmen zur Verbesserung der Arzneimitteltherapiesicherheit erwogen werden.
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Affiliation(s)
- Katharina Endres
- Institut AGATE gGmbH Pentling, Pentling, Deutschland.
- Klinische Pharmakologie, Lehrstuhl für Pharmakologie und Toxikologie, Universität Regensburg, Universitätsstr. 31, 93053, Regensburg, Deutschland.
| | - Ernst Schiller
- Rechenzentrum, Universität Regensburg, Universitätsstr. 31, 93053, Regensburg, Deutschland
| | - Ekkehard Haen
- Institut AGATE gGmbH Pentling, Pentling, Deutschland
- Klinische Pharmakologie, Lehrstuhl für Pharmakologie und Toxikologie, Universität Regensburg, Universitätsstr. 31, 93053, Regensburg, Deutschland
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14
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Girardi P, Schievano E, Fedeli U, Braggion M, Nuti M, Amaddeo F. Causes of mortality in a large population-based cohort of psychiatric patients in Southern Europe. J Psychiatr Res 2021; 136:167-172. [PMID: 33601168 DOI: 10.1016/j.jpsychires.2021.01.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [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] [Received: 09/29/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/25/2022]
Abstract
The World Health Organization considers excess morbidity and mortality among people with mental disorders as a high public health priority. This study aims to estimate the mortality risk and causes of death among a large population-based cohort of psychiatric patients. All residents in Veneto (Northeastern Italy) aged between 18 and 84 years with a contact with Community Mental Health Centers in 2008 and a psychiatric diagnosis (n = 54,350) were followed-up for 10 years. Standardized Mortality Ratios (SMR) and excess mortality were computed, with the general regional population as a reference. Mortality was more than doubled (males SMR = 2.4; females SMR = 2.2) and the relative increase in mortality was much larger in young and middle-aged adults (18-44 and 45-64 years) across all diagnostic groups. The most frequent causes were circulatory diseases (27%) and neoplasms (26%). Although the risk was increased by about tenfold, deaths from suicide were limited to 6% and 4% of all decedents in males and females, respectively. Patients with schizophrenia showed a very high risk for mortality for diabetes and cardiovascular disorders. A large excess was found also for respiratory diseases and a two-fold increase for lung cancer in males and breast cancer in females. Although chronic physical disorders are known to be the main causes of mortality in such patients, they receive far less attention than suicide or accidents. Our results suggest that there is still a need to plan actions to prevent excess mortality and to improve the quality of life of patients with mental disorders.
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Affiliation(s)
- Paolo Girardi
- Department of Developmental Psychology and Socialization, University of Padua, Via Venezia 8, 35131, Padua, Italy.
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Marco Braggion
- Epidemiological Department, Azienda Zero, Veneto Region, Via Jacopo d'Avanzo 35, 35132, Padua, Italy.
| | - Marco Nuti
- Mental Health and Penitentiary Health Care Unit, Veneto Region, Rio Novo, Dorsoduro 3493, 30123, Venice, Italy.
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
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15
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Moreno-Küstner B, Guzman-Parra J, Pardo Y, Sanchidrián Y, Díaz-Ruiz S, Mayoral-Cleries F. Excess mortality in patients with schizophrenia spectrum disorders in Malaga (Spain): A cohort study. Epidemiol Psychiatr Sci 2021; 30:e11. [PMID: 33536113 DOI: 10.1017/S2045796020001146] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Indexed: 11/07/2022] Open
Abstract
AIMS There is evidence that patients with schizophrenia spectrum disorders present higher mortality in comparison with the general population. The aim of this study was to analyse the causes of mortality and sociodemographic factors associated with mortality, standardised mortality ratios (SMRs), life expectancy and potential years of life lost (YLL) in patients with schizophrenia spectrum disorders in Spain. METHODS The study included a cohort of patients from the Malaga Schizophrenia Case Register (1418 patients; 907 males; average age 42.31 years) who were followed up for a minimum of 10 years (median = 13.43). The factors associated with mortality were analysed with a survival analysis using Cox's proportional hazards regression model. RESULTS The main causes of mortality in the cohort were circulatory disease (21.45%), cancer (17.09%) and suicide (13.09%). The SMR of the cohort was more than threefold that of the population of Malaga (3.19). The life expectancy at birth was 67.11 years old, which is more than 13 years shorter than that of the population of Malaga. The YLL was 20.74. The variables associated with a higher risk of mortality were age [adjusted hazard ratio (AHR) = 1.069, p < 0.001], male gender (AHR = 1.751, p < 0.001) and type of area of residence (p = 0.028; deprived urban zone v. non-deprived urban area, AHR = 1.460, p = 0.028). In addition, receiving welfare benefit status in comparison with employed status (AHR = 1.940, p = 0.008) was associated with increased mortality. CONCLUSIONS There is excess mortality in patients with schizophrenia spectrum disorders and also an association with age, gender, socioeconomic inequalities and receiving welfare benefits. Efforts directed towards improved living conditions could have a positive effect on reducing mortality.
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16
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Huỳnh C, Kisely S, Rochette L, Pelletier É, Jutras-Aswad D, Larocque A, Fleury MJ, Lesage A. Using administrative health data to estimate prevalence and mortality rates of alcohol and other substance-related disorders for surveillance purposes. Drug Alcohol Rev 2021; 40:662-672. [PMID: 33432695 DOI: 10.1111/dar.13235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Administrative health databases (AHD) are critical to guide health service management and can inform the whole spectrum of substance-related disorders (SRD). This study estimates prevalence and mortality rates of SRD in administrative health databases. METHODS The Quebec Integrated Chronic Disease Surveillance System consists of linked AHD. Analyses were performed on data of all Quebec residents aged 12 and over and eligible for health-care coverage using the International Classification of Diseases (ninth or tenth revision) for case identification. Mortality rate ratios stratified by causes of death were obtained to calculate an excess of mortality. RESULTS Since 2001-2002, the annual age-adjusted prevalence rate of diagnosed overall SRD remained stable (8.6 per 1000 in 2017-2018). In any given year, the annual prevalence rate was significantly higher in males; adolescents had the lowest rate, while adults 65 years and older the highest. The annual 2017-2018 rate was 2.1 per 1000 for alcohol-induced disorder, 1.9 for other drug-induced disorder, 0.7 for alcohol intoxication and 0.6 for other drug intoxications. Cumulative rate of any diagnosis related to alcohol was 32 per 1000 females and 53 per 1000 males (2001-2018), and 33 per 1000 females and 49 per 1000 males for any diagnosis related to other drugs. There was an excess of all-cause mortality among individuals with SRD compared to the general population. DISCUSSION AND CONCLUSIONS AHD can complement epidemiological surveys in monitoring SRD jurisdiction-wide. Surveillance of services utilisation and interventions, coupled with health outcomes like mortality, could be useful in guiding health services planning.
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Affiliation(s)
- Christophe Huỳnh
- University Institute on Addictions, CIUSSS du Centre-Sud-de-l'Île-de-Montréal (Integrated University Centre of Health and Social Services of the Centre-South-of-the-Island-of-Montréal), Montreal, Canada.,Department of Psychiatry and Addiction, University of Montréal, Montreal, Canada.,School of Psychoeducation, University of Montreal, Montreal, Canada.,Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Louis Rochette
- Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada
| | - Éric Pelletier
- Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada
| | - Didier Jutras-Aswad
- University Institute on Addictions, CIUSSS du Centre-Sud-de-l'Île-de-Montréal (Integrated University Centre of Health and Social Services of the Centre-South-of-the-Island-of-Montréal), Montreal, Canada.,Department of Psychiatry and Addiction, University of Montréal, Montreal, Canada.,Research Centre, Centre Hospitalier de l'Université de Montréal (University of Montreal Health Centre), Montreal, Canada
| | - Alexandre Larocque
- Department of Emergency Medicine, Centre Hospitalier de l'Université de Montréal (University of Montreal Health Centre), Montreal, Canada.,Quebec Poison Control Center, Québec City, Canada
| | | | - Alain Lesage
- Department of Psychiatry and Addiction, University of Montréal, Montreal, Canada.,Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada.,Research Centre of the Montreal Mental Health University Institute, Montreal, Canada
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17
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Espinel P, Marshall N, Yee BJ, Hollis J, Smith K, D'Rozario AL, Gauthier G, Lambert T, Grunstein RR. Sleep-disordered breathing in severe mental illness: clinical evaluation of oximetry diagnosis and management limitations. Sleep Breath 2020; 25:1433-1440. [PMID: 33245500 DOI: 10.1007/s11325-020-02259-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/08/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To describe the diagnosis and management pathway of sleep-disordered breathing (SDB) in a sample of patients with severe mental illness (SMI), and to assess the feasibility and patient acceptability of overnight oximetry as a first-step screening method for detecting severe SDB in this population. METHODS The study was a retrospective audit of patients with SMI seen at a Collaborative Centre for Cardiometabolic Health in Psychosis service who were invited for overnight oximetry between November 2015 and May 2018. The adjusted oxygen desaturation index (ODI) was calculated using 4% desaturation criteria. Results were discussed with a sleep specialist and categorized into a 4-level risk probability tool for SDB. RESULTS Of 91 adults consenting for overnight oximetry, 90 collected some oximetry data, though 11 of these 90 patients collected technically unsatisfactory oximetry. Thus 79/90 patients (88%) collected adequate oximetry data for at least one night. The oximetry traces suggested likely minimal obstructive sleep apnea (OSA) in 41 cases, moderate to severe OSA in 25 patients, severe OSA in 9 patients and possible obesity hypoventilation syndrome (OHS) in 4 cases. Full polysomnography was recommended for 39 patients but only one-third underwent testing. Nineteen patients were reviewed by a sleep specialist. Of the 10 patients who initiated CPAP, four were considered adherent to treatment. CONCLUSION Home oximetry may be a pragmatic option for SDB screening in patients with SMI but reliable full diagnostic and management pathways need to be developed.
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Affiliation(s)
- P Espinel
- CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW, 2018, Australia.,Collaborative Centre for Cardiometabolic Health in Psychosis - Sydney Local Health District, Ground Floor, Clinical Sciences Building, Hospital Road, Concord, NSW, 2139, Australia
| | - N Marshall
- CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW, 2018, Australia.,Susan Wakil School of Nursing and Midwifery, The University of Sydney, 88 Mallett Street, Camperdown, NSW, 2050, Australia
| | - B J Yee
- CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW, 2018, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Level 11, 50 Missenden Road, Camperdown, NSW, 2050, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - J Hollis
- Collaborative Centre for Cardiometabolic Health in Psychosis - Sydney Local Health District, Ground Floor, Clinical Sciences Building, Hospital Road, Concord, NSW, 2139, Australia
| | - K Smith
- Collaborative Centre for Cardiometabolic Health in Psychosis - Sydney Local Health District, Ground Floor, Clinical Sciences Building, Hospital Road, Concord, NSW, 2139, Australia.,Concord Clinical School, Medical Education Centre, Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 2139, Australia
| | - A L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW, 2018, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - G Gauthier
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Level 11, 50 Missenden Road, Camperdown, NSW, 2050, Australia
| | - T Lambert
- Collaborative Centre for Cardiometabolic Health in Psychosis - Sydney Local Health District, Ground Floor, Clinical Sciences Building, Hospital Road, Concord, NSW, 2139, Australia.,Concord Clinical School, Medical Education Centre, Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 2139, Australia.,RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, John Hopkins Drive, Camperdown, NSW, 2050, Australia
| | - R R Grunstein
- CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW, 2018, Australia. .,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia. .,RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, John Hopkins Drive, Camperdown, NSW, 2050, Australia.
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18
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Leclerc J, Lesage A, Rochette L, Huỳnh C, Pelletier É, Sampalis J. Prevalence of depressive, bipolar and adjustment disorders, in Quebec, Canada. J Affect Disord 2020; 263:54-59. [PMID: 31818796 DOI: 10.1016/j.jad.2019.11.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/28/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of mood disorders was estimated at 5.4% according to the latest Canadian survey. It has been suggested to use administrative data and self-reported data to optimize the estimation for mental health care in the population. Using administrative data, algorithms (combination of codes from the International Classification of Diseases) had been previously developed to identify the population with mood and anxiety disorders. However, the specific prevalence of each component of mood disorders (depressive, bipolar and adjustment disorders) are still unknown in Quebec, Canada. OBJECTIVE To 1) identify the population diagnosed respectively with depressive, bipolar and adjustment disorders in administrative data, and 2) provide annual prevalence estimates of each component. METHOD Data were extracted from the Quebec Integrated Chronic Disease Surveillance System and the entire population of Quebec (2000-2017) was included in this study (8.3 million; 2017). The prevalence of depressive, bipolar and adjustment disorders were estimated using specific algorithms. RESULTS The annual prevalence of depressive disorders was 3.7% in 2000-2001; it decreased to 2.8% in 2016-2017. In comparison, the prevalence of bipolar disorders was 0.8% in 2000-2001, decreasing to 0.6% in 2016-2017, and the prevalence of adjustment disorders was 1.3% in 2000-2001 and increased to 1.6% in 2016-2017. CONCLUSION Using specific algorithms, we observed that the trend of adjustment disorders is increasing while trends of depressive and bipolar disorders are decreasing. Further studies should assess if the related burden of care respectively follows the same trends as policy makers' allocations of resources may need to be adapted.
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Affiliation(s)
- Jacinthe Leclerc
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Canada; Faculty of Medicine, Department of Surgery, McGill University, Canada; Nursing department, Université du Québec à Trois-Rivières, Canada.
| | - Alain Lesage
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Canada; Département de psychiatrie et d'addictologie, Université de Montréal, Canada
| | - Louis Rochette
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Canada
| | - Christophe Huỳnh
- Département de psychiatrie et d'addictologie, Université de Montréal, Canada; Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Institut universitaire sur les dépendances, Canada
| | - Éric Pelletier
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Canada
| | - John Sampalis
- Faculty of Medicine, Department of Surgery, McGill University, Canada
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von Boetticher D, Meyer T. [The risk of medical comorbidity in mental disorders with a particular focus on depressive syndromes]. Z Psychosom Med Psychother 2019; 65:129-43. [PMID: 31154922 DOI: 10.13109/zptm.2019.65.2.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The risk of medical comorbidity in mental disorders with a particular focus on depressive syndromes Objectives: It has long been recognized that certain mental disorders, and in particular depressive syndromes, are associated with increased medical comorbidity. However, reliable data on the prevalence of comorbid medical diagnoses as well as the impact of these comorbidities on mortality are often rare and sometimes conflicting. Methods: A systematic literature review was conducted using PubMed and Google Scholar to provide a critical account of the current state of research on the comorbidities of medical and mental disorders, with a particular focus on depressive syndromes. Results: Among patients with mental disorders, all-cause mortality is about doubled as compared to the general population causing a significantly shortened life expectancy in the range of one to two decades. This excess mortality is primarily due to increased physical morbidity and mortality, and it cannot be excluded that, for patients with severe mental disorders, excess mortality has been increased over time. Depressive syndromes are often linked to a broad range of somatic symptoms and can be found in diseases, such as heart disease, stroke, diabetes mellitus, overweight/obesity, and asthma. Conclusion: Current studies provide ample evidence of close interactions between physical and mental health. Further developments in the field of psychosomatic medicine should take into consideration the health-related consequences of these interactions.
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Lix LM, Ayles J, Bartholomew S, Cooke CA, Ellison J, Emond V, Hamm NC, Hannah H, Jean S, LeBlanc S, O'Donnell S, Paterson JM, Pelletier C, Phillips KAM, Puchtinger R, Reimer K, Robitaille C, Smith M, Svenson LW, Tu K, VanTil LD, Waits S, Pelletier L. The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance. Int J Popul Data Sci 2018; 3:433. [PMID: 32935015 PMCID: PMC7299467 DOI: 10.23889/ijpds.v3i3.433] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.
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Affiliation(s)
- Lisa M Lix
- University of Manitoba, Winnipeg, MB CANADA
| | - James Ayles
- New Brunswick Department of Health, Fredericton, NB CANADA
| | | | - Charmaine A Cooke
- Investment and Decision Support, Nova Scotia Department of Health and Wellness, Halifax, NS CANADA
| | | | - Valerie Emond
- Institut national de santé publique du Québec, Québec, QC CANADA
| | | | - Heather Hannah
- Department of Health & Social Services, Government of the Northwest Territories, Yellowknife, NT CANADA
| | - Sonia Jean
- Institut national de santé publique du Québec, Québec, QC CANADA
| | - Shannon LeBlanc
- Department of Health & Social Services, Government of the Northwest Territories, Yellowknife, NT CANADA
| | | | | | | | - Karen A M Phillips
- Chief Public Health Office, Prince Edward Island Department of Health and Wellness, Charlottetown, PE CANADA
| | - Rolf Puchtinger
- Ministry of Health, Government of Saskatchewan, Regina, SK CANADA
| | - Kim Reimer
- Office of the Provincial Health Officer, BC Ministry of Health, Victoria, BC CANADA
| | | | - Mark Smith
- Manitoba Centre for Health Policy, Winnipeg, MB CANADA
| | | | - Karen Tu
- University of Toronto, Toronto, ON CANADA
| | | | - Sean Waits
- Department of Health, Government of Nunavut, Iqaluit, NU CANADA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Aylin P, Bottle A, Burnett S, Cecil E, Charles KL, Dawson P, D’Lima D, Esmail A, Vincent C, Wilkinson S, Benn J. Evaluation of a national surveillance system for mortality alerts: a mixed-methods study. Health Serv Deliv Res 2018. [DOI: 10.3310/hsdr06070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSince 2007, Imperial College London has generated monthly mortality alerts, based on statistical process control charts and using routinely collected hospital administrative data, for all English acute NHS hospital trusts. The impact of this system has not yet been studied.ObjectivesTo improve understanding of mortality alerts and evaluate their impact as an intervention to reduce mortality.DesignMixed methods.SettingEnglish NHS acute hospital trusts.ParticipantsEleven trusts were included in the case study. The survey involved 78 alerting trusts.Main outcome measuresRelative risk of mortality and perceived efficacy of the alerting system.Data sourcesHospital Episodes Statistics, published indicators on quality and safety, Care Quality Commission (CQC) reports, interviews and documentary evidence from case studies, and a national evaluative survey.MethodsDescriptive analysis of alerts; association with other measures of quality; associated change in mortality using an interrupted time series approach; in-depth qualitative case studies of institutional response to alerts; and a national cross-sectional evaluative survey administered to describe the organisational structure for mortality governance and perceptions of efficacy of alerts.ResultsA total of 690 mortality alerts generated between April 2007 and December 2014. CQC pursued 75% (154/206) of alerts sent between 2011 and 2013. Patient care was cited as a factor in 70% of all investigations and in 89% of sepsis alerts. Alerts were associated with indicators on bed occupancy, hospital mortality, staffing, financial status, and patient and trainee satisfaction. On average, the risk of death fell by 58% during the 9-month lag following an alert, levelling afterwards and reaching an expected risk within 18 months of the alert. Acute myocardial infarction (AMI) and sepsis alerts instigated institutional responses across all the case study sites, although most sites were undertaking some parallel activities at a more general level to address known problems in care in these and other areas. Responses included case note review and coding improvements, changes in patient pathways, changes in diagnosis of sepsis and AMI, staff training in case note write-up and coding, greater transparency in patient deterioration, and infrastructure changes. Survey data revealed that 86% of responding trusts had a dedicated trust-level lead for mortality reduction and 92% had a dedicated trust-level mortality group or committee in place. Trusts reported that mortality reduction was a high priority and that there was strong senior leadership support for mortality monitoring. The weakest areas reported concerned the accuracy of coding, the quality of specialty-level mortality data and understanding trends in specialty-level mortality data.LimitationsOwing to the correlational nature of our analysis, we could not ascribe a causal link between mortality alerts and reductions in mortality. The complexity of the institutional context and behaviour hindered our capacity to attribute locally reported changes specifically to the effects of the alerts rather than to ongoing institutional strategy.ConclusionsThe mortality alert surveillance system reflects aspects of quality care and is valued by trusts. Alerts were considered a useful focus for identifying problems and implementing interventions around mortality.Future workA further analysis of site visits and survey material, the application of evaluative framework to other interventions, a blinded case note review and the dissemination of findings.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Paul Aylin
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Alex Bottle
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Susan Burnett
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Elizabeth Cecil
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Kathryn L Charles
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Paul Dawson
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Danielle D’Lima
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Aneez Esmail
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | | | - Samantha Wilkinson
- Dr Foster Unit at Imperial, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Jonathan Benn
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
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Perron L, Simard M, Brisson J, Hamel D, Lo E. Standard Period Life Table Used to Compute the Life Expectancy of Diseased Subpopulations: More Confusing Than Helpful. Am J Public Health 2017; 107:1615-1620. [PMID: 28817326 DOI: 10.2105/ajph.2017.303932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Life expectancy (LE) based on a period life table (PLT) traditionally serves as a general population summary metric. It is, however, becoming more frequently reported for chronically afflicted subpopulations. In general populations, there is always an obvious real cohort sharing the hypothetical PLT cohort characteristics, and the LE estimate is intuitively understood as that real cohort mean survival time, assuming constancy of death risks. In diseased subpopulations, the correspondence between the hypothetical cohort and a real cohort is not straightforward. Furthermore, the excess mortality of chronic diseases usually changes according to age at onset and time since onset. The standard PLT method does not allow for proper control of these issues, so the LE estimate can only be deemed valid under specific assumptions. Without clear statements about the real cohort to whom the estimate is intended and the assumptions allowing disregard of the effect of age at onset and time since onset, LEs of afflicted subpopulations computed with the PLT are only abstract numbers summarizing mortality rates. If called "life expectancy," they can be seriously misleading. The same applies to health-adjusted LE.
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Affiliation(s)
- Linda Perron
- Linda Perron, Marc Simard, Denis Hamel, and Ernest Lo are with the Institut national de santé publique du Québec, Quebec City, QC. Linda Perron and Jacques Brisson are with the Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City. Jacques Brisson is also with the Centre de recherche du chu de Québec-Université Laval, Centre hospitalier universitaire de Québec, Quebec City. Ernest Lo is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| | - Marc Simard
- Linda Perron, Marc Simard, Denis Hamel, and Ernest Lo are with the Institut national de santé publique du Québec, Quebec City, QC. Linda Perron and Jacques Brisson are with the Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City. Jacques Brisson is also with the Centre de recherche du chu de Québec-Université Laval, Centre hospitalier universitaire de Québec, Quebec City. Ernest Lo is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| | - Jacques Brisson
- Linda Perron, Marc Simard, Denis Hamel, and Ernest Lo are with the Institut national de santé publique du Québec, Quebec City, QC. Linda Perron and Jacques Brisson are with the Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City. Jacques Brisson is also with the Centre de recherche du chu de Québec-Université Laval, Centre hospitalier universitaire de Québec, Quebec City. Ernest Lo is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| | - Denis Hamel
- Linda Perron, Marc Simard, Denis Hamel, and Ernest Lo are with the Institut national de santé publique du Québec, Quebec City, QC. Linda Perron and Jacques Brisson are with the Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City. Jacques Brisson is also with the Centre de recherche du chu de Québec-Université Laval, Centre hospitalier universitaire de Québec, Quebec City. Ernest Lo is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| | - Ernest Lo
- Linda Perron, Marc Simard, Denis Hamel, and Ernest Lo are with the Institut national de santé publique du Québec, Quebec City, QC. Linda Perron and Jacques Brisson are with the Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City. Jacques Brisson is also with the Centre de recherche du chu de Québec-Université Laval, Centre hospitalier universitaire de Québec, Quebec City. Ernest Lo is also with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
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Lora A, Lesage A, Pathare S, Levav I. Information for mental health systems: an instrument for policy-making and system service quality. Epidemiol Psychiatr Sci 2017; 26:383-394. [PMID: 27780495 PMCID: PMC6998623 DOI: 10.1017/s2045796016000743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Received: 02/07/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022] Open
Abstract
AIMS Information is crucial in mental healthcare, yet it remains undervalued by stakeholders. Its absence undermines rationality in planning, makes it difficult to monitor service quality improvement, impedes accountability and human rights monitoring. For international organizations (e.g., WHO, OECD), information is indispensable for achieving better outcomes in mental health policies, services and programs. This article reviews the importance of developing system level information with reference to inputs, processes and outputs, analyzes available tools for collecting and summarizing information, highlights the various goals of information gathering, discusses implementation issues and charts the way forward. METHODS Relevant publications and research were consulted, including WHO studies that purport to promote the use of information systems to upgrade mental health care in high- and low-middle income countries. RESULTS Studies have shown that once information has been collected by relevant systems and analyzed through indicator schemes, it can be put to many uses. Monitoring mental health services, represents a first step in using information. In addition, studies have noted that information is a prime resource in many other areas such as evaluation of quality of care against evidence based standards of care. Services data may support health services research where it is possible to link mental health data with other health and non-health databases. Information systems are required to carefully monitor involuntary admissions, restrain and seclusion, to reduce human rights violations in care facilities. Information has been also found useful for policy makers, to monitor the implementation of policies, to evaluate their impact, to rationally allocate funding and to create new financing models. CONCLUSIONS Despite its manifold applications, Information systems currently face many problems such as incomplete recording, poor data quality, lack of timely reporting and feedback, and limited application of information. Corrective action is needed to upgrade data collection in outpatient facilities, to improve data quality, to establish clear rules and norms, to access adequate information technology equipment and to train health care personnel in data collection. Moreover, it is necessary to shift from mere administrative data collection to analysis, dissemination and use by relevant stakeholders and to develop a "culture of information" to dismantle the culture of intuition and mere tradition. Clinical directors, mental health managers, patient and family representatives, as well as politicians should be educated to operate with information and not just intuition.
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Affiliation(s)
- A. Lora
- Department of Mental Health - Manzoni Hospital, Lecco, Italy
| | - A. Lesage
- Centre de recherche de l'Institut Universitaire en Santé Mentale, Université de Montréal, Montreal, Canada
| | - S. Pathare
- Centre for MH Law & Policy, Indian Law Society, Pune, India
| | - I. Levav
- Department of Community Mental Health, Faculty of Welfare and Health Sciences, University of Haifa, Israel
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Carrier JD, Blais L, Cohen A, Courteau J, Roberge P, Larouche A, Grignon S, Fleury MJ, Lesage A, Demers MF, Roy MA, Delorme A, Vanasse A. Amorcer un traitement antipsychotique en schizophrénie : la situation au Québec de 1998 à 2006. smq 2017. [DOI: 10.7202/1040245ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Contexte Cet article vise à décrire les facteurs associés à la prescription d’antipsychotiques par un psychiatre plutôt qu’un omnipraticien, la prescription d’un antipsychotique de seconde plutôt que de première génération, la prescription d’une multithérapie d’antipsychotiques et le non-renouvellement de la prescription initiale.
Méthodologie Il s’agit d’une étude pharmacoépidémiologique observationnelle avec analyses secondaires d’une banque de données médicoadministratives (RAMQ). Les données disponibles portaient sur un échantillon exhaustif des personnes adultes ayant reçu un diagnostic de schizophrénie et ayant obtenu un antipsychotique couvert par le régime public d’assurance médicaments de 1998 à 2006. Les résultats de régression logistique multiple sont rapportés.
Résultats Parmi les 16 225 personnes éligibles, 46,2 % étaient des femmes et 70 % étaient bénéficiaires d’une aide financière. La clientèle des psychiatres était plus jeune et plus atteinte au niveau de la santé mentale. La multithérapie était associée aux hospitalisations pour psychose, au faible statut socio-économique et à un âge entre 35 et 64 ans. Les antipsychotiques de seconde génération ont pris une place importante au cours de la période à l’étude. Le non-renouvellement était associé à l’abus de substances et était moins fréquent suite à une hospitalisation pour trouble mental.
Conclusions Malgré les limites liées à l’utilisation de données administratives, l’utilisation d’une banque de données exhaustive provenant autant de médecine générale que de spécialité permet à cette étude de brosser un portrait populationnel pertinent pour connaître la situation réelle du traitement incident de la schizophrénie au Québec de 1998 à 2006, une période caractérisée par l’introduction des antipsychotiques de seconde génération.
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Affiliation(s)
- Jean-Daniel Carrier
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de psychiatrie, Université de Sherbrooke, Québec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Québec, Canada
- Centre de recherche, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
- Chaire pharmaceutique AstraZeneca en santé respiratoire, Montréal, Québec, Canada
| | - Alan Cohen
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
| | - Pasquale Roberge
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
| | - Annie Larouche
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
| | - Sylvain Grignon
- Département de psychiatrie, Université de Sherbrooke, Québec, Canada
| | - Marie-Josée Fleury
- Université McGill, Montréal, Québec, Canada
- Institut universitaire en santé mentale Douglas, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Québec, Canada
| | | | - Marc-André Roy
- Département de psychiatrie et de neurosciences, Université Laval, Québec, Canada
- Centre de recherche CERVO, Québec, Canada
| | - André Delorme
- Département de psychiatrie, Université de Montréal – Direction de la santé mentale, ministère de la Santé et des Services sociaux du Québec, Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l’Université de Sherbrooke (CHUS), Québec, Canada
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Québec, Canada
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De Rosa C, Sampogna G, Luciano M, Del Vecchio V, Pocai B, Borriello G, Giallonardo V, Savorani M, Pinna F, Pompili M, Fiorillo A. Improving physical health of patients with severe mental disorders: a critical review of lifestyle psychosocial interventions. Expert Rev Neurother 2017; 17:667-681. [PMID: 28468528 DOI: 10.1080/14737175.2017.1325321] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION People with severe mental disorders have a mortality rate that is more than two times higher than the general population, with at least a decade of potential years of life lost. People with mental disorders have a significantly higher risk of obesity, hyperglycemia and metabolic syndrome, which are related to modifiable risk factors, such as heavy smoking, poor physical activities, and inappropriate unhealthy diet, which can be improved through lifestyle changes. Areas covered: Lifestyle behaviours are amenable to change through the adoption of specific psychosocial interventions, and several approaches have been promoted. In the present review, the authors aim to: 1) critically analyze studies involving multimodal lifestyle interventions; 2) discuss the way forward to integrate these interventions in clinical routine care. Expert commentary: The psychoeducational approaches developed for the improvement of healthy lifestyle behaviours differ for several aspects: 1) the format (individual vs. group); 2) the setting (outpatient vs. inpatient vs. home-based); 3) the professional characteristics of the staff running the intervention (psychiatrists or nurses or dietitians or psychologists); 4) the active ingredients of the intervention (education only or inclusion of motivational interview or of problem solving); 5) the duration of treatment (ranging from 3 months to 2 years).
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Affiliation(s)
- Corrado De Rosa
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
| | - Gaia Sampogna
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
| | - Mario Luciano
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
| | | | - Benedetta Pocai
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
| | | | | | - Micaela Savorani
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
| | - Federica Pinna
- b Department of Public Health, Clinical and Molecular Medicine, Section of Psychiatry , University of Cagliari , Cagliari , Italy
| | - Maurizio Pompili
- c Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre , Sapienza University of Rome , Rome , Italy
| | - Andrea Fiorillo
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
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Kirino S, Suzuki T, Takeuchi H, Mimura M, Uchida H. Representativeness of clinical PET study participants with schizophrenia: A systematic review. J Psychiatr Res 2017; 88:72-9. [PMID: 28088727 DOI: 10.1016/j.jpsychires.2016.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/25/2016] [Accepted: 12/31/2016] [Indexed: 01/23/2023]
Abstract
While positron emission tomography (PET) studies have provided invaluable data on antipsychotic effects, selection bias remains a serious concern. A systematic review of PET studies that measured dopamine D2 receptor blockade with antipsychotics was conducted to examine their inclusion/exclusion criteria, using PubMed, EMBASE, and ClinicalTrials.gov (last search, September 2016). PET studies were included if they measured D2 receptor occupancy in patients with schizophrenia and included introduction of antipsychotic treatment or antipsychotic regimen change in a systematic manner. Twenty-six studies were identified. Age limit was included in 13 studies; one study solely included geriatric patients while others targeted younger adults. Eleven, 6, and 3 studies specifically targeted clinically stable patients, patients with severe psychopathology, and antipsychotic-free patients, respectively. Nineteen and 18 studies excluded patients with physical comorbidity and substance abuse, respectively. As a result, the mean age of subjects ranged from 23 to 42 years when one study that targeted geriatric patients was excluded. Mean Positive and Negative Syndrome Scale total scores ranged from 54 to 95. No comparison active-drug or placebo arm was employed in 24 studies. Blind assessment of symptomatology was performed in 5 studies. In general, subjects participating in clinical PET studies were relatively young, presented with mild symptomatology, and were free from substance abuse or physical comorbidities. These characteristics need to be taken into account when clinical PET data are interpreted. On the other hand, it should also be noted that this study was only qualitative and conservative interpretation is necessary for possibility of subjective bias.
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Hjorthøj C, Stürup AE, McGrath JJ, Nordentoft M. Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis. Lancet Psychiatry 2017; 4:295-301. [PMID: 28237639 DOI: 10.1016/S2215-0366(17)30078-0] [Citation(s) in RCA: 657] [Impact Index Per Article: 93.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several studies and meta-analyses have shown that mortality in people with schizophrenia is higher than that in the general population but have used relative measures, such as standardised mortality ratios. We did a systematic review and meta-analysis to estimate years of potential life lost and life expectancy in schizophrenia, which are more direct, absolute measures of increased mortality. METHODS We searched MEDLINE, PsycINFO, Embase, Cinahl, and Web of Science for published studies on years of potential life lost and life expectancy in schizophrenia. Data from individual studies were combined in meta-analyses as weighted averages. We did subgroup analyses for sex, geographical region, timing of publication, and risk of bias (estimated with the Newcastle-Ottawa Scale). FINDINGS We identified 11 studies in 13 publications covering all inhabited continents except South America (Africa n=1, Asia n=1, Australia n=1, Europe n=7, and North America n=3) that involved up to 247 603 patients. Schizophrenia was associated with a weighted average of 14·5 years of potential life lost (95% CI 11·2-17·8), and was higher for men than women (15·9, 13·8-18·0 vs 13·6, 11·4-15·8). Loss was least in the Asian study and greatest in Africa. The overall weighted average life expectancy was 64·7 years (95% CI 61·1-71·3), and was lower for men than women (59·9 years, 95% CI 55·5-64·3 vs 67·6 years, 63·1-72·1). Life expectancy was lowest in Asia and Africa. Timing of publication and risk of bias had little effect on results. INTERPRETATION The effects of schizophrenia on years potential life lost and life expectancy seem to be substantial and not to have lessened over time. Development and implementation of interventions and initiatives to reduce this mortality gap are urgently needed. FUNDING None.
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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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Yarborough BJH, Hanson GC, Perrin NA, Stumbo SP, Green CA. Colorectal Cancer Screening Completion Among Individuals With and Without Mental Illnesses: A Comparison of 2 Screening Methods. Am J Health Promot 2017; 32:925-931. [PMID: 29214818 DOI: 10.1177/0890117116686573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Cancer mortality is worse among people with psychiatric disorders. The purpose of this study was to compare facilitators and rates of colorectal cancer (CRC) screening between people with and without mental illnesses. DESIGN We conducted a secondary analysis using data from a general population cohort study (N = 92 445) that assessed effects of 2 types of CRC screening test kits-guaiac fecal occult blood testing (gFOBT) and fecal immunochemical testing (FIT)-on CRC screening completion. SETTING The setting was a health system that served approximately 485 000 members in urban and suburban Oregon and Washington. PARTICIPANTS Participants were health system members, categorized by mental illness diagnosis (psychotic disorders, non-psychotic unipolar depression, and no mental illness), who were age-eligible, at average risk of CRC, and were at least 366 days past their last gFOBT with no evidence of other CRC screening. MEASURES The outcome was time until completion of CRC screening. ANALYSIS We used Cox proportional hazard models. RESULTS FIT reduced CRC screening barriers for all the groups. Compared to people without mental illness diagnoses, those with psychotic disorders were equally likely to screen using FIT (hazard ratio [HR] = .95, p = .679) and those with depression were more likely (HR = 1.17, p = .006). CONCLUSIONS FIT can improve CRC screening rates among people with mental illnesses, particularly depression.
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Affiliation(s)
| | | | - Nancy A Perrin
- 1 Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Scott P Stumbo
- 1 Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Carla A Green
- 1 Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
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Zolezzi M, Abdulrhim S, Isleem N, Zahrah F, Eltorki Y. Medical comorbidities in patients with serious mental illness: a retrospective study of mental health patients attending an outpatient clinic in Qatar. Neuropsychiatr Dis Treat 2017; 13:2411-2418. [PMID: 28979128 PMCID: PMC5608084 DOI: 10.2147/ndt.s141448] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The life span of individuals with serious mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. The aim of the study was to investigate the prevalence rates of different physical illnesses in individuals with SMI and to examine how these are being managed. METHODS The study was a cross-sectional retrospective chart review of a cohort of patients with SMI. A comprehensive electronic data extraction tool using SurveyMonkey® was used to collect patient demographics, psychiatric and medical comorbidities, medications and all relevant physical assessments. Data were then first extrapolated into an Excel® spreadsheet and later to SPSS® for data analysis. A descriptive statistical approach was used to analyze the demographic and clinical data. Chi-square test for categorical variables and t-test for continuous variables were used to compare the demographic and clinical characteristics of the cohort. RESULTS A total of 336 patients with SMI were included for the retrospective chart review. The majority of these patients had a diagnosis of depression (50.3%), followed by schizophrenia (33.0%) and bipolar disorder (19.6%). Diabetes was the most frequent medical comorbidity, diagnosed in 16.1% of SMI patients, followed by hypertension (9.2%) and dyslipidemia (9.8%). Monitoring of comorbidity-associated risk factors and other relevant physical assessment parameters (such as blood pressure, weight, hemoglobin A1c [HbA1c], blood glucose and lipids) were documented in less than 50% of patients, and some parameters, such as smoking status, were not documented at all. CONCLUSION Both, the literature and our cohort provide evidence that individuals with SMI are less likely to receive standard levels of care for their medical comorbidities.
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Affiliation(s)
| | | | | | | | - Yassin Eltorki
- Department of Pharmacy, Hamad Medical Corporation Mental Health Hospital, Doha, Qatar
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Abstract
PURPOSE 'Big data' are accumulating in a multitude of domains and offer novel opportunities for research. The role of these resources in mental health investigations remains relatively unexplored, although a number of datasets are in use and supporting a range of projects. We sought to review big data resources and their use in mental health research to characterise applications to date and consider directions for innovation in future. METHODS A narrative review. RESULTS Clear disparities were evident in geographic regions covered and in the disorders and interventions receiving most attention. DISCUSSION We discuss the strengths and weaknesses of the use of different types of data and the challenges of big data in general. Current research output from big data is still predominantly determined by the information and resources available and there is a need to reverse the situation so that big data platforms are more driven by the needs of clinical services and service users.
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Affiliation(s)
- Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 63, De Crespigny Park, London, SE5 8AF, UK.
| | - Katrina Davis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 63, De Crespigny Park, London, SE5 8AF, UK
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Patten SB. Psychiatric Epidemiology: It Is About Much More Than Prevalence. Can J Psychiatry 2015; 60:529-30. [PMID: 26720819 PMCID: PMC4679159 DOI: 10.1177/070674371506001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Scott B Patten
- Editor-in-Chief, The Canadian Journal of Psychiatry, Ottawa, Ontario; Professor, Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta; Member, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
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