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Stagg AL, Harber-Aschan L, Hatch SL, Fear NT, Dorrington S, Madan I, Stevelink SAM. Risk factors for the progression to multimorbidity among UK urban working-age adults. A community cohort study. PLoS One 2023; 18:e0291295. [PMID: 37682940 PMCID: PMC10490989 DOI: 10.1371/journal.pone.0291295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES The progression of long-term conditions (LTCs) from zero-to-one (initiation), and from one-to-many (progression)are common trajectories that impact a person's quality of life including their ability to work. This study aimed to explore the demographic, socioeconomic, psychosocial, and health-related determinants of LTC initiation and progression, with a focus on work participation. METHODS Data from 622 working-age adults who had completed two waves (baseline and follow-up) of the South-East London Community Health survey were analysed. Chi square tests and multinomial logistic regression were used to describe the associations between self-reported demographic, socioeconomic, psychosocial, and health-related variables, and the progression of LTCs. RESULTS Small social networks, an increased number of stressful life events, low self-rated health, functional impairment, and increased somatic symptom severity were all associated with both the progression from zero-to-one LTC and from one LTC to multimorbidity (two or more LTCs). Renting accommodation (RRR 1.73 [95% CI 1.03-2.90]), smoking (RRR 1.91 [95% CI 1.16-3.14]) and being overweight (RRR 1.88 [95% CL 1.12-3.16]) were unique risk factors of developing initial LTCs, whereas low income (RRR 2.53 [95% CI 1.11-5.80]), working part-time (RRR 2.82 ([95% CL 1.12-7.10]), being unemployed (RRR 4.83 [95% CI 1.69-13.84]), and making an early work exit (RRR 16.86 [95% CI 3.99-71.30]) all increased the risk of progressing from one LTC to multimorbidity compared to being employed full-time. At follow-up, depression was the most prevalent LTC in the unemployed group whereas musculoskeletal conditions were the most prevalent in those working. CONCLUSIONS The journey to multimorbidity is complex, with both common and unique risk factors. Non-full-time employment was associated with an increased risk of progression to multimorbidity. Future research should explore the risk and benefit pathways between employment and progression of LTCs. Interventions to prevent progression of LTCs should include mitigation of modifiable risk factors such as social isolation.
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Affiliation(s)
- Anne L. Stagg
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Department of Occupational Health, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lisa Harber-Aschan
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Nicola T. Fear
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Ira Madan
- Department of Occupational Health, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sharon A. M. Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
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Hinze V, Ford T, Gjelsvik B, Byford S, Cipriani A, Montero-Marin J, Ganguli P. Service use and costs in adolescents with pain and suicidality: a cross-sectional study. EClinicalMedicine 2023; 55:101778. [PMID: 36712889 PMCID: PMC9874333 DOI: 10.1016/j.eclinm.2022.101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Persistent/recurrent pain for more than three months and suicidality (suicide and self-harm related thoughts and behaviours) are serious and co-occurring health problems in adolescence, underscoring the need for targeted support. However, little is known about service use and costs in adolescents with pain-suicidality comorbidity, compared to those with either problem alone. This study aimed to shed light on service use and costs in adolescents with pain and/or suicidality, and the role of individual and school characteristics. Methods We analysed cross-sectional, pre-intervention data from a large cluster randomised controlled trial, collected between 2017 and 2019 on a representative sample of 8072 adolescents (55% female; aged 11-15 years; 76% white) in 84 schools in the UK. We explored service use settings, covering health, social, educational settings, and medication for mental health problems over three months. Data were analysed using descriptive statistics and two-part hurdle models to obtain odds ratios (ORs) and incident rate ratios (IRRs). Findings 9% of adolescents reported comorbidity between pain and suicidality, 11% only suicidality, 13% only pain, and 66% neither pain nor suicidality. Approximately 55% of adolescents used services, especially general practitioner visits, outpatient appointments for injuries and contacts with a school nurse or pharmacist. Compared to adolescents with neither pain nor suicidality: (i) adolescents with pain (OR 3.79, 95% CI 2.63-5.48), suicidality (1.68, 1.12-2.51), and pain-suicidality comorbidity (2.35, 1.26-4.41) were more likely to use services and (ii) if services were used, they were more likely to have higher total costs (Pain: IRR 1.25, 95% CI 1.11-1.42; Suicidality: 1.27, 1.11-1.46; Comorbidity: 1.57, 1.34-1.85). Interpretation In our study, adolescents with pain and suicidality reported increased contact with health, social, and educational services, which could provide an opportunity for suicide prevention. Given the diversity of identified settings, multi-sector suicide prevention strategies are paramount. Funding Wellcome Trust [WT104908/Z/14/Z; WT107496/Z/15/Z]; Stiftung Oskar-Helene-Heim.
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Affiliation(s)
- Verena Hinze
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Hershel Smith Building, Robinson Way, Cambridge Biomedical Campus, Cambridge CB2 0SZ, UK
| | - Bergljot Gjelsvik
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Sarah Byford
- King’s College London, King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Oxford, UK
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Poushali Ganguli
- King’s College London, King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
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Stagg AL, Hatch S, Fear NT, Dorrington S, Madan I, Stevelink SAM. Long-term health conditions in UK working-age adults: a cross-sectional analysis of associations with demographic, socioeconomic, psychosocial and health-related factors in an inner-city population. BMJ Open 2022; 12:e062115. [PMID: 36385039 PMCID: PMC9670944 DOI: 10.1136/bmjopen-2022-062115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To study the overall disease prevalence, and associations between demographic, socioeconomic, psychosocial, and health-related factors, and self-reporting one or more long-term health conditions (LTCs) in a working-age inner-city population. DESIGN Cross-sectional household-based survey with a follow-up timepoint. SETTING South-East London Community Health survey data. PARTICIPANTS 893 adults aged 16-64 years living in Lambeth and Southwark, London. OUTCOME MEASURES Prevalence estimates of individual and multiple LTCs. Multinomial logistic regression was used to analyse the association of demographic, socioeconomic, psychosocial and health-related indicators with having one and multiple LTCs at two timepoints. RESULTS More than one third of participants reported at least one LTC, with the most prevalent being musculoskeletal conditions and asthma. The prevalence of one LTC at both timepoints was 20.6% and 21.4%, and of multimorbidity was 14.0% and 16.4%. At both timepoints, the 35-44 age group showed the largest increase in prevalence of one LTC compared with the preceding age group (16-34). After adjusting for age and gender, small social networks and a larger number of stressful life events were associated with increased risk of having both one and multiple LTCs. The risk of multimorbidity was greater than for initial LTCs for small social networks (3.8 (95% CI: 1.8 to 7.8) compared with 2.0 (95% CI: 1.0 to 3.9)), and three to five stressful life events (3.0 (95% CI: 1.7 to 5.3) compared with 1.5 (95% CI 1.0 to 2.2)). CONCLUSIONS In this study, the prevalence of multimorbidity increased more than the prevalence of one LTC between the two timepoints, indicating a progression of the overall disease prevalence over time. The 35-44 age group showed the greatest increase in the number of initial LTCs which support health-promotion interventions targeting younger age groups. Focusing on increasing social support networks and treating the psychological impact of stressful life events may also be of benefit.
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Affiliation(s)
- Anne L Stagg
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Stephani Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Nicola T Fear
- Academic Department of Military Mental Health, King's College London, London, UK
- King's Centre for Military Health Research, King's College, London, UK
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sharon A M Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research, King's College, London, UK
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Maconick L, Sheridan Rains L, Jones R, Lloyd-Evans B, Johnson S. Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study. BMC Health Serv Res 2021; 21:951. [PMID: 34507575 PMCID: PMC8434730 DOI: 10.1186/s12913-021-06976-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is evidence of geographical variation in the use of mental health services in the UK and in international settings. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, or if there is evidence of variation related to other factors, such as population socioeconomic status and access to primary care services. METHODS This is a cross-sectional ecological study using Public Health England data. The unit of analysis was the population served by clinical commissioning groups (CCGs), National Health Service (NHS) catchment areas. The analysis explored associations between area characteristics and the number of people in contact with mental health services using regression modelling. Explanatory variables included age, gender, prevalence of severe mental illness (SMI), prevalence of common mental disorder (CMD), index of multiple deprivation (IMD), unemployment, proportion of the population who are Black and Minority Ethnic (BAME), population density, access to and recovery in primary care psychological therapies. Unadjusted results are reported, as well as estimates adjusted for age, prevalence of CMD and prevalence of SMI. RESULTS The populations of 194 CCGs were included, clustered within 62 trusts (NHS providers of mental health services). The number of people in contact with mental health services showed wide variation by area (range from 1131 to 5205 per 100,000 population). Unemployment (adjusted IRR 1.11; 95% CI 1.05 to 1.17; p < 0.001) and deprivation (adjusted IRR 1.02 95% CI 1.01 to 1.04; p < 0.001) were associated with more people being in contact with mental health services. Areas with a higher proportion of the population who are BAME (IRR 0.95 95% CI 0.92 to 0.99 p = 0.007) had lower service use per 100,000 population. There was no evidence for association with access to primary care psychological therapies. CONCLUSIONS There is substantial variation in the use of mental health services by area of England. Social factors including deprivation, unemployment and population ethnicity continued to be associated with the outcome after controlling for the prevalence of mental illness. This suggests that there are factors that influence the local population use of mental health services in addition to the prevalence of mental disorder.
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Affiliation(s)
- Lucy Maconick
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom
| | - Luke Sheridan Rains
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom
| | - Rebecca Jones
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom.
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Suesse B, Lago L, Westley-Wise V, Cuenca J, Pai N. Predisposing, enabling and need factors associated with increased use and ongoing increased use of inpatient mental health care: A population-based longitudinal study. Aust N Z J Psychiatry 2021; 55:409-421. [PMID: 33287552 DOI: 10.1177/0004867420976848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study investigated factors associated with frequent (admissions), high (total length of stay) or heavy (frequent and high) hospital use, and with ongoing increased hospital use, for mental health conditions in a regional health district. METHODS A retrospective population-based study using longitudinal hospital, emergency department and community service use data for people admitted with a mental health condition between 1 January 2012 and 31 December 2016. Multivariate logistic regression models assessed the association of predisposing, enabling and need factors with increased, and ongoing increased, hospital use. RESULTS A total of 5,631 people had at least one mental health admission. Frequent admission was associated with not being married (odds ratio = 2.3, 95% confidence interval = [1.5, 3.3]), no private hospital insurance (odds ratio = 2.2, 95% confidence interval = [1.2, 3.8]), previous mental health service use (community, emergency department, lengthy admissions) and a history of a substance use disorder, childhood trauma, self-harm or chronic obstructive pulmonary disease. High and heavy hospital use was associated with marital status, hospital insurance, admission for schizophrenia, previous mental health service use and a history of self-harm. Ongoing frequent use was less likely among those aged 65 and older (odds ratio = 0.2, 95% confidence interval = [0.1, 1.0]) but more likely among those with a history of depression (odds ratio = 2.2, 95% confidence interval = [1.1, 4.4]). Ongoing high use was also associated with admissions for schizophrenia and a history of self-harm. CONCLUSION Interventions targeted at younger people hospitalised with schizophrenia, a history of depression or self-harm, particularly with evidence of social and or health disadvantage, should be considered to improve long-term consumer and health system outcomes. These data can support policymakers to better understand the context and need for improvements in stepped or staged care for people frequently using inpatient mental health care.
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Affiliation(s)
- Bianca Suesse
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia
| | - Victoria Westley-Wise
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute (AHSRI), Faculty of Business and Law, University of Wollongong (UOW), Wollongong, NSW, Australia.,Integrated Care, Mental Health, Planning, Information and Performance Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia
| | - Jose Cuenca
- Research Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia
| | - Nagesh Pai
- Integrated Care, Mental Health, Planning, Information and Performance Directorate, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, NSW, Australia.,Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong (UOW), Wollongong, NSW, Australia
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Kohut SA, Saltzman A. Mindfulness in Pediatrics: Practices to Improve Clinician and Patient Mental Health and Enhance Well-Being. Pediatr Ann 2021; 50:e77-e83. [PMID: 33576833 DOI: 10.3928/19382359-20210117-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Children and adolescents with symptoms of mental health disorders often present to primary care settings. In the context of the coronavirus disease 2019 pandemic, mental health symptoms in children, adolescents, families, and health care clinicians are rising. Mindfulness is an approach to improve both mental and physical health that can be practiced freely in any circumstance. Although not a panacea, research does support the use of mindfulness-based practices not only to improve overall well-being but also to address a variety of symptoms and diagnoses in numerous populations. This review defines mindfulness, describes the current state of the literature, outlines ways to support youth and families in cultivating and applying mindfulness in their daily lives, and provides guidance for health care clinicians on how to begin a personal practice to support their own health and well-being. [Pediatr Ann. 2021;50(2):e77-e83.].
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Xiong F, Wang L, Shen L, Guo W, Li S, Guan Q. The relationship between multimorbidity and suicidal ideation: A meta-analysis. J Psychosom Res 2020; 138:110257. [PMID: 32992210 DOI: 10.1016/j.jpsychores.2020.110257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/06/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Multimorbidity refers to the individual has two or more medical conditions, which include physical multimorbidity (two or more physical conditions), mental multimorbidity (two or more mental conditions) and physical and mental multimorbidity (one or more mental and one or more physical conditions). This study is to assess the relationship between multimorbidity and suicidal ideation (SI) by conducting a meta-analysis. METHODS Through using subject word and random word, Web of Science, Cochrane Library and PubMed were searched for related records up to March 2020. The Newcastle-Ottawa scale and the Agency for Healthcare Research and Quality were used to evaluate the quality of included studies. Subgroup and sensitivity analysis were performed. The publication bias was evaluated by the funnel plots, Begg's test and Egger's test. RESULTS A total of 19 studies were included for analysis. The pooled odd ratio (OR) for the association between multimorbidity and SI was 2.90 (95%CI 2.29-3.67, P < .001). Subgroup analysis based on nature of study, category of multimorbidity, country, whether adjusted the covariates, and quality ratings was performed. The result of sensitivity analysis indicated that no individual studies had a substantial impact on the pooled OR. There was no publication bias in the studies. CONCLUSIONS Multimorbidity is one important factor in increased risk of SI. It is critical to assessing SI among patients with multimorbidity in primary care and specialty medical practices, particularly among physical and mental multimorbidity patients who may have higher risk of SI.
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Affiliation(s)
- Feiyang Xiong
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China; NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
| | - Li Wang
- School of Public Health, Nanjing Medical University, Nanjing 211166, China.
| | - Lianlian Shen
- School of Public Health, Nanjing Medical University, Nanjing 211166, China.
| | - Wenhui Guo
- School of Public Health, Nanjing Medical University, Nanjing 211166, China.
| | - Shixue Li
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China; NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
| | - Qiangdong Guan
- School of Public Health, Nanjing Medical University, Nanjing 211166, China.
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