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Laporte D, Chilman N, Morgan C, Schofield P, Wykes T, Das-Munshi J. The association between area-level factors and mortality in severe mental illnesses: A systematic review. Schizophr Res 2024; 264:95-104. [PMID: 38118264 DOI: 10.1016/j.schres.2023.12.012] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/06/2023] [Accepted: 12/10/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Premature mortality is a well-documented adverse outcome for people living with severe mental illnesses (SMI). Emerging evidence suggests that area-level factors play a role that are experienced disproportionately by this population. This review assesses the potential association between area-level factors and mortality in people with SMI. METHOD We searched Medline, EMBASE, PsychINFO, Social Policy and Practice, Web of Science and OpenGrey databases. Literature searches were conducted in May 2020 and updated in June 2023. Reference lists were hand-searched and authors of included studies contacted to identify additional studies and minimise publication biases. Narrative synthesis was used to appraise the included studies. The review protocol was registered on PROSPERO (CRD42019155447). RESULTS Our searches identified 7 studies (8 papers), which were included in the review, and indicated evidence of an association between deprivation and mortality. One study suggested an association between mortality in SMI and urbanicity in low to middle income settings which was not observed in studies from high income settings. One study suggested a protective association of area-level ethnic density with mortality within urbanised settings. CONCLUSION Consistent associations were reported between residence in areas of higher deprivation and increased risk of mortality in SMI. Two studies suggested an association between area-level ethnic density and urbanicity and mortality in SMI. Most studies were conducted across high income countries and therefore future research could benefit from similar investigations being conducted in low- and middle-income countries. These methods would inform health and social policies, including interventions to reduce premature mortality in SMI.
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Affiliation(s)
- D Laporte
- King's College London (Institute of Psychiatry, Psychology & Neurosciences), London, United Kingdom; NIHR Maudsley Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, United Kingdom.
| | - N Chilman
- King's College London (Institute of Psychiatry, Psychology & Neurosciences), London, United Kingdom; Economic and Social Research Council (ESRC), KCL Centre for Society and Mental Health, United Kingdom
| | - C Morgan
- King's College London (Institute of Psychiatry, Psychology & Neurosciences), London, United Kingdom; Economic and Social Research Council (ESRC), KCL Centre for Society and Mental Health, United Kingdom
| | - P Schofield
- School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - T Wykes
- King's College London (Institute of Psychiatry, Psychology & Neurosciences), London, United Kingdom; NIHR Maudsley Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, United Kingdom
| | - J Das-Munshi
- King's College London (Institute of Psychiatry, Psychology & Neurosciences), London, United Kingdom; NIHR Maudsley Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, United Kingdom; Economic and Social Research Council (ESRC), KCL Centre for Society and Mental Health, United Kingdom
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Das-Munshi J, Chang CK, Dregan A, Hatch SL, Morgan C, Thornicroft G, Stewart R, Hotopf M. How do ethnicity and deprivation impact on life expectancy at birth in people with serious mental illness? Observational study in the UK. Psychol Med 2021; 51:2581-2589. [PMID: 32372741 PMCID: PMC8579155 DOI: 10.1017/s0033291720001087] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Across international contexts, people with serious mental illnesses (SMI) experience marked reductions in life expectancy at birth. The intersection of ethnicity and social deprivation on life expectancy in SMI is unclear. The aim of this study was to assess the impact of ethnicity and area-level deprivation on life expectancy at birth in SMI, defined as schizophrenia-spectrum disorders, bipolar disorders and depression, using data from London, UK. METHODS Abridged life tables to calculate life expectancy at birth, in a cohort with clinician-ascribed ICD-10 schizophrenia-spectrum disorders, bipolar disorders or depression, managed in secondary mental healthcare. Life expectancy in the study population with SMI was compared with life expectancy in the general population and with those residing in the most deprived areas in England. RESULTS Irrespective of ethnicity, people with SMI experienced marked reductions in life expectancy at birth compared with the general population; from 14.5 years loss in men with schizophrenia-spectrum and bipolar disorders, to 13.2 years in women. Similar reductions were noted for people with depression. Across all diagnoses, life expectancy at birth in people with SMI was lower than the general population residing in the most deprived areas in England. CONCLUSIONS Irrespective of ethnicity, reductions in life expectancy at birth among people with SMI are worse than the general population residing in the most deprived areas in England. This trend in people with SMI is similar to groups who experience extreme social exclusion and marginalisation. Evidence-based interventions to tackle this mortality gap need to take this into account.
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Affiliation(s)
- Jayati Das-Munshi
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Trust, London, UK
- ESRC Centre for Society and Mental Health, King’s College London, UK
| | | | - Alex Dregan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephani L. Hatch
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College London, UK
| | - Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College London, UK
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Trust, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Trust, London, UK
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Teixeira AL, Krause TM, Ghosh L, Shahani L, Machado-Vieira R, Lane SD, Boerwinkle E, Soares JC. Analysis of COVID-19 Infection and Mortality Among Patients With Psychiatric Disorders, 2020. JAMA Netw Open 2021; 4:e2134969. [PMID: 34812848 PMCID: PMC8611476 DOI: 10.1001/jamanetworkopen.2021.34969] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE People with major psychiatric disorders are more likely to have comorbidities associated with worse outcomes of COVID-19. This fact alone could determine greater vulnerability of people with major psychiatric disorders to COVID-19. OBJECTIVE To assess the odds of testing positive for and mortality from COVID-19 among and between patients with schizophrenia, mood disorders, anxiety disorders and a reference group in a large national database. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used an electronic health record data set aggregated from many national sources in the United States and licensed from Optum with current and historical data on patients tested for COVID-19 in 2020. Three psychiatric cohorts (patients with schizophrenia, mood disorders, or anxiety disorders) were compared with a reference group with no major psychiatric conditions. Statistical analysis was performed from March to April 2021. EXPOSURE The exposures observed include lab-confirmed positivity for COVID-19 and mortality. MAIN OUTCOMES AND MEASURES The odds of testing positive for COVID-19 in 2020 and the odds of death from COVID-19 were measured. RESULTS The population studied included 2 535 098 unique persons, 3350 with schizophrenia, 26 610 with mood disorders, and 18 550 with anxiety disorders. The mean (SD) age was 44 (23) years; 233 519 were non-Hispanic African American, 1 583 440 were non-Hispanic Caucasian; and 1 580 703 (62%) were female. The schizophrenia cohort (positivity rate: 9.86%; adjusted OR, 0.90 [95% CI, 0.84-0.97]) and the mood disorder cohort (positivity rate: 9.86%; adjusted OR, 0.93 [95% CI, 0.87-0.99]) had a significantly lower rate of positivity than the anxiety disorder cohort (positivity rate: 11.17%; adjusted OR, 1.05 [95% CI, 0.98-1.12) which was closer to the reference group (11.91%). After fully adjusting for demographic factors and comorbid conditions, patients with schizophrenia were nearly 4 times more likely to die from the disease than the reference group (OR, 3.74; 95% CI, 2.66-5.24). The mood disorders COVID-19 cohort had a 2.76 times greater odds of mortality than the reference group (OR, 2.76; 95% CI, 2.00-3.81), and the anxiety disorders cohort had a 2.39 times greater odds of mortality than the reference group (OR, 2.39; 95% CI, 1.68-3.27). CONCLUSIONS AND RELEVANCE By examining a large database while controlling for multiple confounding factors such as age, race and ethnicity, and comorbid medical conditions, the present study found that patients with schizophrenia had much increased odds of mortality by COVID-19.
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Affiliation(s)
- Antonio L. Teixeira
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
| | - Trudy Millard Krause
- School of Public Health, The University of Texas Health Science Center at Houston, Houston
| | - Lopita Ghosh
- School of Public Health, The University of Texas Health Science Center at Houston, Houston
| | - Lokesh Shahani
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
| | - Rodrigo Machado-Vieira
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
| | - Scott D. Lane
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
| | - Eric Boerwinkle
- School of Public Health, The University of Texas Health Science Center at Houston, Houston
| | - Jair C. Soares
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston
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Austria B, Haque R, Mittal S, Scott J, Vengassery A, Maltz D, Li W, Greenwald B, Freudenberg-Hua Y. Mortality in association with antipsychotic medication use and clinical outcomes among geriatric psychiatry outpatients with COVID-19. PLoS One 2021; 16:e0258916. [PMID: 34673821 PMCID: PMC8530340 DOI: 10.1371/journal.pone.0258916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Older adults are particularly vulnerable to the negative consequences of antipsychotic exposure and are disproportionally affected by higher mortality from coronavirus disease 2019 (COVID-19). Our goal was to determine whether concurrent antipsychotic medication use was associated with increased COVID-19 mortality in older patients with preexisting behavioral health problems. We also report on findings from post-COVID follow-ups. DESIGN Retrospective observational study. PARTICIPANTS Outpatients at a geriatric psychiatric clinic in New York City. MEASUREMENTS Demographic and clinical data including medication, diagnosis and Clinical Global Impression Severity (CGI-S) scales on outpatients who had COVID-19 between February 28th and October 1st 2020 were extracted from the electronic health records (EHR) from the hospital. RESULTS A total of 56 patients were diagnosed with COVID-19 (mean age 76 years; median age 75 years) and 13 (23.2%) died. We found an increased mortality risk for patients who were prescribed at least one antipsychotic medication at the time of COVID-19 infection (Fisher's exact test P = 0.009, OR = 11.1, 95% confidence interval: 1.4-96.0). This result remains significant after adjusting for age, gender, housing context and dementia (Logistic regression P = 0.035, Beta = 2.4). Furthermore, we found that most patients who survived COVID-19 (88.4%) recovered to pre-COVID baseline in terms of psychiatric symptoms. Comparison of pre- and post-COVID assessments of CGI-S for 33 patients who recovered from COVID-19 were not significantly different. CONCLUSION We observed a higher COVID-19 mortality associated with concurrent antipsychotics use in older patients receiving behavioral health services. The majority of patients in our geriatric clinic who recovered from COVID-19 appeared to return to their pre-COVID psychiatric function. More precise estimates of the risk associated with antipsychotic treatment in older patients with COVID-19 and other underlying factors will come from larger datasets and meta-analyses.
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Affiliation(s)
- Bienvenida Austria
- Division of Geriatric Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
| | - Rehana Haque
- Division of Geriatric Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
| | - Sukriti Mittal
- Division of Geriatric Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
| | - Jamie Scott
- Division of Geriatric Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
| | - Aninditha Vengassery
- Division of Geriatric Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
| | - Daniel Maltz
- Information Services, Product Services and Management, Northwell Health, Lake Success, NY, United States of America
| | - Wentian Li
- Center for Genomics and Human Genetics, The Feinstein Institutes for Medical Research, Manhasset, NY, United States of America
| | - Blaine Greenwald
- Division of Geriatric Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
| | - Yun Freudenberg-Hua
- Division of Geriatric Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, United States of America
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
- Litwin-Zucker Center for Alzheimer’s Disease, The Feinstein Institutes for Medical Research, Manhasset, NY, United States of America
- * E-mail:
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Zimmerman SC, Matthay EC, Rudolph KE, Goin DE, Farkas K, Rowe CL, Ahern J. California's Mental Health Services Act and Mortality Due to Suicide, Homicide, and Acute Effects of Alcohol: A Synthetic Control Application. Am J Epidemiol 2021; 190:2107-2115. [PMID: 33884408 DOI: 10.1093/aje/kwab123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
California's Mental Health Services Act (MHSA) substantially expanded funding of county mental health services through a state tax, and led to broad prevention efforts and intensive services for individuals experiencing serious mental disorders. We estimated the associations between MHSA and mortality due to suicide, homicide, and acute effects of alcohol. Using annual cause-specific mortality data for each US state and the District of Columbia from 1976-2015, we used a generalization of the quasi-experimental synthetic control method to predict California's mortality rate for each outcome in the absence of MHSA using a weighted combination of comparison states. We calculated the association between MHSA and each outcome as the absolute difference and percentage difference between California's observed and predicted average annual rates over the postintervention years (2007-2015). MHSA was associated with modest decreases in average annual rates of homicide (-0.81/100,000 persons, corresponding to a 13% reduction) and mortality from acute alcohol effects (-0.35/100,000 persons, corresponding to a 12% reduction). Placebo test inference suggested that the associations were unlikely to be due to chance. MHSA was not associated with suicide. Protective associations with mortality due to homicide and acute alcohol effects provide evidence for modest health benefits of MHSA at the population level.
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Scher M. Inquest begins over South African mental health failings. Lancet 2021; 398:288. [PMID: 34303424 DOI: 10.1016/s0140-6736(21)01655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Perera G, Mueller C, Broadbent M, Stewart R, Velayudhan L. Mortality among mental health services for older adults during the COVID-19 pandemic: a retrospective analysis from South London. Int Psychogeriatr 2021; 33:527-528. [PMID: 33849671 DOI: 10.1017/s1041610221000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Gayan Perera
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Latha Velayudhan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
BACKGROUND Our understanding of how multimorbidity progresses and changes is nascent. OBJECTIVES Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297). MEASURES Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms. RESULTS Three latent classes were identified in 1998: minimal disease (45.8% of participants), cardiovascular-musculoskeletal (34.6%), cardiovascular-musculoskeletal-mental (19.6%); and 3 in 2014: cardiovascular-musculoskeletal (13%), cardiovascular-musculoskeletal-metabolic (12%), multisystem multimorbidity (15%). Remaining participants were deceased (48%) or lost to follow-up (12%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014. CONCLUSIONS AND RELEVANCE Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.
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Affiliation(s)
- Ana R. Quiñones
- Department of Family Medicine, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Jason T. Newsom
- Department of Psychology, Portland State University, Portland, OR
| | - Miriam R. Elman
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Sheila Markwardt
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR
| | - David A. Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR
| | - Heather G. Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI
- Institute of Gerontology, University of Michigan, Ann Arbor, MI
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Richmond-Rakerd LS, D’Souza S, Milne BJ, Caspi A, Moffitt TE. Longitudinal Associations of Mental Disorders With Physical Diseases and Mortality Among 2.3 Million New Zealand Citizens. JAMA Netw Open 2021; 4:e2033448. [PMID: 33439264 PMCID: PMC7807295 DOI: 10.1001/jamanetworkopen.2020.33448] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Excess risk of physical disease and mortality has been observed among individuals with psychiatric conditions, suggesting that ameliorating mental disorders might also be associated with ameliorating the later onset of physical disability and early mortality. However, the temporal association between mental disorders and physical diseases remains unclear, as many studies have relied on retrospective recall, used cross-sectional designs or prospective designs with limited follow-up periods, or given inadequate consideration to preexisting physical illnesses. OBJECTIVE To examine whether mental disorders are associated with subsequent physical diseases and mortality across 3 decades of observation. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from the New Zealand Integrated Data Infrastructure, a collection of nationwide administrative data sources linked at the individual level, to identify mental disorders, physical diseases, and deaths recorded between July 1, 1988, and June 30, 2018, in the population of New Zealand. All individuals born in New Zealand between January 1, 1928, and December 31, 1978, who resided in the country at any time during the 30-year observation period were included in the analysis. Data were analyzed from July 2019 to November 2020. EXPOSURES Nationwide administrative records of mental disorder diagnoses made in public hospitals. MAIN OUTCOMES AND MEASURES Chronic physical disease diagnoses made in public hospitals, deaths, and health care use. RESULTS The study population comprised 2 349 897 individuals (1 191 981 men [50.7%]; age range at baseline, 10-60 years). Individuals with a mental disorder developed subsequent physical diseases at younger ages (hazard ratio [HR], 2.33; 95% CI, 2.30-2.36) and died at younger ages (HR, 3.80; 95% CI, 3.72-3.89) than those without a mental disorder. These associations remained across sex and age and after accounting for preexisting physical diseases. Associations were observed across different types of mental disorders and self-harm behavior (relative risks, 1.78-2.43; P < .001 for all comparisons). Mental disorders were associated with the onset of physical diseases and the accumulation of physical disease diagnoses (incidence rate ratio [IRR], 2.00; 95% CI, 1.98-2.03), a higher number of hospitalizations (IRR, 2.43; 95% CI, 2.39-2.48), longer hospital stays for treatment (IRR, 2.70; 95% CI, 2.62-2.79), and higher associated health care costs (b = 0.115; 95% CI, 0.112-0.118). CONCLUSIONS AND RELEVANCE In this study, mental disorders were likely to begin and peak in young adulthood, and they antedated physical diseases and early mortality in the population. These findings suggest that ameliorating mental disorders may have implications for improving the length and quality of life and for reducing the health care costs associated with physical diseases.
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Affiliation(s)
| | - Stephanie D’Souza
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | - Barry J. Milne
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
- Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, England
- Promenta Center, University of Oslo, Oslo, Norway
| | - Terrie E. Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
- Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, England
- Promenta Center, University of Oslo, Oslo, Norway
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Davies SJC, Iwajomo T, de Oliveira C, Versloot J, Reid RJ, Kurdyak P. The impact of psychiatric and medical comorbidity on the risk of mortality: a population-based analysis. Psychol Med 2021; 51:320-328. [PMID: 31775914 DOI: 10.1017/s003329171900326x] [Citation(s) in RCA: 5] [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] [Indexed: 01/06/2023]
Abstract
BACKGROUND As life expectancy increases, more people have chronic psychiatric and medical health disorders. Comorbidity may increase the risk of premature mortality, an important challenge for health service delivery. METHODS Population-based cohort study in Ontario, Canada of all 11 246 910 residents aged ⩾16 and <105 on 1 April 2012 and alive on 31 March 2014. Secondary analyses included subjects having common medical disorders in 10 separate cohorts. Exposures were psychiatric morbidity categories identified using aggregated diagnosis groups (ADGs) from Johns Hopkins Adjusted Clinical Groups software® (v10.0); ADG 25: Persistent/Recurrent unstable conditions; e.g. acute schizophrenic episode, major depressive disorder (recurrent episode), ADG 24: Persistent/Recurrent stable conditions; e.g. depressive disorder, paranoid personality disorder, ADG 23: Time-limited/minor conditions; e.g. adjustment reaction with brief depressive reaction. The outcome was all-cause mortality (April 2014-March 2016). RESULTS Over 2 years' follow-up, there were 188 014 deaths (1.7%). ADG 25 conferred an almost threefold excess mortality after adjustment compared to having no psychiatric morbidity [adjusted hazard ratio 2.94 (95% CI 2.91-2.98, p < 0.0001)]. Adjusted hazard ratios for ADG 24 and ADG 23 were 1.12 (95% CI 1.11-1.14, p < 0.0001) and 1.31 (95% CI 1.26-1.36, p < 0.0001). In all 10 medical disorder cohorts, ADG 25 carried significantly greater mortality risk compared to no psychiatric comorbidity. CONCLUSIONS Psychiatric disorders, particularly those graded persistent/recurrent and unstable, were associated with excess mortality in the whole population, and in the medical disorder cohorts examined. Future research should examine whether service design accounting for psychiatric disorder comorbidity improves outcomes across the spectrum of medical disorders.
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Affiliation(s)
- Simon J C Davies
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Judith Versloot
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Mississauga, Ontario, Canada
| | - Robert J Reid
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Mississauga, Ontario, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Song Y, Rhee SJ, Lee H, Kim MJ, Shin D, Ahn YM. Comparison of Suicide Risk by Mental Illness: a Retrospective Review of 14-Year Electronic Medical Records. J Korean Med Sci 2020; 35:e402. [PMID: 33289369 PMCID: PMC7721561 DOI: 10.3346/jkms.2020.35.e402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/16/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Korea is one of the countries with the highest rate of suicide, while suicidality is known to be closely related to mental illnesses. The study aimed to evaluate the suicide rates in psychiatric patients, to compare it to that of the general population, and to investigate the differences among psychiatric diagnoses and comorbidities. METHODS Medical records and mortality statistics of psychiatric patients at Seoul National University Hospital from 2003 to 2017 were reviewed. The standardized mortality ratio (SMR) for suicide was calculated to compare the psychiatric patients with the general population. The diagnosis-specific standardized mortality rate and hazard ratio (HR) were adjusted by age, sex, and psychiatric comorbidity (i.e., personality disorder and/or pain disorder). RESULTS A total of 40,692 survivors or non-suicidal deaths and 597 suicidal death were included. The suicide rate among psychiatric patients was 5.13-fold higher than that of the general population. Psychotic disorder had the highest SMR (13.03; 95% confidence interval [CI], 11.23-15.03), followed by bipolar disorder (10.26; 95% CI, 7.97-13.00) and substance-related disorder (6.78; 95% CI, 4.14-10.47). In survival analysis, psychotic disorder had the highest HR (4.16; 95% CI, 2.86-6.05), which was further increased with younger age, male sex, and comorbidity of personality disorder. CONCLUSION All psychiatric patients are at a higher risk of suicide compared to the general population, and the risk is highest for those diagnosed with psychotic disorder.
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Affiliation(s)
- Yoojin Song
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Hyunju Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Min Ji Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Daun Shin
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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12
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Thordardottir EB, Yin L, Hauksdottir A, Mittendorfer-Rutz E, Hollander AC, Hultman CM, Lichtenstein P, Ye W, Arnberg FK, Fang F, Holmes EA, Valdimarsdottir UA. Mortality and major disease risk among migrants of the 1991-2001 Balkan wars to Sweden: A register-based cohort study. PLoS Med 2020; 17:e1003392. [PMID: 33259494 PMCID: PMC7707579 DOI: 10.1371/journal.pmed.1003392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In recent decades, millions of refugees and migrants have fled wars and sought asylum in Europe. The aim of this study was to quantify the risk of mortality and major diseases among migrants during the 1991-2001 Balkan wars to Sweden in comparison to other European migrants to Sweden during the same period. METHODS AND FINDINGS We conducted a register-based cohort study of 104,770 migrants to Sweden from the former Yugoslavia during the Balkan wars and 147,430 migrants to Sweden from 24 other European countries during the same period (1991-2001). Inpatient and specialized outpatient diagnoses of cardiovascular disease (CVD), cancer, and psychiatric disorders were obtained from the Swedish National Patient Register and the Swedish Cancer Register, and mortality data from the Swedish Cause of Death Register. Adjusting for individual-level data on sociodemographic characteristics and emigration country smoking prevalence, we used Cox regressions to contrast risks of health outcomes for migrants of the Balkan wars and other European migrants. During an average of 12.26 years of follow-up, being a migrant of the Balkan wars was associated with an elevated risk of being diagnosed with CVD (HR 1.39, 95% CI 1.34-1.43, p < 0.001) and dying from CVD (HR 1.45, 95% CI 1.29-1.62, p < 0.001), as well as being diagnosed with cancer (HR 1.16, 95% CI 1.08-1.24, p < 0.001) and dying from cancer (HR 1.27, 95% CI 1.15-1.41, p < 0.001), compared to other European migrants. Being a migrant of the Balkan wars was also associated with a greater overall risk of being diagnosed with a psychiatric disorder (HR 1.19, 95% CI 1.14-1.23, p < 0.001), particularly post-traumatic stress disorder (HR 9.33, 95% CI 7.96-10.94, p < 0.001), while being associated with a reduced risk of suicide (HR 0.68, 95% CI 0.48-0.96, p = 0.030) and suicide attempt (HR 0.57, 95% CI 0.51-0.65, p < 0.001). Later time period of migration and not having any first-degree relatives in Sweden at the time of immigration were associated with greater increases in risk of CVD and psychiatric disorders. Limitations of the study included lack of individual-level information on health status and behaviors of migrants at the time of immigration. CONCLUSIONS Our findings indicate that migrants of the Balkan wars faced considerably elevated risks of major diseases and mortality in their first decade in Sweden compared to other European migrants. War migrants without family members in Sweden or with more recent immigration may be particularly vulnerable to adverse health outcomes. Results underscore that persons displaced by war are a vulnerable group in need of long-term health surveillance for psychiatric disorders and somatic disease.
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Affiliation(s)
| | - Li Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arna Hauksdottir
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Christina M. Hultman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Icahn School of Medicine, Mount Sinai Hospital, New York, New York, United States of America
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Filip K. Arnberg
- Department of Neuroscience, Uppsala Universitet, Uppsala, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Emily A. Holmes
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Unnur Anna Valdimarsdottir
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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13
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Weye N, Momen NC, Christensen MK, Iburg KM, Dalsgaard S, Laursen TM, Mortensen PB, Santomauro DF, Scott JG, Whiteford HA, McGrath JJ, Plana-Ripoll O. Association of Specific Mental Disorders With Premature Mortality in the Danish Population Using Alternative Measurement Methods. JAMA Netw Open 2020; 3:e206646. [PMID: 32492163 PMCID: PMC7272122 DOI: 10.1001/jamanetworkopen.2020.6646] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE The association of mental disorders with premature mortality published in the Global Burden of Disease (GBD) studies has been underestimated because these analyses have recommended using only a small number of mental disorders as causes of death to estimate years of life lost (YLL). Alternative methods have been introduced, such as estimating life-years lost (LYL), to compare individuals with mental disorders with the general population. OBJECTIVES To generate register-based YLL and LYL estimates and to use these measurement methods to assess the association of specific mental disorders with premature mortality. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included all persons with and without mental disorders aged 0 to 94 years who were living in Denmark between January 1, 2000, and December 31, 2015. Data were analyzed from January to December 2019. MAIN OUTCOMES AND MEASURES Danish health registers were used to identify mental disorder diagnoses, dates of death, and causes of death. The YLLs were estimated for the set of mental health-associated causes of death, and all-cause and cause-specific LYLs were estimated for 18 specific mental disorders and 3 broad categories of mental disorders that were recommended for use in the GBD studies. The association between the number of comorbid mental disorders (divided into categories of persons with ≥1 type of disorder, ≥2 types of disorders, ≥3 types of disorders, and ≥4 types of disorders) and LYL estimates was also examined. RESULTS A total of 6 989 627 individuals (3 481 219 male persons [49.8%] and 3 508 408 female persons [50.2%]; mean [SD] age at study enrollment, 32.2 [24.4] years) were followed up for a total of 85 911 461 person-years. The YLL rates per 100 000 person-years were highest for alcohol use disorder (for male individuals, 568.7 [95% CI, 564.4-572.7]; for female individuals, 155.5 [95% CI, 153.5-157.9]) and suicide (for male individuals, 590.1 [95% CI, 583.8-596.5]; for female individuals, 202.3 [95% CI, 198.5-206.4]). Although only 3 of 18 mental and substance use disorders could be associated with YLL, all mental disorders were associated with shorter life expectancies when LYL was used for measurement. Male and female individuals diagnosed with any mental disorder had life expectancies that were shorter by 11.2 years (95% CI, 11.1-11.3 years) and 7.9 years (95% CI, 7.8-8.0 years), respectively, and remaining life expectancy decreased further among those with comorbid mental disorders. Drug use disorders were associated with the highest excess LYL estimates; however, common mental disorders, such as depressive and anxiety disorders, were also associated with substantial premature mortality. CONCLUSIONS AND RELEVANCE Mental disorders were observed to be associated with reductions in life expectancy. This finding provides a foundation for future intervention programs designed to reduce the differential mortality gap associated with mental disorders. Register-based studies allow the calculation of precise individual-level YLLs and LYLs, and both measurement methods are informative for health care planning. Compared with YLL, the novel LYL measurement approach may more precisely capture the association of mental disorders with premature mortality and facilitates the exploration of comorbidity and specific causes of death in individuals with mental disorders.
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Affiliation(s)
- Nanna Weye
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Natalie C Momen
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Maria K Christensen
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kim M Iburg
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Søren Dalsgaard
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Thomas M Laursen
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Preben B Mortensen
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Damian F Santomauro
- Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - James G Scott
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Metro North Mental Health Service, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - Harvey A Whiteford
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - John J McGrath
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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14
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Ahlgrén-Rimpiläinen AJ, Arffman M, Suvisaari J, Manderbacka K, Lumme S, Keskimäki I, Huovinen R, Pukkala E. Excess mortality from breast cancer in female breast cancer patients with severe mental illness. Psychiatry Res 2020; 286:112801. [PMID: 32001004 DOI: 10.1016/j.psychres.2020.112801] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 10/02/2019] [Revised: 01/13/2020] [Accepted: 01/19/2020] [Indexed: 02/07/2023]
Abstract
Women with a history of severe mental illness (SMI) have elevated breast cancer mortality. Few studies have compared cancer-specific mortality in women with breast cancer with or without SMI to reveal gaps in breast cancer treatment outcomes. We compared breast-cancer specific mortality in women with or without SMI and investigated effects of stage at presentation, comorbidity, and differences in cancer treatment. Women with their first breast cancer diagnosis in 1990-2013 (n = 80,671) were identified from the Finnish Cancer Registry, their preceding hospital admissions due to SMI (n = 4,837) from the Hospital Discharge Register and deaths from the Causes of Death Statistics. Competing risk models were used in statistical analysis. When controlling for age, year of cancer diagnosis, and comorbidity, breast cancer mortality was significantly elevated in patients with SMI. Relative mortality was highest in breast cancer patients with non-affective psychosis, partly explained by stage at presentation. Mortality was also significantly elevated in breast cancer patients with a substance use disorder and mood disorder. Patients with SMI received radiotherapy significantly less often than patients without SMI. Our findings emphasize the need to improve early detection of breast cancer in women with SMI and the collaboration between mental health care and oncological teams.
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Affiliation(s)
| | - Martti Arffman
- National Institute for Health and Welfare, Health and Social Systems Research, P.O. Box 30, Helsinki 00271, Finland
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Mental Health Unit, P.O. Box 30, Helsinki 00271, Finland
| | - Kristiina Manderbacka
- National Institute for Health and Welfare, Health and Social Systems Research, P.O. Box 30, Helsinki 00271, Finland
| | - Sonja Lumme
- National Institute for Health and Welfare, Health and Social Systems Research, P.O. Box 30, Helsinki 00271, Finland
| | - Ilmo Keskimäki
- National Institute for Health and Welfare, Health and Social Systems Research, P.O. Box 30, Helsinki 00271, Finland; Tampere University, Faculty of Social Sciences, P.O. Box 100, 33014, Tampere, Finland
| | - Riikka Huovinen
- Department of Oncology and Radiotherapy, Turku University Hospital, P.O. Box 52, Turku 20521, Finland
| | - Eero Pukkala
- Tampere University, Faculty of Social Sciences, P.O. Box 100, 33014, Tampere, Finland; Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Unioninkatu 22, Helsinki 00130, Finland
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15
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Affiliation(s)
- Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; Harvard T H Chan School of Public Health, Boston, MA, USA; Sangath, Goa, India.
| | - Paul E Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Partners In Health, Boston, MA, USA
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16
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Plana-Ripoll O, Pedersen CB, Agerbo E, Holtz Y, Erlangsen A, Canudas-Romo V, Andersen PK, Charlson FJ, Christensen MK, Erskine HE, Ferrari AJ, Iburg KM, Momen N, Mortensen PB, Nordentoft M, Santomauro DF, Scott JG, Whiteford HA, Weye N, McGrath JJ, Laursen TM. A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. Lancet 2019; 394:1827-1835. [PMID: 31668728 DOI: 10.1016/s0140-6736(19)32316-5] [Citation(s) in RCA: 284] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/07/2019] [Accepted: 08/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Systematic reviews have consistently shown that individuals with mental disorders have an increased risk of premature mortality. Traditionally, this evidence has been based on relative risks or crude estimates of reduced life expectancy. The aim of this study was to compile a comprehensive analysis of mortality-related health metrics associated with mental disorders, including sex-specific and age-specific mortality rate ratios (MRRs) and life-years lost (LYLs), a measure that takes into account age of onset of the disorder. METHODS In this population-based cohort study, we included all people younger than 95 years of age who lived in Denmark at some point between Jan 1, 1995, and Dec 31, 2015. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and the date and cause of death was obtained from the Danish Register of Causes of Death. We classified mental disorders into ten groups and causes of death into 11 groups, which were further categorised into natural causes (deaths from diseases and medical conditions) and external causes (suicide, homicide, and accidents). For each specific mental disorder, we estimated MRRs using Poisson regression models, adjusting for sex, age, and calendar time, and excess LYLs (ie, difference in LYLs between people with a mental disorder and the general population) for all-cause mortality and for each specific cause of death. FINDINGS 7 369 926 people were included in our analysis. We found that mortality rates were higher for people with a diagnosis of a mental disorder than for the general Danish population (28·70 deaths [95% CI 28·57-28·82] vs 12·95 deaths [12·93-12·98] per 1000 person-years). Additionally, all types of disorders were associated with higher mortality rates, with MRRs ranging from 1·92 (95% CI 1·91-1·94) for mood disorders to 3·91 (3·87-3·94) for substance use disorders. All types of mental disorders were associated with shorter life expectancies, with excess LYLs ranging from 5·42 years (95% CI 5·36-5·48) for organic disorders in females to 14·84 years (14·70-14·99) for substance use disorders in males. When we examined specific causes of death, we found that males with any type of mental disorder lost fewer years due to neoplasm-related deaths compared with the general population, although their cancer mortality rates were higher. INTERPRETATION Mental disorders are associated with premature mortality. We provide a comprehensive analysis of mortality by different types of disorders, presenting both MRRs and premature mortality based on LYLs, displayed by age, sex, and cause of death. By providing accurate estimates of premature mortality, we reveal previously underappreciated features related to competing risks and specific causes of death. FUNDING Danish National Research Foundation.
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Affiliation(s)
| | - Carsten Bøcker Pedersen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Yan Holtz
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Annette Erlangsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Vladimir Canudas-Romo
- School of Demography, ANU College of Arts & Social Sciences, Australian National University, Canberra, ACT, Australia
| | | | - Fiona J Charlson
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Maria K Christensen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Holly E Erskine
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alize J Ferrari
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Natalie Momen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Damian F Santomauro
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - James G Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Harvey A Whiteford
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nanna Weye
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - John J McGrath
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.
| | - Thomas M Laursen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
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Farrell M, Martin NK, Stockings E, Bórquez A, Cepeda JA, Degenhardt L, Ali R, Tran LT, Rehm J, Torrens M, Shoptaw S, McKetin R. Responding to global stimulant use: challenges and opportunities. Lancet 2019; 394:1652-1667. [PMID: 31668409 PMCID: PMC6924572 DOI: 10.1016/s0140-6736(19)32230-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 07/31/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022]
Abstract
We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.
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Affiliation(s)
- Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Robert Ali
- Discipline of Pharmacology, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jürgen Rehm
- Institute Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marta Torrens
- Addiction Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
| | - Steve Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
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18
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Grunewald C, Esscher A, Lutvica A, Parén L, Saltvedt S. [Maternal deaths in Sweden: Diagnostics and clinical management could be improved]. Lakartidningen 2019; 116:FPL4. [PMID: 31573669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
MM-ARG, the Swedish maternal maternity mortality group within SFOG (Swedish Society of Obstetrics and Gynecology) has, since 2008, surveyed and analysed maternal deaths in Sweden with the aim to find and give feedback on lessons learned to the medical professions. MM-ARG consists of obstetricians, midwives and anesthetists and the strength of the working model is that the profession itself takes responsibility for the scrutiny. A summary of 67 known maternal deaths from 2007‒2017 is presented. Direct causes of death are dominated by hypertensive disease/preeclampsia, followed by thromboembolic disease, sepsis and obstetric bleeding. Indirect death, where a known or unknown underlying disease is exacerbated by pregnancy, is dominated by cardiovascular disease. This review shows that the diagnostics and clinical management could be improved. Besides obstetrics/gynecology, maternal mortality affects other specialties and thus holds important lessons to many.
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Affiliation(s)
- Charlotta Grunewald
- Karolinska Universitetssjukhuset - PO Graviditet och Förlossning Stockholm, Sweden Karolinska Universitetssjukhuset - PO Graviditet och Förlossning Stockholm, Sweden
| | - Annika Esscher
- Uppsala Universitet - Kvinnosjukvården Uppsala, Sweden Uppsala Universitet - Kvinnosjukvården Uppsala, Sweden
| | - Ajlana Lutvica
- Uppsala Universitet - Kvinnosjukvården Uppsala, Sweden Uppsala Universitet - Kvinnosjukvården Uppsala, Sweden
| | - Lisa Parén
- Sahlgrenska universitetssjukhuset - Obstetriken Goteborg, Sweden Sahlgrenska universitetssjukhuset - Obstetriken Goteborg, Sweden
| | - Sissel Saltvedt
- Karolinska Universitetssjukhuset - PO Graviditet och Förlossning Stockholm, Sweden Karolinska Universitetssjukhuset - PO Graviditet och Förlossning Stockholm, Sweden
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19
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Abstract
This article presents a broad narrative review of the epidemiological evidence on how and why the mental health of older adults varies by gender. We draw upon international research literatures spanning gerontology and population mental health, as well as major reports from global health agencies. Compared with older men, older women are more likely to experience common mental disorders such as depression and anxiety, although the gender gap is smaller than it is at younger ages. In contrast, the mortality-related impacts of poor mental health, including suicide, are more severe for older men. These gendered patterns vary by country and other social contexts. Factors proposed to account for these findings include cultural and social norms, differentiation of gender roles, disadvantage and (dis)empowerment across the life course, and the coping styles of older men. However, little research has explicitly tested these explanations. Research to date has overwhelmingly focused on identifying differences in the mental health of older men and women. Notably, most studies have been restricted to binary comparisons, lacking the data to disentangle sex and gender dynamics, and few studies have examined the mental health of minority gendered adults in later life. Finally, there remains a need for high-quality population-based research into the mental health of those aged over 80 that includes coverage of people living in residential aged care settings.
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Affiliation(s)
- Kim M Kiely
- Neuroscience Research Australia (NeuRA), Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia; UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia.
| | - Brooke Brady
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia; ARC Centre for Excellence in Population Ageing Research, University of New South Wales, Sydney, Australia
| | - Julie Byles
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, Australia
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Ho HC, Wong MS. Urban environmental influences on the temperature-mortality relationship associated mental disorders and cardiorespiratory diseases during normal summer days in a subtropical city. Environ Sci Pollut Res Int 2019; 26:24272-24285. [PMID: 31230236 DOI: 10.1007/s11356-019-05594-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/28/2018] [Accepted: 05/27/2019] [Indexed: 06/09/2023]
Abstract
Temperature is associated with mortality risk across cities. However, there is lack of study investigating the summer effect on mortality associated with mental/behavioral disorders, especially in cities with subtropical climate. In addition, summer mortality in subtropical cities is different from tropical cities, and previous studies have not investigated the urban environmental inequality on heat mortality associated with mental/behavioral disorders. A register-based study was developed to estimate the temperature effects on decedents on days with 50th percentile of average daily temperature between 2007 and 2014 in Hong Kong (n = 133,359). Poisson regression was firstly applied to estimate the incidence rate ratio (IRR) from the summer temperature effects on all-cause mortality, cardiovascular mortality, respiratory mortality, and mortality associated with mental/behavioral disorders. For a 1 °C increase in average temperature on days with temperature ≥ 24.51 °C, IRRs of mortality associated with mental and behavioral disorders on lag 0 and lag 1 days were 1.033 [1.004, 1.062] and 1.030 [1.002, 1.060], while temperature effects on cardiovascular mortality and respiratory mortality during normal summer days (not extreme heat events) were not significant. A further investigation with linear regression has shown that decedents with mental/behavioral disorders on higher temperature days resided in areas with lower percentage of sky view, lower percentage of vegetation cover, higher level of neighborhood-level PM2.5, higher level of neighborhood-level NO, and higher level of neighborhood-level black carbon (BC). In order to develop protocols for community healthcare based on the "Leaving no one behind" scheme documented in the 2016 Sustainable Development Goals report of the United Nations, it is necessary to include heat effects on mental/behavioral disorders, especially people with dementia, for community planning and healthcare development.
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Affiliation(s)
- Hung Chak Ho
- Department of Urban Planning and Design, The University of Hong Kong, Pok Fu Lam, Hong Kong.
| | - Man Sing Wong
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
- Research Institute for Sustainable Urban Development, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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21
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Alexander D, Schnell M. Just what the nurse practitioner ordered: Independent prescriptive authority and population mental health. J Health Econ 2019; 66:145-162. [PMID: 31220792 DOI: 10.1016/j.jhealeco.2019.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 06/09/2023]
Abstract
We examine whether relaxing occupational licensing to allow nurse practitioners (NPs)-registered nurses with advanced degrees-to prescribe medication without physician oversight improves population mental health. Exploiting time-series variation in independent prescriptive authority for NPs from 1990 to 2014, we find that broadening prescriptive authority leads to improvements in self-reported mental health and decreases in mental health-related mortality. These improvements are concentrated in areas that are underserved by physicians and among populations that have difficulty accessing physician-provided care. Our results demonstrate that extending independent prescriptive authority to NPs can help mitigate physician shortages and extend care to disadvantaged populations.
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22
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Das-Munshi J, Schofield P, Bhavsar V, Chang CK, Dewey ME, Morgan C, Stewart R, Thornicroft G, Prince MJ. Ethnic density and other neighbourhood associations for mortality in severe mental illness: a retrospective cohort study with multi-level analysis from an urbanised and ethnically diverse location in the UK. Lancet Psychiatry 2019; 6:506-517. [PMID: 31097399 PMCID: PMC6551347 DOI: 10.1016/s2215-0366(19)30126-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neighbourhood social context might play a role in modifying mortality outcomes in severe mental illness, but has received little attention to date. Therefore, we aimed to assess in an ethnically diverse and urban location the association of neighbourhood-level characteristics and individual-level factors for all-cause, natural-cause, and unnatural-cause mortality in those with severe mental illness. METHODS We did a retrospective cohort study using a case-registry from a large secondary mental health-care Trust in an ethnically diverse and urban location in south London, UK. Linked data for deaths and areas of residence were identified from the case-registry. We included all individuals aged 15 years or more at the time of diagnosis for a severe mental illness from Jan 1, 2007, to Dec 31, 2014. We used individual-level information in our analyses, such as gender, marital status, and the presence of current or previous substance use disorders. We assessed neighbourhood or area-level indicators at the Lower Super Output Area level. Association of neighbourhood-level characteristics, which included the interaction between ethnicity and own ethnic density, deprivation, urbanicity, and social fragmentation, alongside individual-level factors for all-cause, natural-cause, and unnatural-cause mortality in those with severe mental illness was assessed. FINDINGS A total of 18 201 individuals were included in this cohort for analyses, with a median follow-up of 6·36 years. There were 1767 (9·7%) deaths from all causes, 1417 (7·8%) from natural causes, and 192 (1·1%) from unnatural causes. In the least ethnically dense areas, the adjusted rate ratio (aRR) for all-cause mortality in ethnic minority groups with severe mental illness compared with white British people with severe mental illness were similar (aRR 0·96, 95% CI 0·71-1·29); however in the highest ethnic density areas, ethnic minority groups with severe mental illness had a lower risk of death (aRR 0·52, 95% CI 0·38-0·71; p<0·0001), with similar trends for natural-cause mortality (p=0·071 for statistical interaction). In the cohort with severe mental illness, residency in deprived, urban, and socially fragmented neighbourhoods was not associated with higher mortality rates. Compared with the general population, age-standardised and gender-standardised mortality ratios were elevated in the cohort with severe mental illness across all neighbourhood-level characteristics assessed. INTERPRETATION For ethnic minority groups with severe mental illness, residency in areas of higher own-group ethnic density is associated with lower mortality compared to white British groups with severe mental illness. FUNDING Health Foundation, National Institute for Health Research, EU Seventh Framework, and National Institute of Mental Health.
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Affiliation(s)
- Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, London, UK.
| | - Peter Schofield
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Vishal Bhavsar
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Chin-Kuo Chang
- Department of Health and Welfare, University of Taipei, Taipei City, Taiwan
| | - Michael E Dewey
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Graham Thornicroft
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Martin J Prince
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
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23
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Rentería-Ramos R, Hurtado-Heredia R, Urdinola BP. Morbi-Mortality of the Victims of Internal Conflict and Poor Population in the Risaralda Province, Colombia. Int J Environ Res Public Health 2019; 16:ijerph16091644. [PMID: 31083523 PMCID: PMC6540234 DOI: 10.3390/ijerph16091644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 12/18/2022]
Abstract
This work studies the health status of two populations similar in most social and environmental interactions but one: the individuals from one population are victims of an internal armed conflict. Both populations are located in the Risaralda province, Colombia and the data for this study results from a combination of administrative records from the health system, between 2011 and 2016. We implemented a methodology based on graph theory that defines the system as a set of heterogeneous social actors, including individuals as well as organizations, embedded in a biological environment. The model of analysis uses the diagnoses in medical records to detect morbidity and mortality patterns for each individual (ego-networks), and assumes that these patterns contain relevant information about the effects of the actions of social actors, in a given environment, on the status of health. The analysis of the diagnoses and causes of specific mortality, following the Social Network Analysis framework, shows similar morbidity and mortality rates for both populations. However, the diagnoses' patterns show that victims portray broader interactions between diagnoses, including mental and behavioral disorders, due to the hardships of this population.
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Affiliation(s)
- Rafael Rentería-Ramos
- Departments of Physics and Statistics, Universidad Nacional de Colombia, Cra 45 Bogotá, Colombia.
- School of Basic Sciences, Technologies and Engineering, Universidad Nacional Abierta y a Distancia de Colombia, 111321 Bogotá, Colombia.
| | | | - B Piedad Urdinola
- Department of Statistics, Universidad Nacional de Colombia, Cra 45 Bogotá, Colombia.
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24
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Waddle MR, Niazi S, Aljabri D, White L, Kaleem T, Naessens J, Spaulding A, Habboush J, Rummans T, Miller R. Cost of Acute and Follow-Up Care in Patients With Pre-Existing Psychiatric Diagnoses Undergoing Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 104:748-755. [PMID: 30904707 DOI: 10.1016/j.ijrobp.2019.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/04/2019] [Accepted: 03/12/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The impact of psychiatric comorbidities on the cost of cancer care in radiation oncology practices is not well studied. We assessed the acute and 24-month follow-up costs for patients with and without pre-existing psychiatric comorbidities undergoing radiation therapy. METHODS AND MATERIALS Patients with cancer undergoing radiation therapy at our institution from 2009 to 2014 were denoted as having pre-existing psychiatric conditions (Psych group) if they had associated billing codes for any of the 422 International Classification of Diseases, 9th revision psychiatric conditions during the 12 months before their cancer diagnosis. The Elixhauser comorbidity index was calculated, excluding psychiatric categories. Medicare reimbursement was assigned to professional services, and Medicare departmental cost-to-charge ratios were applied to service line hospital charges and adjusted for inflation to create 2017 standardized costs. Acute (0-6 month) and follow-up (6-24 month) costs were subcategorized into clinic, emergency department, hospital inpatient, and outpatient costs. RESULTS Among 1275 patients, 126 (9.9%) had at least 1 pre-existing psychiatric diagnosis. On univariate analysis, both acute and long-term costs were higher in the Psych group. The largest significant differences in costs were follow-up hospital inpatient costs ($5861 higher; 95% confidence interval [CI], $687-$11,035; P = .002), follow-up hospital outpatient costs ($2086 higher; 95% CI, -$142 to $4,314; P = .040), and follow-up emergency department costs ($396 higher; 95% CI, $149-$643; P < .001). Age, race, sex, and treatment modalities were comparable, but the Psych group patients had more median comorbidities (2 vs 1) and had more respiratory cancer diagnoses than the nonpsychiatric group (31% vs 17%). On multivariate analysis adjusted for age, sex, cancer diagnosis, and comorbidities, global follow-up costs remained 150% higher in the Psych group (P < .001). Acute costs were similar after adjustment (P = .63). CONCLUSIONS Psychiatric comorbidities independently predict elevated healthcare costs in patients treated for cancer. Radiation oncology payment models should consider adjustments to account for psychiatric comorbidities because addressing these may mitigate cost differential.
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Affiliation(s)
- Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Shehzad Niazi
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida
| | - Duaa Aljabri
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrhman Bin Faisal University, Dammam, Saudi Arabia
| | - Launia White
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Tasneem Kaleem
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - James Naessens
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida; Division of Health Care Policy & Research, Mayo Clinic, Jacksonville, Florida
| | - Aaron Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Jacob Habboush
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Teresa Rummans
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida
| | - Robert Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
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25
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Lindskou TA, Pilgaard L, Søvsø MB, Kløjgård TA, Larsen TM, Jensen FB, Weinrich UM, Christensen EF. Symptom, diagnosis and mortality among respiratory emergency medical service patients. PLoS One 2019; 14:e0213145. [PMID: 30817792 PMCID: PMC6395033 DOI: 10.1371/journal.pone.0213145] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/17/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Breathing difficulties and respiratory diseases have been under-reported in Emergency Medical Services research, despite these conditions being prevalent with substantial mortality. Our aim was two-fold; 1) to investigate the diagnostic pattern and mortality among EMS patients to whom an ambulance was dispatched due to difficulty breathing, and 2) to investigate the initial symptoms and mortality for EMS patients diagnosed with respiratory diseases in hospital. METHODS Population-based historic cohort study in the North Denmark Region 2012-2015. We included two patient groups; 1) patients calling the emergency number with breathing difficulty as main symptom, and 2) patients diagnosed with respiratory diseases in hospital following an emergency call. Main outcome was estimated 1- and 30-day mortality rates. RESULTS There were 3803 patients with the symptom breathing difficulty, nearly half were diagnosed with respiratory diseases 47.3%, followed by circulatory diseases 13.4%, and symptoms and signs 12.0%. The 1-day mortality rate was highest for circulatory diseases, then respiratory diseases and other factors. Over-all 30-day mortality was 13.2%, and the highest rate was for circulatory diseases (17.7%) then respiratory diseases and other factors. A total of 4014 patients were diagnosed with respiratory diseases, 44.8% had the symptom breathing difficulty, 13.4% unclear problems and 11.3%. chest pain/heart disease. 1-day mortality rates were highest for decreased consciousness, then breathing difficulties and unclear problem. Over-all 30-day mortality rates were 12.5%, the highest with symptoms of decreased consciousness (19.1%), then unclear problem and breathing difficulty. There was an overlap of 1797 patients between the two groups. CONCLUSIONS The over-all mortality rates alongside the distribution of symptoms and diagnoses, suggest the breathing difficulty patient group is complex and has severe health problems. These findings may be able to raise awareness towards the patient group, and thereby increase focus on diagnostics and treatment to improve the patient outcome.
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Affiliation(s)
- Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- * E-mail:
| | - Laura Pilgaard
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Torben Anders Kløjgård
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas Mulvad Larsen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Unit of Business Intelligence, North Denmark Region, Aalborg, Denmark
| | | | - Ulla Møller Weinrich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
- The Pulmonary Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Emergency Medical Services, North Denmark Region, Aalborg, Denmark
- Clinic for Internal and Emergency Medicine, Aalborg University Hospital, Aalborg, Denmark
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26
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Kingsbury M, Sucha E, Horton NJ, Sampasa-Kanyinga H, Murphy JM, Gilman SE, Colman I. Lifetime experience of multiple common mental disorders and 19-year mortality: results from a Canadian population-based cohort. Epidemiol Psychiatr Sci 2019; 29:e18. [PMID: 30712520 PMCID: PMC6679827 DOI: 10.1017/s2045796018000859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 01/08/2023] Open
Abstract
AIMS To examine the impact of multiple psychiatric disorders over the lifetime on risk of mortality in the general population. METHODS Data came from a random community-based sample of 1397 adults in Atlantic Canada, recruited in 1992. Major depression, dysthymia, panic disorder, generalised anxiety disorder and alcohol use disorders were assessed using the Diagnostic Interview Schedule (DIS). Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. Cox proportional hazard models with age at study entry as the time scale were used to investigate the relationship between DIS diagnoses and mortality, adjusted for participant education, smoking and obesity at baseline. RESULTS Results suggested that mood and anxiety disorders rarely presented in isolation - the majority of participants experienced multiple psychiatric disorders over the lifetime. Elevated risk of death was found among men with both major depression and dysthymia (HR 2.56; 95% CI 1.12-5.89), depression and alcohol use disorders (HR 2.45; 95% CI 1.18-5.10) and among men and women who experienced both panic disorder and alcohol use disorders (HR 3.80; 95% CI 1.19-12.16). CONCLUSION The experience of multiple mental disorders over the lifetime is extremely common, and associated with increased risk of mortality, most notably among men. Clinicians should be aware of the importance of considering contemporaneous symptoms of multiple psychiatric conditions.
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Affiliation(s)
- M. Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - E. Sucha
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - N. J. Horton
- Department of Mathematics and Statistics, Amherst College, Amherst, MA, USA
| | - H. Sampasa-Kanyinga
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - J. M. Murphy
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Psychiatry, Dalhousie University Faculty of Medicine, Halifax, NS, Canada
| | - S. E. Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - I. Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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27
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Naslund JA, Aschbrenner KA. Digital technology for health promotion: opportunities to address excess mortality in persons living with severe mental disorders. Evid Based Ment Health 2019; 22:17-22. [PMID: 30559332 PMCID: PMC6359972 DOI: 10.1136/ebmental-2018-300034] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/31/2018] [Accepted: 11/21/2018] [Indexed: 12/24/2022]
Abstract
Persons with severe mental disorders (SMDs) experience dramatically reduced life expectancy compared with the general population. We consider the role of digital technologies for addressing this serious public health concern. In this clinical review, we apply the multilevel risk model recently introduced by the WHO to conceptualise how digital technology can support efforts to reduce excess mortality risk at the individual, health system and social determinants of health levels. In particular, digital technologies show promise for targeting preventable physical health conditions in persons with SMDs. However, evidence on the use of these technologies for addressing early mortality risk factors is lacking. At the individual level, digital interventions show promise for managing mental health symptoms, promoting healthy lifestyle behaviours and targeting substance use concerns. At the health system level, digital interventions can support care coordination, clinician training, screening and monitoring health indices and shared decision-making. At the social determinants of health level, digital interventions can facilitate opportunities to engage peers for illness self-management and health promotion and for delivering and/or augmenting supported employment programmes. The time is ripe to capitalise on early evidence to support future development, testing and delivery of effective digital efforts targeting risk factors that contribute to shorter life expectancy in persons with SMDs. Key challenges and opportunities for future research include increasing user engagement, involving users during development and testing of digital interventions, carefully considering risks/harms and rigorously evaluating effectiveness and costs to support the scalability and sustainability of promising digital approaches.
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Affiliation(s)
- John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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28
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Liang Y, Yang M, Zhao G, Mao Y, Zhang L, Hu Z. Relationship between mortality in people with mental disorders and suicide mortality in China during 2000 to 2014: An observational study. Medicine (Baltimore) 2018; 97:e13359. [PMID: 30544403 PMCID: PMC6310536 DOI: 10.1097/md.0000000000013359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Suicide is one of the top 10 causes of death in many countries. Although there are many studies on mental disorders, few studies have examined mortality in suicide population and mentally ill population. This study examined the association between mortality and mental disorders using data on suicides and mental disorders in China. Data from China's Health and Family Planning Statistical Yearbook for 2000 to 2014 were used to analyze the relationship between mortality associated with suicide and mental disorders. The analyses found that mortality among people with mental disorders dropped from 5.42/10 million in 2000 to 2.68/10 million in 2014, decreased more among females than males, and differed between urban and rural areas; that suicide mortality dropped from 10.79/10 million in 2000 to 6.79/10 million in 2014; the decrease was greater in women than in men, with suicide being highest among male residents of cities; and no significant correlation was found between mortality among persons with mental disorders and suicide mortality. There was no correlation between suicide mortality and mental-disorder mortality during 2000 to 2014; however, overall mortality decreased more among females than males during this period.
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Affiliation(s)
- Yundan Liang
- Department of Pathology and Pathophysiology, Chengdu Medical College
| | - Mengchang Yang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan
| | - Gaofeng Zhao
- Mental Health Hospital of Jining, Jining, Shandong
| | - Yuanyi Mao
- Department of Forensic Psychiatry, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Lushun Zhang
- Department of Pathology and Pathophysiology, Chengdu Medical College
| | - Zeqing Hu
- Department of Forensic Psychiatry, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
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29
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Torgerson J, Risö Bergerlind LL. [Increased somatic morbidity in patients with severe mental illness]. Lakartidningen 2018; 115:E6AM. [PMID: 30226633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patients with severe mental illness suffer an increased somatic mortality and morbidity from cardiovascular disease, diabetes and cancer. Furthermore, they are less likely to have adequate diagnostic and therapeutic procedures for somatic disorders. Life style issues, side effects of pharmacotherapy, cognitive impairment and suboptimal organization of the health care system all contribute. In total, a challenging situation that has to be addressed by the health care system. In Region Västra Götaland, Sweden, new medical routines for psychiatric patients are currently implemented. All patients should be offered an annual medical somatic checkup, including blood tests and ECG, and be advised about their life style, i.e. diet, exercise, smoking and alcohol. At the Department of psychosis, Sahlgrenska University Hospital, Göteborg, Sweden, a new permanent position as senior consultant in internal medicine/liaison physician has been established.
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Affiliation(s)
- Jarl Torgerson
- Regionkansliet, Västra Götalandsregionen - Göteborg, Sweden Regionkansliet, Västra Götalandsregionen - Göteborg, Sweden
| | - Lise-Lotte Risö Bergerlind
- Vastra Gotalandsregion - Kunskapsstöd för psykisk hälsa Göteborg, Sweden Vastra Gotalandsregion - Kunskapsstöd för psykisk hälsa Göteborg, Sweden
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30
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John A, McGregor J, Jones I, Lee SC, Walters JTR, Owen MJ, O'Donovan M, DelPozo-Banos M, Berridge D, Lloyd K. Premature mortality among people with severe mental illness - New evidence from linked primary care data. Schizophr Res 2018; 199:154-162. [PMID: 29728293 DOI: 10.1016/j.schres.2018.04.009] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/19/2018] [Accepted: 04/03/2018] [Indexed: 02/04/2023]
Abstract
Studies assessing premature mortality in people with severe mental illness (SMI) are usually based in one setting, hospital (secondary care inpatients and/or outpatients) or community (primary care). This may lead to ascertainment bias. This study aimed to estimate standardised mortality ratios (SMRs) for all-cause and cause-specific mortality in people with SMI drawn from linked primary and secondary care populations compared to the general population. SMRs were calculated using the indirect method for a United Kingdom population of almost four million between 2004 and 2013. The all-cause SMR was higher in the cohort identified from secondary care hospital admissions (SMR: 2.9; 95% CI: 2.8-3.0) than from primary care (SMR: 2.2; 95% CI: 2.1-2.3) when compared to the general population. The SMR for the combined cohort was 2.6 (95% CI: 2.5-2.6). Cause specific SMRs in the combined cohort were particularly elevated in those with SMI relative to the general population for ill-defined and unknown causes, suicide, substance abuse, Parkinson's disease, accidents, dementia, infections and respiratory disorders (particularly pneumonia), and Alzheimer's disease. Solely hospital admission based studies, which have dominated the literature hitherto, somewhat over-estimate premature mortality in those with SMI. People with SMI are more likely to die by ill-defined and unknown causes, suicide and other less common and often under-reported causes. Comprehensive characterisation of mortality is important to inform policy and practice and to discriminate settings to allow for proportionate interventions to address this health injustice.
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Affiliation(s)
- Ann John
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
| | - Joanna McGregor
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Ian Jones
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Sze Chim Lee
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - James T R Walters
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Michael J Owen
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Michael O'Donovan
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Marcos DelPozo-Banos
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Damon Berridge
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK
| | - Keith Lloyd
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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Abstract
Substance use and mental health disorders can result in disability, death, and economic cost. In the United States, rates of death from suicide, drug overdose, and chronic liver disease (a marker for alcohol abuse) have been rising for the past 15 years. Good public health surveillance for these disorders, their consequences, and their risk factors is crucially important for their prevention and control, but surveillance has not been conducted consistently in the states. In 2015, the Council of State and Territorial Epidemiologists convened a workgroup to develop a set of uniformly defined surveillance indicators that could be used by state and local health departments to monitor these disorders and to compare their occurrence in various jurisdictions. This report briefly describes the indicators and outlines the process used to develop them.
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Affiliation(s)
- Richard S. Hopkins
- Department of Epidemiology, Colleges of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Megan Toe
- Council of State and Territorial Epidemiologists, Atlanta, GA, USA
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32
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Lõhmus M. Possible Biological Mechanisms Linking Mental Health and Heat-A Contemplative Review. Int J Environ Res Public Health 2018; 15:ijerph15071515. [PMID: 30021956 PMCID: PMC6068666 DOI: 10.3390/ijerph15071515] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 12/15/2022]
Abstract
This review provides examples of possible biological mechanisms that could, at least partly, explain the existing epidemiological evidence of heatwave-related exacerbation of mental disease morbidity. The author reviews the complicated central processes involved in the challenge of maintaining a stable body temperature in hot environments, and the maladaptive effects of certain psychiatric medicines on thermoregulation. In addition, the author discusses some alternative mechanisms, such as interrupted functional brain connectivity and the effect of disrupted sleep, which may further increase the vulnerability of mental health patients during heatwaves.
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Affiliation(s)
- Mare Lõhmus
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Solnavägen 4, 113 65 Stockholm, Sweden.
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 17177 Solna, Sweden.
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Hengartner MP. [A Patient´s Personality: A Frequently Ignored but Important Component in General Medical Practice]. Praxis (Bern 1994) 2018; 107:641-647. [PMID: 29871573 DOI: 10.1024/1661-8157/a002998] [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] [Indexed: 06/08/2023]
Abstract
A Patient´s Personality: A Frequently Ignored but Important Component in General Medical Practice Abstract. In general medical practice, a patient's personality is hardly considered and assessed. In this mini-review the author summarises how a comprehensive personality assessment may provide valuable patient information. Prospective effects of personality traits on general lifestyle as well as mental and physical health are presented. In addition, original research is introduced that shows meaningful associations between personality traits, clinical disease markers, and all-cause mortality. These findings are discussed with respect to selected etiological models. The studies illustrate that a personality assessment could be a useful aid for diagnosis, prognosis, and treatment planning.
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Affiliation(s)
- Michael P Hengartner
- 1 Departement für Angewandte Psychologie, Zürcher Hochschule für Angewandte Wissenschaften, Zürich
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34
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Tingle J. A crisis point for mental health care. Br J Nurs 2018; 27:412-413. [PMID: 29634333 DOI: 10.12968/bjon.2018.27.7.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
John Tingle, Associate Professor (Teaching and Scholarship), Nottingham Trent University, discusses failings in NHS care for highly vulnerable mental health patients.
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Affiliation(s)
- John Tingle
- Associate Professor (Teaching and Scholarship), Nottingham Trent University
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35
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Abstract
A psychiatric investigation was carried out on patients aged 65–80 years who were admitted to the medical wards of six general hospitals in an industrial urban area of West Germany. In all, 626 patients were screened for cognitive and affective disorder using a short standardized interview, and at the second stage all those with abnormal responses, as well as a subsample of the apparently normal patients, were examined in greater detail. After correction for inaccuracies of screening, the frequency of psychiatric illness in this patient population was estimated as 30.2%, made up of 9.1% with organic brain syndromes and 21.1% with functional mental disorders. Comparison with field-study data for the same background population showed that the hospital patients were at increased risk for mental disturbance. At follow up after one year, outcome in terms of mortality, admission to long-term care and dependency on others was worst for patients with organic mental disorder, even after matching for age and initial severity of physical impairment. Functional mental illness was also associated with a relatively poor outcome in terms of dependency. The mental status of elderly medical patients appears to be important for the prognosis.
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36
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Yarborough BJH, Perrin NA, Stumbo SP, Muench J, Green CA. Preventive Service Use Among People With and Without Serious Mental Illnesses. Am J Prev Med 2018; 54:1-9. [PMID: 29056371 PMCID: PMC5736432 DOI: 10.1016/j.amepre.2017.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION People with serious mental illnesses experience excess morbidity and premature mortality resulting from preventable conditions. The goal was to examine disparities in preventive care that might account for poor health outcomes. METHODS In this retrospective cohort study, adults (N=803,276) served by Kaiser Permanente Northwest and federally qualified health centers/safety-net community health clinics were categorized into five groups: schizophrenia spectrum disorders, bipolar disorders/affective psychoses, anxiety disorders, nonpsychotic unipolar depression, and reference groups with no evidence of these specific mental illnesses. The primary outcome was overall preventive care-gap rate, the proportion of incomplete preventive services for which each patient was eligible in 2012-2013. Secondary analyses examined Kaiser Permanente Northwest data from 2002 to 2013. Data were analyzed in 2015. RESULTS Controlling for patient characteristics and health services use, Kaiser Permanente Northwest mean care-gap rates were significantly lower for bipolar disorders/affective psychoses (mean=18.6, p<0.001) and depression groups (mean=18.6, p<0.001) compared with the reference group. Schizophrenia (mean=19.4, p=0.236) and anxiety groups (mean=19.9, p=0.060) did not differ from the reference group (mean=20.3). In community health clinics, schizophrenia (mean=34.1, p<0.001), bipolar/affective psychosis (mean=35.7, p<0.001), anxiety (mean=38.5, p<0.001), and depression groups (mean=36.3, p<0.001) had significantly lower care-gap rates than those in the reference group (mean=40.0). Secondary analyses of diabetes and dyslipidemia screening trends in Kaiser Permanente Northwest showed diagnostic groups consistently had fewer care gaps than patients in the reference group. CONCLUSIONS In vastly different settings, individuals with serious mental illnesses received preventive services at equal or better rates than the general population.
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Affiliation(s)
| | - Nancy A Perrin
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Scott P Stumbo
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - John Muench
- Oregon Health & Science University, Department of Family Medicine, Portland, Oregon
| | - Carla A Green
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
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37
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Ilyas A, Chesney E, Patel R. Improving life expectancy in people with serious mental illness: should we place more emphasis on primary prevention? Br J Psychiatry 2017; 211:194-197. [PMID: 28882826 PMCID: PMC5623876 DOI: 10.1192/bjp.bp.117.203240] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/23/2017] [Accepted: 05/26/2017] [Indexed: 12/31/2022]
Abstract
People with serious mental illness have a reduced life expectancy that is partly attributable to increased cardiovascular disease. One approach to address this is regular physical health monitoring. However, physical health monitoring is poorly implemented in everyday clinical practice and there is little evidence to suggest that it improves physical health. We argue that greater emphasis should be placed on primary prevention strategies such as assertive smoking cessation, dietary and exercise interventions and more judicious psychotropic prescribing.
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Affiliation(s)
- Athif Ilyas
- Athif Ilyas, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Edward Chesney, BM, BCh, Rashmi Patel, BM, BCh, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Edward Chesney
- Athif Ilyas, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Edward Chesney, BM, BCh, Rashmi Patel, BM, BCh, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rashmi Patel
- Athif Ilyas, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Edward Chesney, BM, BCh, Rashmi Patel, BM, BCh, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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38
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Rice NC, Rauscher NA, Langston JL, Myers TM. Behavioral intoxication following voluntary oral ingestion of tetramethylenedisulfotetramine: Dose-dependent onset, severity, survival, and recovery. Neurotoxicology 2017; 63:21-32. [PMID: 28855111 DOI: 10.1016/j.neuro.2017.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Received: 02/03/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 01/13/2023]
Abstract
Tetramethylenedisulfotetramine (tetramine, or TETS) is a highly toxic rodenticide that has been responsible for over 14,000 accidental and intentional poisonings worldwide. Although the vast majority of TETS poisonings involved tainted food or drink, the laboratory in vivo studies of TETS intoxication used intraperitoneal injection or gavage for TETS exposure. Seeking to develop and characterize a more realistic model of TETS intoxication in the present study, rats were trained to rapidly and voluntarily consume a poisoned food morsel. Initially, the overt toxic effects of TETS consumption across a large range of doses were characterized, then a focused range of doses was selected for more intensive behavioral evaluation (in operant test chambers providing a variable-interval schedule of food reinforcement). The onset of intoxication following voluntary oral consumption of TETS was rapid, and clear dose-dependent response-rate suppression was observed across multiple performance measures within the operant-chamber environment. At most doses, recovery of operant performance did not occur within 30h. Food consumption and body weight changes were also dose dependent and corroborated the behavioral measures of intoxication. This voluntary oral-poisoning method with concomitant operant-behavioral assessment shows promise for future studies of TETS (and other toxic chemicals of interest) and may be extremely valuable in characterizing treatment outcomes.
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Affiliation(s)
- Nathaniel C Rice
- United States Army Medical Research Institute of Chemical Defense, 2900 Ricketts Point Rd, Aberdeen Proving Ground, MD, 21010, USA
| | - Noah A Rauscher
- United States Army Medical Research Institute of Chemical Defense, 2900 Ricketts Point Rd, Aberdeen Proving Ground, MD, 21010, USA
| | - Jeffrey L Langston
- United States Army Medical Research Institute of Chemical Defense, 2900 Ricketts Point Rd, Aberdeen Proving Ground, MD, 21010, USA
| | - Todd M Myers
- United States Army Medical Research Institute of Chemical Defense, 2900 Ricketts Point Rd, Aberdeen Proving Ground, MD, 21010, USA.
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39
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Boyer L, Zendjidjian XY, Baumstarck K, Samuelian JC, François P. [Benefit of mortality and morbidity reviews in psychiatry]. Soins Psychiatr 2017; 38:41-44. [PMID: 28886837 DOI: 10.1016/j.spsy.2017.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A mortality and morbidity (M&M) review consists in analysing, collectively and retrospectively, the cases of patients whose evolution has been marked by a complication or death. This analysis must question whether such an outcome could have been avoided, making it possible to identify the causes and correct the factors having contributed to its occurrence. After a presentation of the methodological and organisational principles, as well as the M&M reviews carried out in France, attention is turned to those performed in psychiatry and identifying the main perspectives for the discipline.
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Affiliation(s)
- Laurent Boyer
- Aix-Marseille Université, EA 3279-santé publique, maladies chroniques et qualité de vie, Faculté de médecine secteur Timone, 27, boulevard Jean-Moulin, 13005 Marseille, France.
| | - Xavier-Yves Zendjidjian
- Aix-Marseille Université, EA 3279-santé publique, maladies chroniques et qualité de vie, Faculté de médecine secteur Timone, 27, boulevard Jean-Moulin, 13005 Marseille, France; Pôle de psychiatrie, hôpital La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Karine Baumstarck
- Aix-Marseille Université, EA 3279-santé publique, maladies chroniques et qualité de vie, Faculté de médecine secteur Timone, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - Jean-Claude Samuelian
- Pôle de psychiatrie, hôpital La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Patrice François
- Pôle santé publique, unité d'évaluation médicale, centre hospitalier universitaire Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
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40
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O'Reilly D, Rosato M, Ferry F, Moriarty J, Leavy G. Caregiving, volunteering or both? Comparing effects on health and mortality using census-based records from almost 250,000 people aged 65 and over. Age Ageing 2017; 46:821-826. [PMID: 28338778 DOI: 10.1093/ageing/afx017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Indexed: 11/13/2022] Open
Abstract
Background the health impacts of caregiving and volunteering are rarely studied concurrently, despite the potential for both synergies and conflicts. This population-based study examines the association of these activities on health and subsequent mortality. Method a census-based record-linkage study of 244,429 people aged 65 and over, with cohort characteristics, caregiving and volunteering status, and presence of chronic health conditions derived from the Census returns. Mortality risk was assessed over the following 45 months with adjustment for baseline characteristics. Results caregivers and volunteers were individually more mobile than those undertaking neither activity; caregivers who also volunteered were more mobile than those who did not volunteer, but no less likely to suffer from poor mental health. Both caregiving and volunteering were separately associated with reduced mortality risk (HR = 0.74: 95% confidence intervals (CIs) = 0.71, 0.77 and HR = 0.76: 0.73, 0.81, respectively); the lowest mortality was found amongst light caregivers who also volunteered (HR = 0.53: 95% CIs = 0.45, 0.62), compared to those engaged in neither. There was no evidence of a multiplicative effect of caregiving and volunteering at more intense levels of caregiving. Conclusion there is a large overlap in caregiving and volunteering activities with complex associations with health status. There is some evidence that combining caregiving and volunteering activities, for those involved in less intense levels of caregiving, maybe associated with lower mortality risk than associated with either activity alone. Further research is needed to understand which aspects of caregiving and volunteering are best and for whom and in which circumstances.
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Affiliation(s)
- Dermot O'Reilly
- Queen's University Belfast - Centre for Public Health, Belfast, UK
| | - Michael Rosato
- Ulster University - Bamford Centre for Mental Health and Wellbeing, Derry, UK
| | - Finola Ferry
- Ulster University - Bamford Centre for Mental Health and Wellbeing, Derry, UK
| | - John Moriarty
- Queen's University Belfast - Administrative Data Research Centre for Northern Ireland, ICBS-B Grosvenor Road, Belfast BT76BA, UK
| | - Gerard Leavy
- Ulster University - Bamford Centre for Mental Health and Wellbeing, Derry, UK
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Lavin K, Davydow DS, Downey L, Engelberg RA, Dunlap B, Sibley J, Lober WB, Okimoto K, Khandelwal N, Loggers ET, Teno JM, Curtis JR. Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness. J Pain Symptom Manage 2017; 54:176-185.e1. [PMID: 28495487 DOI: 10.1016/j.jpainsymman.2017.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/06/2016] [Revised: 03/10/2017] [Accepted: 04/05/2017] [Indexed: 11/21/2022]
Abstract
CONTEXT Little is known about psychiatric illness and utilization of end-of-life care. OBJECTIVES We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. METHODS We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases-9 codes. We used International Classification of Diseases-9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation. RESULTS Eleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk of death in nursing homes (P = 0.002) and decreased risk of death in hospitals (P < 0.001). In the last 30 days of life, psychiatric illness was associated with reduced inpatient and intensive care unit utilization but increased emergency department utilization. Path analyses confirmed an association between psychiatric illness and increased hospital utilization mediated by severity of illness and care fragmentation, but a stronger direct effect of psychiatric illness decreasing hospitalizations. CONCLUSION Our findings differ from the increased hospital utilization for patients with psychiatric illness in circumstances other than end-of-life care. Path analyses confirmed hypothesized associations between psychiatric illness and increased utilization mediated by severity of illness and care fragmentation but identified more powerful direct effects decreasing hospital use. Further investigation should examine whether this effect represents a disparity in access to preferred care.
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Affiliation(s)
- Kyle Lavin
- Department of Psychiatry and Palliative Care Program, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Dimitry S Davydow
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Lois Downey
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Ben Dunlap
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - James Sibley
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Bioinformatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - William B Lober
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Bioinformatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Kelson Okimoto
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Nita Khandelwal
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Elizabeth T Loggers
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Medical Oncology, University of Washington, Seattle, Washington, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joan M Teno
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Gerontology and Geriatrics, University of Washington, Seattle, Washington, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA.
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42
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Roberts LW, Louie AK, Guerrero APS, Balon R, Beresin EV, Brenner A, Coverdale J. Premature Mortality Among People with Mental Illness: Advocacy in Academic Psychiatry. Acad Psychiatry 2017; 41:441-446. [PMID: 28585124 DOI: 10.1007/s40596-017-0738-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | | | | | | | | | - Adam Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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43
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Dierickx S, Deliens L, Cohen J, Chambaere K. Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases. BMC Psychiatry 2017; 17:203. [PMID: 28641576 PMCID: PMC5481967 DOI: 10.1186/s12888-017-1369-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/23/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Euthanasia for people who are not terminally ill, such as those suffering from psychiatric disorders or dementia, is legal in Belgium under strict conditions but remains a controversial practice. As yet, the prevalence of euthanasia for people with psychiatric disorders or dementia has not been studied and little is known about the characteristics of the practice. This study aims to report on the trends in prevalence and number of euthanasia cases with a psychiatric disorder or dementia diagnosis in Belgium and demographic, clinical and decision-making characteristics of these cases. METHODS We analysed the anonymous databases of euthanasia cases reported to the Federal Control and Evaluation Committee Euthanasia from the implementation of the euthanasia law in Belgium in 2002 until the end of 2013. The databases we received provided the information on all euthanasia cases as registered by the Committee from the official registration forms. Only those with one or more psychiatric disorders or dementia and no physical disease were included in the analysis. RESULTS We identified 179 reported euthanasia cases with a psychiatric disorder or dementia as the sole diagnosis. These consisted of mood disorders (N = 83), dementia (N = 62), other psychiatric disorders (N = 22) and mood disorders accompanied by another psychiatric disorder (N = 12). The proportion of euthanasia cases with a psychiatric disorder or dementia diagnosis was 0.5% of all cases reported in the period 2002-2007, increasing from 2008 onwards to 3.0% of all cases reported in 2013. The increase in the absolute number of cases is particularly evident in cases with a mood disorder diagnosis. The majority of cases concerned women (58.1% in dementia to 77.1% in mood disorders). All cases were judged to have met the legal requirements by the Committee. CONCLUSIONS While euthanasia on the grounds of unbearable suffering caused by a psychiatric disorder or dementia remains a comparatively limited practice in Belgium, its prevalence has risen since 2008. If, as this study suggests, people with psychiatric conditions or dementia are increasingly seeking access to euthanasia, the development of practice guidelines is all the more desirable if physicians are to respond adequately to these highly delicate requests.
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Affiliation(s)
- Sigrid Dierickx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
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Kask J, Ramklint M, Kolia N, Panagiotakos D, Ekbom A, Ekselius L, Papadopoulos FC. Anorexia nervosa in males: excess mortality and psychiatric co-morbidity in 609 Swedish in-patients. Psychol Med 2017; 47:1489-1499. [PMID: 28162109 DOI: 10.1017/s0033291717000034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is a psychiatric disorder with high mortality. METHOD A retrospective register study of 609 males who received hospitalized care for AN in Sweden between 1973 and 2010 was performed. The standardized mortality ratios (SMRs) and Cox regression-derived hazard ratios (HRs) were calculated as measures of mortality. The incidence rate ratios (IRRs) were calculated to compare the mortality rates in patients with AN and controls both with and without psychiatric diagnoses. RESULTS The SMR for all causes of death was 4.1 [95% confidence interval (CI) 3.1-5.3]. For those patients with psychiatric co-morbidities, the SMR for all causes of death was 9.1 (95% CI 6.6-12.2), and for those without psychiatric co-morbidity, the SMR was 1.6 (95% CI 0.9-2.7). For the group of patients with alcohol use disorder, the SMR for natural causes of death was 11.5 (95% CI 5.0-22.7), and that for unnatural causes was 35.5 (95% CI 17.7-63.5). The HRs confirmed the increased mortality for AN patients with psychiatric co-morbidities, even after adjusting for confounders. The IRRs revealed no significant difference in mortality patterns between the AN patients with psychiatric co-morbidity and the controls with psychiatric diagnoses, with the exceptions of alcohol use disorder and neurotic, stress-related and somatoform disorders, which seemed to confer a negative synergistic effect on mortality. CONCLUSION Mortality in male AN patients was significantly elevated compared with the general population among only the patients with psychiatric co-morbidities. Specifically, the presence of alcohol and other substance use disorders was associated with more profound excess mortality.
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Affiliation(s)
- J Kask
- Department of Neuroscience, Psychiatry,University Hospital, Uppsala University,Uppsala,Sweden
| | - M Ramklint
- Department of Neuroscience, Psychiatry,University Hospital, Uppsala University,Uppsala,Sweden
| | - N Kolia
- Department of Nutrition and Dietetics,Harokopio University,Athens,Greece
| | - D Panagiotakos
- Department of Nutrition and Dietetics,Harokopio University,Athens,Greece
| | - A Ekbom
- Unit of Clinical Epidemiology, Department of Medicine,Karolinska Hospital,Karolinska Institute,Stockholm,Sweden
| | - L Ekselius
- Department of Neuroscience, Psychiatry,University Hospital, Uppsala University,Uppsala,Sweden
| | - F C Papadopoulos
- Department of Neuroscience, Psychiatry,University Hospital, Uppsala University,Uppsala,Sweden
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45
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Ray WA, Chung CP, Murray KT, Hall K, Stein CM. High-Dose Citalopram and Escitalopram and the Risk of Out-of-Hospital Death. J Clin Psychiatry 2017; 78:190-195. [PMID: 27736049 PMCID: PMC5916769 DOI: 10.4088/jcp.15m10324] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/11/2015] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Studies demonstrating that higher doses of citalopram (> 40 mg) and escitalopram (> 20 mg) prolong the corrected QT interval prompted regulatory agency warnings, which are controversial, given the absence of confirmatory clinical outcome studies. We compared the risk of potential arrhythmia-related deaths for high doses of these selective serotonin reuptake inhibitors (SSRIs) to that for equivalent doses of fluoxetine, paroxetine, and sertraline. METHODS The Tennessee Medicaid retrospective cohort study included 54,220 persons 30-74 years of age without cancer or other life-threatening illness who were prescribed high-dose SSRIs from 1998 through 2011. The mean age was 47 years, and 76% were female. Demographic characteristics and comorbidity for individual SSRIs were comparable. Because arrhythmia-related deaths are typically sudden and occur outside the hospital, we analyzed out-of-hospital sudden unexpected death as well as sudden cardiac deaths, a more specific indicator of proarrhythmic effects. RESULTS The adjusted risk of sudden unexpected death for citalopram did not differ significantly from that for the other SSRIs. The respective hazard ratios (HRs) for citalopram versus escitalopram, fluoxetine, paroxetine, and sertraline were 0.84 (95% CI, 0.40-1.75), 1.24 (95% CI, 0.75-2.05), 0.75 (95% CI, 0.45-1.24), and 1.53 (95% CI, 0.91-2.55). There were no significant differences for sudden cardiac death or all study deaths, nor were there significant differences among high-risk patients (≥ 60 years of age, upper quartile baseline cardiovascular risk). Escitalopram users had no significantly increased risk for any study end point. CONCLUSIONS We found no evidence that risk of sudden unexpected death, sudden cardiac death, or total mortality for high-dose citalopram and escitalopram differed significantly from that for comparable doses of fluoxetine, paroxetine, and sertraline.
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Affiliation(s)
- Wayne A Ray
- Department of Health Policy, Village at Vanderbilt, Ste 2600, 1501 21st Ave S, Nashville, TN 37212.
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Cecilia P Chung
- Department of Medicine and Pharmacology, Division of Rheumatology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Katherine T Murray
- Department of Medicine and Pharmacology, Division of Cardiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Medicine and Pharmacology, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Kathi Hall
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - C Michael Stein
- Department of Medicine and Pharmacology, Division of Rheumatology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Medicine and Pharmacology, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Kujansuu A, Rautiainen S, Hakko H, Kanamüller J, Sihvola N, Riipinen P. Drivers' psychiatric disorders and fatal motor vehicle accidents in Finland. J Psychiatr Res 2017; 84:227-236. [PMID: 27770742 DOI: 10.1016/j.jpsychires.2016.10.010] [Citation(s) in RCA: 9] [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: 04/01/2016] [Revised: 10/10/2016] [Accepted: 10/14/2016] [Indexed: 11/19/2022]
Abstract
Relatively little is known about fatal motor vehicle accidents (FMVA) involving drivers with psychiatric disorders. In this study of all drivers killed in FMVAs in Finland between 1990 and 2011, we aimed to study drivers' death rate trends in FMVAs, with special focus on drivers with a history of psychiatric disorders. Prevalence of drivers' hospital treated psychiatric disorders, and characteristics of drivers with psychiatric disorders were also studied. For the purpose of this study, three national registers were accessed. Drivers' hospital treated psychiatric disorders were screened in a five-year period prior to death. Drivers with (n = 425) and without (n = 3856) psychiatric disorders were compared, female and male drivers separately. The main outcome measure was any psychiatric disorder in drivers within the five-year timescale. Socio-demographic factors, use of intoxicants and medication at the time of death, recent adverse life events, and drivers' physical and emotional states were used as covariates in the statistical analyses. During the study period, death rates increased for females with psychiatric disorders, and decreased for females without psychiatric disorders. Death rates for males with psychiatric disorders decreased between the years 1990-2000 and 2007-2011, and increased between the years 2000-2007. Death rates decreased over the whole study period in males without psychiatric disorders. Alcohol related disorders and affective disorders were the most prevalent hospital treated psychiatric disorders among drivers involved in FMVAs. Use of medications at the time of death, and committing suicide in traffic both associated with being a driver with psychiatric disorders involved in FMVAs for both genders. As FMVAs involving drivers with psychiatric disorders have increased, a more focused and detailed evaluation of the driving performance of drivers with psychiatric disorders is recommended. These evaluations should also be extended to drivers with non-psychotic disorders.
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Affiliation(s)
- Antti Kujansuu
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, P.O. Box 5000, Peltolantie 17, 90014 Oulu, Finland
| | - Simo Rautiainen
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, P.O. Box 5000, Peltolantie 17, 90014 Oulu, Finland.
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90029 Oulu, Finland
| | - Juha Kanamüller
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90029 Oulu, Finland
| | - Niina Sihvola
- Finnish Motor Insurers' Centre, Bulevardi 28, 00120 Helsinki, Finland
| | - Pirkko Riipinen
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, P.O. Box 5000, Peltolantie 17, 90014 Oulu, Finland
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Birkbak J, Stuart EA, Lind BD, Qin P, Stenager E, Larsen KJ, Wang AG, Nielsen AC, Pedersen CM, Winsløv JH, Langhoff C, Mühlmann C, Nordentoft M, Erlangsen A. Psychosocial therapy and causes of death after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching. Psychol Med 2016; 46:3419-3427. [PMID: 27654845 DOI: 10.1017/s0033291716001872] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death. METHOD In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period. RESULTS At the end of follow-up, 391 (6.9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37-0.79], alcohol-related causes (0.63, 95% CI 0.50-0.80) and other diseases and medical conditions (0.61, 95% CI 0.49-0.77) were noted in the psychosocial therapy group. Also, we found a reduced risk of dying by suicide as well as other external causes, however, not by neoplasms and circulatory system diseases. Numbers needed to treat were 212.9 (95% CI 139.5-448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2-210.5) for alcohol-related causes and 96.8 (95% CI 69.1-161.8) for other diseases and medical conditions. CONCLUSIONS Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death from select medical conditions and external causes. These promising results should be tested in a randomized design.
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Affiliation(s)
- J Birkbak
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - E A Stuart
- Department of Mental Health,Johns Hopkins Bloomberg School of Public Health,Baltimore, MD,USA
| | - B D Lind
- Department of Psychiatry,Clinic of Suicide Prevention and Treatment for Adults,Region of Southern Denmark,Denmark
| | - P Qin
- National Centre for Suicide Research and Prevention, University of Oslo,Oslo,Norway
| | - E Stenager
- Psychiatric Research Unit,Aabenraa,University of Southern Denmark,Odense,Denmark
| | - K J Larsen
- Department of Child and Adolescent Psychiatry,Clinic of Suicide Prevention and Treatment for Children and Adolescents,Region of Southern Denmark,Denmark
| | - A G Wang
- Competence Centre for Suicide Prevention,Amager,Capital Region of Denmark,Denmark
| | - A C Nielsen
- Competence Centre for Suicide Prevention,Copenhagen,Capital Region of Denmark,Denmark
| | - C M Pedersen
- Clinic for Suicide Prevention, Aarhus University Hospital Risskov,Aarhus,Central Denmark Region,Denmark
| | - J-H Winsløv
- Unit for Suicide Prevention,Aalborg University Hospital,North Denmark Region,Denmark
| | - C Langhoff
- Clinic for Suicide Prevention,Herning,Central Denmark Region,Denmark
| | - C Mühlmann
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - M Nordentoft
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - A Erlangsen
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
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48
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Onoe S, Koda T, Nobutoki T, Watanabe M. [Study of death with the severely disabled]. No To Hattatsu 2016; 48:407-412. [PMID: 30010286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective: The characteristics of death in patients with severe mental and physical disabilities include, a short period from the onset of symptoms to death and sudden death in the young. However in recent years, it has not been rare for such patients to live to more than 50 years old. We examined the survival rate and current state of death within 24 hours among this patient population at our center. Methods: We identified 314 deaths from April 1 in 1969 to March 31 in 2013 and a total of 388 survivors during this date range. Based on confirmation, cases of death occurring within 24 hours from onset were extracted. The probability of survival was estimated and graphed using the Kaplan-Meier method, and factors influencing the characteristics of death within 24 hours and/or the survival rate were investigated using medical records after 1995. Results: The median age at survival was 56 years. The need for gastrostomy feeding was associated with a 2.4 times higher mortality rate than oral feeding. The survival estimate at 60 years for the cases of gastrostomy feeding was 34%, and the survival estimate at 70 years for the cases involving severe motor impairment was 34%. The age distribution showed no significant differences between the two groups, i. e.; cases of death within 24 hours and others. In the cases of death within 24 hours, the patients were tracheotomized and/or not followed with a monitor, which suggests that death may occur in all cases, irrespective of the patient’s condition. Conclusions: This study showed that patients with severe motor impairment may survive beyond 70 years of age. Death within 24 hours is not associated with a specific mortality age and can occur in any patient regardless of the severity of their condition, accounting for a relatively high proportion of causes of death, even now.
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49
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Affiliation(s)
- Lisa Rosenbaum
- Dr. Rosenbaum is a national correspondent for the Journal
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50
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Donneyong MM, Bykov K, Bosco-Levy P, Dong YH, Levin R, Gagne JJ. Risk of mortality with concomitant use of tamoxifen and selective serotonin reuptake inhibitors: multi-database cohort study. BMJ 2016; 354:i5014. [PMID: 27694571 PMCID: PMC5044871 DOI: 10.1136/bmj.i5014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To compare differences in mortality between women concomitantly treated with tamoxifen and selective serotonin reuptake inhibitors (SSRIs) that are potent inhibitors of the cytochrome-P450 2D6 enzyme (CYP2D6) versus tamoxifen and other SSRIs. DESIGN Population based cohort study. SETTING Five US databases covering individuals enrolled in private and public health insurance programs from 1995 to 2013. PARTICIPANTS Two cohorts of women who started taking tamoxifen. In cohort 1, women started taking an SSRI during tamoxifen treatment. In cohort 2, women were already taking an SSRI when they started taking tamoxifen. MAIN OUTCOME MEASURES All cause mortality in each cohort in women taking SSRIs that are potent inhibitors of CYP2D6 (paroxetine, fluoxetine) versus other SSRIs. Propensity scores were used to match exposure groups in a variable ratio fashion. Results were measured separately for each cohort and combined hazard ratios calculated from Cox regression models across the two cohorts with random effects meta-analysis. RESULTS There were 6067 and 8465 new users of tamoxifen in cohorts 1 and 2, respectively. Mean age was 55. A total of 991 and 1014 deaths occurred in cohorts 1 and 2 during a median follow-up of 2.2 (interquartile range 0.9-4.5) and 2.0 (0.8-3.9) years, respectively. The pooled hazard ratio for death for potent inhibitors (rate 58.6/1000 person years) compared with other SSRIs (rate 57.9/1000 person years) across cohorts 1 and 2 was 0.96 (95% confidence interval 0.88 to 1.06). Results were consistent across sensitivity analyses. CONCLUSION Concomitant use of tamoxifen and potent CYP2D6 inhibiting SSRIs versus other SSRIs was not associated with an increased risk of death.
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Affiliation(s)
- Macarius M Donneyong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA 02120
| | - Katsiaryna Bykov
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA 02120 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA 02115
| | - Pauline Bosco-Levy
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA 02120
| | - Yaa-Hui Dong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA 02120
| | - Raisa Levin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA 02120
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA 02120 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA 02115
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