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Moran P, Chandler A, Dudgeon P, Kirtley OJ, Knipe D, Pirkis J, Sinyor M, Allister R, Ansloos J, Ball MA, Chan LF, Darwin L, Derry KL, Hawton K, Heney V, Hetrick S, Li A, Machado DB, McAllister E, McDaid D, Mehra I, Niederkrotenthaler T, Nock MK, O'Keefe VM, Oquendo MA, Osafo J, Patel V, Pathare S, Peltier S, Roberts T, Robinson J, Shand F, Stirling F, Stoor JPA, Swingler N, Turecki G, Venkatesh S, Waitoki W, Wright M, Yip PSF, Spoelma MJ, Kapur N, O'Connor RC, Christensen H. The Lancet Commission on self-harm. Lancet 2024; 404:1445-1492. [PMID: 39395434 DOI: 10.1016/s0140-6736(24)01121-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 10/14/2024]
Affiliation(s)
- Paul Moran
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
| | - Amy Chandler
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Pat Dudgeon
- Poche Centre for Indigenous Health, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
| | | | - Duleeka Knipe
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane Pirkis
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Jeffrey Ansloos
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Melanie A Ball
- Midlands Partnership University NHS Foundation Trust, Stafford, UK
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Kate L Derry
- Poche Centre for Indigenous Health, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Veronica Heney
- Institute for Medical Humanities, Durham University, Durham, UK
| | - Sarah Hetrick
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Ang Li
- Department of Psychology, Beijing Forestry University, Beijing, China
| | - Daiane B Machado
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil; Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | | | - David McDaid
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Thomas Niederkrotenthaler
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Matthew K Nock
- Department of Psychology, Harvard University, Boston, MA, USA
| | - Victoria M O'Keefe
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Joseph Osafo
- Department of Psychology, University of Ghana, Accra, Ghana
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Soumitra Pathare
- Centre for Mental Health Law & Policy, Indian Law Society, Pune, India
| | - Shanna Peltier
- Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Tessa Roberts
- Unit for Social and Community Psychiatry, Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jo Robinson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Orygen, Melbourne, VIC, Australia
| | - Fiona Shand
- Black Dog Institute, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Stirling
- School of Health and Social Sciences, Abertay University, Dundee, UK
| | - Jon P A Stoor
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Natasha Swingler
- Orygen, Melbourne, VIC, Australia; Royal Children's Hospital, Melbourne, VIC, Australia
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Svetha Venkatesh
- Applied Artificial Intelligence Institute, Deakin University, Geelong, VIC, Australia
| | - Waikaremoana Waitoki
- Faculty of Māori and Indigenous Studies, The University of Waikato, Hamilton, New Zealand
| | - Michael Wright
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Paul S F Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention and Department of Social Work and Social Administration, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Michael J Spoelma
- Black Dog Institute, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Navneet Kapur
- Centre for Mental Health and Safety and National Institute for Health Research Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; Mersey Care NHS Foundation Trust, Prescot, UK
| | - Rory C O'Connor
- Suicidal Behaviour Research Lab, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Christensen
- Black Dog Institute, Sydney, NSW, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Ocloo J, Stuart R, Dasch HK, Dyer J, Choudhury D, McAnuff L, McGowan S, Bakolis I, Das-Munshi J. Living less safely through the pandemic in England for people with serious mental and physical health conditions: qualitative interviews with service users and carers of Black African, Caribbean, and South-Asian descent. BMC Public Health 2024; 24:2718. [PMID: 39369197 PMCID: PMC11452990 DOI: 10.1186/s12889-024-20107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 09/16/2024] [Indexed: 10/07/2024] Open
Abstract
BACKGROUND COVID-19 Ethnic Inequalities in Mental health and Multimorbidities (COVEIMM) is a mixed methods study to explore whether COVID-19 exacerbated ethnic health inequalities in adults with serious mental and physical health conditions. We analysed data from electronic health records for England and conducted interviews in Birmingham and Solihull, Manchester, and South London. Sites were selected because they were pilot sites for the Patient and Carer Race Equality Framework being introduced by NHS England to tackle race inequalities in mental health. Prior to the pandemic people in England with severe mental illnesses (SMIs) faced an 11-17-year reduction in life expectancy, mostly due to preventable, long-term, physical health conditions. During the pandemic there was a marked increase in deaths of those living with an SMI. AIMS This qualitative interview study aimed to understand the reasons underlying ethnic inequalities in mortality and service use during the COVID-19 pandemic for adult service users and carers of Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds living with serious multiple long-term mental and physical health conditions. METHODS We took a participatory action research approach and qualitative interviews undertaken by experts-by-experience and university researchers Participants were purposively sampled by ethnicity, diagnoses, and comorbidities across three geographically distinct sites in England. Transcriptions were coded inductively and deductively and analysed thematically. RESULTS Findings indicated multiple points along primary and secondary health pathways for mental and physical health that have the potential to exacerbate the unjust gap in mortality that exists for Black and Asian people with SMIs. Issues such as timely access to care (face-to-face and remote), being treated in a culturally appropriate manner with empathy, dignity and respect, and being able to use services without experiencing undue force, racism or other forms of intersectional discrimination were important themes arising from interviews. CONCLUSION These poor experiences create systemic and enduring healthcare harms for racialised groups with SMIs that need to be addressed. Our findings suggest a need to address these, not only in mental health providers, but across the whole health and care system and a need to ensure more equitable healthcare partnerships with service users, carers, and communities from racialised backgrounds who are often excluded.
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Affiliation(s)
- Josephine Ocloo
- Centre for Implementation Science, Department of Health Service and Population Research, Institute for Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK.
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
| | - Ruth Stuart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Hannah K Dasch
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK
| | - Jacqui Dyer
- Black Thrive Global, Great Portland Street, London, UK
| | - Dina Choudhury
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Leroy McAnuff
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Stephen McGowan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Department of Health Service and Population Research, Institute for Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC), Hosted By South London and Maudsley NHS Foundation Trust and King's College London, Denmark Hill, London, UK
| | - Jayati Das-Munshi
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC), Hosted By South London and Maudsley NHS Foundation Trust and King's College London, Denmark Hill, London, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
- ESRC Centre for Society and Mental Health, King's College London, Aldwych, London, UK
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O'Connor RC, Kirtley OJ, de Beurs D. Preventing suicide: understanding the complex interplay between individual and societal factors. Lancet Public Health 2024; 9:e714-e715. [PMID: 39265605 DOI: 10.1016/s2468-2667(24)00217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 08/28/2024] [Indexed: 09/14/2024]
Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Lab, School of Health & Wellbeing, University of Glasgow, Glasgow G12 8TA, UK.
| | | | - Derek de Beurs
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
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Visoki E, Moore TM, Zhang X, Tran KT, Ly C, Gataviņš MM, DiDomenico GE, Brogan L, Fein JA, Warrier V, Guloksuz S, Barzilay R. Classification of Suicide Attempt Risk Using Environmental and Lifestyle Factors in 3 Large Youth Cohorts. JAMA Psychiatry 2024; 81:1020-1029. [PMID: 39018056 PMCID: PMC11255979 DOI: 10.1001/jamapsychiatry.2024.1887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/30/2024] [Indexed: 07/18/2024]
Abstract
Importance Suicide is the third-leading cause of death among US adolescents. Environmental and lifestyle factors influence suicidal behavior and can inform risk classification, yet quantifying and incorporating them in risk assessment presents a significant challenge for reproducibility and clinical translation. Objective To quantify the aggregate contribution of environmental and lifestyle factors to youth suicide attempt risk classification. Design, Setting, and Participants This was a cohort study in 3 youth samples: 2 national longitudinal cohorts from the US and the UK and 1 clinical cohort from a tertiary pediatric US hospital. An exposome-wide association study (ExWAS) approach was used to identify risk and protective factors and compute aggregate exposomic scores. Logistic regression models were applied to test associations and model fit of exposomic scores with suicide attempts in independent data. Youth from the Adolescent Brain Cognitive Development (ABCD) study, the UK Millennium Cohort Study (MCS), and the Children's Hospital of Philadelphia emergency department (CHOP-ED) were included in the study. Exposures A single-weighted exposomic score that sums significant risk and protective environmental/lifestyle factors. Main Outcome and Measure Self-reported suicide attempt. Results A total of 40 364 youth were included in this analysis: 11 564 from the ABCD study (3 waves of assessment; mean [SD] age, 12.0 [0.7] years; 6034 male [52.2%]; 344 attempted suicide [3.0%]; 1154 environmental/lifestyle factors were included in the ABCD study), 9000 from the MCS cohort (mean [SD] age, 17.2 [0.3] years; 4593 female [51.0%]; 661 attempted suicide [7.3%]; 2864 environmental/lifestyle factors were included in the MCS cohort), and 19 800 from the CHOP-ED cohort (mean [SD] age, 15.3 [1.5] years; 12 937 female [65.3%]; 2051 attempted suicide [10.4%]; 36 environmental/lifestyle factors were included in the CHOP-ED cohort). In the ABCD discovery subsample, ExWAS identified 99 risk and protective exposures significantly associated with suicide attempt. A single weighted exposomic score that sums significant risk and protective exposures was associated with suicide attempt in an independent ABCD testing subsample (odds ratio [OR], 2.2; 95% CI, 2.0-2.6; P < .001) and explained 17.6% of the variance (based on regression pseudo-R2) in suicide attempt over and above that explained by age, sex, race, and ethnicity (2.8%) and by family history of suicide (6.3%). Findings were consistent in the MCS and CHOP-ED cohorts (explaining 22.6% and 19.3% of the variance in suicide attempt, respectively) despite clinical, demographic, and exposure differences. In all cohorts, compared with youth at the median quintile of the exposomic score, youth at the top fifth quintile were substantially more likely to have made a suicide attempt (OR, 4.3; 95% CI, 2.6-7.2 in the ABCD study; OR, 3.8; 95% CI, 2.7-5.3 in the MCS cohort; OR, 5.8; 95% CI, 4.7-7.1 in the CHOP-ED cohort). Conclusions and Relevance Results suggest that exposomic scores of suicide attempt provided a generalizable method for risk classification that can be applied in diverse samples from clinical or population settings.
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Affiliation(s)
- Elina Visoki
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
- Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, Pennsylvania
| | - Tyler M. Moore
- Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Xinhe Zhang
- Cambridge University, Cambridge, United Kingdom
| | - Kate T. Tran
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
- Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, Pennsylvania
| | - Christina Ly
- Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, Pennsylvania
| | - Mārtiņš M. Gataviņš
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
- Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, Pennsylvania
| | - Grace E. DiDomenico
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
- Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, Pennsylvania
| | - Leah Brogan
- Center for Violence Prevention, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
| | - Joel A. Fein
- Center for Violence Prevention, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Ran Barzilay
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
- Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Van der Burgt MCA, Mérelle S, Brinkman WP, Beekman ATF, Gilissen R. Breaking Down Barriers to a Suicide Prevention Helpline: Web-Based Randomized Controlled Trial. JMIR Ment Health 2024; 11:e56396. [PMID: 39235321 PMCID: PMC11391658 DOI: 10.2196/56396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/11/2024] [Accepted: 05/28/2024] [Indexed: 09/06/2024] Open
Abstract
Background Every month, around 3800 people complete an anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. Although 70% score high on the severity of suicidal thoughts, <10% navigate to the web page about contacting the helpline. Objective This study aimed to test the effectiveness of a brief barrier reduction intervention (BRI) in motivating people with severe suicidal thoughts to contact the suicide prevention helpline, specifically in high-risk groups such as men and middle-aged people. Methods We conducted a fully automated, web-based, randomized controlled trial. Respondents with severe suicidal thoughts and little motivation to contact the helpline were randomly allocated either to a brief BRI, in which they received a short, tailored message based on their self-reported barrier to the helpline (n=610), or a general advisory text (care as usual as the control group: n=612). Effectiveness was evaluated using both behavioral and attitudinal measurements. The primary outcome measure was the use of a direct link to contact the helpline after completing the intervention or control condition. Secondary outcomes were the self-reported likelihood of contacting the helpline and satisfaction with the received self-test. Results In total, 2124 website visitors completed the Suicidal Ideation Attributes Scale and the demographic questions in the entry screening questionnaire. Among them, 1222 were randomized into the intervention or control group. Eventually, 772 respondents completed the randomized controlled trial (intervention group: n=369; control group: n=403). The most selected barrier in both groups was "I don't think that my problems are serious enough." At the end of the trial, 33.1% (n=122) of the respondents in the intervention group used the direct link to the helpline. This was not significantly different from the respondents in the control group (144/403, 35.7%; odds ratio 0.87, 95% CI 0.64-1.18, P=.38). However, the respondents who received the BRI did score higher on their self-reported likelihood of contacting the helpline at a later point in time (B=0.22, 95% CI 0.12-0.32, P≤.001) and on satisfaction with the self-test (B=0.27, 95% CI 0.01-0.53, P=.04). For male and middle-aged respondents specifically, the results were comparable to that of the whole group. Conclusions This trial was the first time the helpline was able to connect with high-risk website visitors who were hesitant to contact the helpline. Although the BRI could not ensure that those respondents immediately used the direct link to the helpline at the end of the trial, it is encouraging that respondents indicated that they were more likely to contact the helpline at a later point in time. In addition, this low-cost intervention provided greater insight into the perceived barriers to service. Follow-up research should be focused on identifying the added value of other components (eg, video or photo material) in the BRI and increasing its effectiveness, especially for men and middle-aged people.
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Affiliation(s)
- Margot C A Van der Burgt
- Department of Research, 113 Suicide Prevention, Paasheuvelweg 25, Amsterdam, 1105 BP, The Netherlands, 31 203113883
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Saskia Mérelle
- Department of Research, 113 Suicide Prevention, Paasheuvelweg 25, Amsterdam, 1105 BP, The Netherlands, 31 203113883
| | - Willem-Paul Brinkman
- Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Renske Gilissen
- Department of Research, 113 Suicide Prevention, Paasheuvelweg 25, Amsterdam, 1105 BP, The Netherlands, 31 203113883
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Greydanus DE, Nazeer A, Qayyum Z, Patel DR, Rausch R, Hoang LN, Miller C, Chahin S, Apple RW, Saha G, Prasad Rao G, Javed A. Pediatric suicide: Review of a preventable tragedy. Dis Mon 2024; 70:101725. [PMID: 38480023 DOI: 10.1016/j.disamonth.2024.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ahsan Nazeer
- Division of Child and Adolescent Psychiatry, Sidra Medicine/Weill Cornell Medicine, Doha, Qatar
| | - Zheala Qayyum
- Harvard Medical School, Boston, Massachusetts, United States
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Rebecca Rausch
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Western Michigan University, Kalamazoo, MI, United States
| | - Caroline Miller
- Fielding Graduate University, Santa Barbara, CA, United States
| | - Summer Chahin
- Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
| | - Roger W Apple
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Gautam Saha
- Immediate Past President of the SAARC (South Asian Association for Regional Cooperation) Psychiatric Federation (SPF), India
| | - G Prasad Rao
- President, Asian Federation of Psychiatric Association (AFPA), India
| | - Afzal Javed
- Chairman Pakistan Psychiatric Research Centre, Immediate Past President of the World Psychiatric Association (WPA), Pakistan
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7
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Werdin S, Wyss K. Challenges in the evaluation of suicide prevention measures and quality of suicide data in Germany, Austria, and Switzerland: findings from qualitative expert interviews. BMC Public Health 2024; 24:2209. [PMID: 39138493 PMCID: PMC11323587 DOI: 10.1186/s12889-024-19726-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Suicide prevention requires diverse, integrated, and evidence-based measures. Comprehensive evaluation of interventions and reliable suicide data are crucial for guiding policy-making and advancing suicide prevention efforts. This study aimed to analyze current issues and gaps in the evaluation of suicide prevention measures and the quality of suicide data in Germany, Austria, and Switzerland to derive specific recommendations for improvement. METHODS Online, semi-structured interviews were conducted with 36 experts in suicide prevention from Germany, Austria, and Switzerland, covering insights from policy, science, and practice. The interviews took place between September 2022 and February 2023, were audio-recorded, transcribed verbatim, and analyzed using the Framework method. RESULTS While solid evidence supports the effectiveness of some suicide prevention interventions, experts indicated that the evaluation of many other measures is weak. Conducting effectiveness studies in suicide prevention presents a range of methodological and practical challenges, including recruitment difficulties, choosing adequate outcome criteria, ethical considerations, and trade-offs in allocating resources to evaluation efforts. Many interviewees rated the quality of national suicide statistics in Germany, Austria, and Switzerland as comparatively high. However, they noted limitations in the scope, timeliness, and reliability of these data, prompting some regions to implement their own suicide monitoring systems. None of the three countries has national routine data on suicide attempts. CONCLUSION While some challenges in evaluating suicide prevention measures are inevitable, others can potentially be mitigated. Evaluations could be enhanced by combining traditional and innovative research designs, including intermediate outcomes and factors concerning the implementation process, and employing participatory and transdisciplinary research to engage different stakeholders. Reliable suicide data are essential for identifying trends, supporting research, and designing targeted prevention measures. To improve the quality of suicide data, a standardized monitoring approach, including uniform definitions, trained professionals, and cross-sector agreement on leadership and financing, should be pursued. This study provides actionable recommendations and highlights existing good practice approaches, thereby supporting decision-makers and providing guidance for advancing suicide prevention on a broader scale.
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Affiliation(s)
- Sophia Werdin
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Öberg NP, Lindström SP, Bergqvist E, Ehnvall A, Sellin T, Stefenson A, Sunnqvist C, Waern M, Westrin Å. Last general practitioner consultation during the final month of life: a national medical record review of suicides in Sweden. BMC PRIMARY CARE 2024; 25:256. [PMID: 39010009 PMCID: PMC11247819 DOI: 10.1186/s12875-024-02498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/26/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES Individuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide. DESIGN A nationwide retrospective explorative study investigating medical records. SETTING Primary care in Sweden. PARTICIPANTS Individuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death. RESULTS The study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020). CONCLUSION A high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs' management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms. STRENGTHS AND LIMITATIONS OF THIS STUDY The National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs' documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group.
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Affiliation(s)
- Nina Palmqvist Öberg
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden.
- Office of Psychiatry and Habilitation, Region Skåne, Lund, SE-221 85, Sweden.
| | - Sara Probert Lindström
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, Lund, SE-221 85, Sweden
| | - Erik Bergqvist
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden
- Psychiatric In-patient Clinic, Hallands Sjukhus Varberg, Region Halland, Varberg, SE-432 81, Sweden
| | - Anna Ehnvall
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Psychiatric Out-patient Clinic, Region Halland, Varberg, SE-432 43, Sweden
| | - Tabita Sellin
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, SE-701 82, Sweden
| | - Anne Stefenson
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, SE-17177, Sweden
| | - Charlotta Sunnqvist
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden
- The Region Skåne Committee on Psychiatriy, Habilitation and Technical Aids, Lund, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, SE-413 45, Sweden
- Psychosis Clinic, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, 41345, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, SE-221 84, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, Lund, SE-221 85, Sweden
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de Beurs D, Giltay EJ, Nuij C, O'Connor R, de Winter RFP, Kerkhof A, van Ballegooijen W, Riper H. Symptoms of a feather flock together? An exploratory secondary dynamic time warp analysis of 11 single case time series of suicidal ideation and related symptoms. Behav Res Ther 2024; 178:104572. [PMID: 38833835 DOI: 10.1016/j.brat.2024.104572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/09/2024] [Accepted: 05/17/2024] [Indexed: 06/06/2024]
Abstract
Suicidal ideation fluctuates over time, as does its related risk factors. Little is known about the difference or similarities of the temporal patterns. The current exploratory secondary analysis examines which risk symptoms have similar time dynamics using a mathematical algorithm called dynamic time warping (DTW). Ecological momentary assessment data was used of 11 depressed psychiatric outpatients with suicidal ideation who answered three daytime surveys at semi-random sampling points for a period of three to six months. Patients with 45 assessments or more were included. Results revealed significant inter-individual variability in symptom dynamics and clustering, with certain symptoms often clustering due to similar temporal patterns, notably feeling sad, hopelessness, feeling stuck, and worrying. The directed network analyses shed light on the temporal order, highlighting entrapment and worrying as symptoms strongly related to suicide ideation. Still, all patients also showed unique directed networks. While for some patients changes in entrapment directly preceded change in suicide ideation, the reverse temporal ordering was also found. Relatedly, within some patients, perceived burdensomeness played a pivotal role, whereas in others it was unconnected to other symptoms. The study underscores the individualized nature of symptom dynamics and challenges linear models of progression, advocating for personalized treatment strategies.
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Affiliation(s)
- Derek de Beurs
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands.
| | - Chani Nuij
- Faculty of Behavioral and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Rory O'Connor
- Suicidal Behavior Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Remco F P de Winter
- Mental Health Institution GGZ Rivierduinen, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Ad Kerkhof
- Faculty of Behavioral and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Faculty of Behavioral and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Heleen Riper
- Faculty of Behavioral and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
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10
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Cogley C, Bramham J, Bramham K, Judge RC, Lynch J, MacHale S, Holian J, Smith A, Carswell C, Conlon P, D'Alton P. Improving kidney care for people with severe mental health difficulties: A thematic analysis of personal and family members' perspectives. J Health Psychol 2024:13591053241254715. [PMID: 38898612 DOI: 10.1177/13591053241254715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
People with severe mental health difficulties (SMHDs) often have poorer access to kidney healthcare. To better understand the barriers and facilitators to kidney healthcare for this population, we conducted interviews with nine individuals with SMHDs and four family members. Through reflexive thematic analysis, we generated three themes: (1) 'One size doesn't fit all' describes the need for individualised kidney healthcare, adapted to meet the specific needs of each person with a SMHD. (2) 'You just can't say, "I'm only dealing with your kidney here"' describes how fragmentation of physical and mental healthcare services can lead to poorer outcomes for people with SMHDs, underscoring the need for coordinated care. (3) 'Just treat me with respect' describes the impact of healthcare provider attitudes. Overall, participants praised the dedication and kindness of renal clinicians. However, some participants also described experiences of stigma and discrimination, and called for additional education for healthcare providers regarding SMHDs.
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11
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Sheldon E, Ezaydi N, Desoysa L, Young J, Simmonds-Buckley M, Hind PD, Burton PC. Barriers to help-seeking, accessing and providing mental health support for medical students: a mixed methods study using the candidacy framework. BMC Health Serv Res 2024; 24:738. [PMID: 38877493 PMCID: PMC11179297 DOI: 10.1186/s12913-024-11204-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 06/13/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The mental health of medical students is a national and international problem increasing in both demand and acuity. Medical students face barriers to accessing mental health support that is clinically effective, timely and appropriate for their needs. This mixed methods study aimed to explore experiences of these barriers and the challenges to health service delivery aligned to the Candidacy Framework. METHODS One hundred three medical students studying at The University of Sheffield completed an online survey comprising the CCAPS-34 and follow-up questions about service access and use. Semi-structured interviews with a nested sample of 20 medical students and 10 healthcare professionals explored barriers to service access and provision. A stakeholder panel of medical students and professionals met quarterly to co-produce research materials, interpret research data and identify touchpoints by pinpointing specific areas and moments of interaction between a medical student as a service user and a mental health service. RESULTS Medical students who experienced barriers to help-seeking and accessing support scored significantly higher for psychological symptoms on the CCAPS-34. Uncertainty and fear of fitness to practice processes were important barriers present across all seven stages of candidacy. The fragmented structure of local services, along with individual factors such as perceived stigma and confidentiality concerns, limited the progression of medical students through the Candidacy Framework (a framework for understanding the different stages of a person's journey to healthcare). CONCLUSION This study outlines important areas of consideration for mental health service provision and policy development to improve access to and the quality of care for medical students.
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Affiliation(s)
- Elena Sheldon
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
- Clinical Trials Research Unit, Sheffield Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Naseeb Ezaydi
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Lauren Desoysa
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Jasmine Young
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | | | - Prof Daniel Hind
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Prof Chris Burton
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
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12
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Mortier P, Conde S, Alayo I, Amigo F, Ballester L, Cirici Amell R, Guinart D, Contaldo SF, Ferrer M, Leis A, Mayer MA, Portillo-Van Diest A, Puértolas-Gracia B, Ramírez-Anguita JM, Peña-Salazar C, Sanz F, Kessler RC, Palao D, Pérez Sola V, Mehlum L, Qin P, Vilagut G, Alonso J. Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge. JAMA Netw Open 2024; 7:e2417131. [PMID: 38922620 PMCID: PMC11208976 DOI: 10.1001/jamanetworkopen.2024.17131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/13/2024] [Indexed: 06/27/2024] Open
Abstract
Importance There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. Objective To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. Design, Setting, and Participants This retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. Exposures Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Main Outcomes and Measures Postdischarge premature death (ie, all-cause death before age 70 years) and suicide (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. Results A total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males). Conclusions and Relevance In this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.
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Affiliation(s)
- Philippe Mortier
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Susana Conde
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Itxaso Alayo
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Biosistemak Institute for Health Systems Research, Barakaldo, Bizkaia, Spain
| | - Franco Amigo
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Laura Ballester
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Roser Cirici Amell
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Daniel Guinart
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
- Mental Health Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Psychiatry, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | | | - Montserrat Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Angela Leis
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel Angel Mayer
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana Portillo-Van Diest
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Beatriz Puértolas-Gracia
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlos Peña-Salazar
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Mental Health and Intellectual Disability Services, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Neurology Department, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Ferran Sanz
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Instituto Nacional de Bioinformatica–ELIXIR-ES (IMPaCT-Data-ISCIII), Barcelona, Spain
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Diego Palao
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
- Department of Mental Health, Hospital Universitari Parc Taulí; Institut d’Investigació i Innovació Parc Taulí (I3PT), Unitat de Neurociències Traslacional I3PT-INc Universitat Autònoma de Barcelona, Sabadell, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Víctor Pérez Sola
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gemma Vilagut
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Jordi Alonso
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
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13
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Yu H, Zhang Y, Hu M, Xiang B, Wang S, Wang Q. Inter- and intrapopulation differences in the association between physical multimorbidity and depressive symptoms. J Affect Disord 2024; 354:434-442. [PMID: 38508455 DOI: 10.1016/j.jad.2024.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The association between physical multimorbidity and depression differs by populations. However, no direct inter- or intrapopulation comparison of the association has been conducted. Thus, this study aims to estimate the association in China and the United States and reveal inter- and intrapopulation differences in the association. METHODS Middle-aged and older adults from the China Health and Retirement Longitudinal Study and the Health and Retirement Study were included. Physical multimorbidity was defined as the simultaneous presence of two or more chronic physical conditions and depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale. Generalized estimating equation model and stratification multilevel method were the main statistical models. RESULTS The presence of physical multimorbidity was associated with a higher risk of depression in both China (RR = 1.360 [95 % CI: 1.325-1.395]) and the US (RR = 1.613 [95 % CI: 1.529-1.701]). For individuals at a low risk of multimorbidity, multimorbidity was associated with 47.4 % (95 % CI: 1.377-1.579) and 71.1 % (95 % CI: 1.412-2.074) increases in the likelihood of depression in China and the US. The effect size was smaller for individuals at a moderate or high risk. However, the cross-national differences were greater for those with a high risk of multimorbidity. LIMITATIONS The self-report measures, attribution bias. CONCLUSIONS Compared to Chinese adults, the presence of physical multimorbidity led to an additional increase in depressive symptoms for American counterparts. The association was stronger for individuals at a low risk of multimorbidity, but cross-national differences were observed mostly among individuals at a high risk.
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Affiliation(s)
- Haiyang Yu
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Yike Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Mengxiao Hu
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Bowen Xiang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Sijia Wang
- National Institute of Health Data Science of China, Shandong University, Jinan, China; Institute for Global Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Qing Wang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China; Yellow River National Strategic Research Institute, Shandong University, Jinan, Shandong, China.
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14
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Smith KA, Hardy A, Vinnikova A, Blease C, Milligan L, Hidalgo-Mazzei D, Lambe S, Marzano L, Uhlhaas PJ, Ostinelli EG, Anmella G, Zangani C, Aronica R, Dwyer B, Torous J, Cipriani A. Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions. JMIR Ment Health 2024; 11:e57155. [PMID: 38717799 PMCID: PMC11112473 DOI: 10.2196/57155] [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] [Received: 02/07/2024] [Revised: 03/08/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). OBJECTIVE An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI. METHODS The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group. RESULTS Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI. CONCLUSIONS The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation.
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Affiliation(s)
- Katharine A Smith
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Charlotte Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Lea Milligan
- MQ Mental Health Research, London, United Kingdom
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Sinéad Lambe
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Lisa Marzano
- School of Science and Technology, Middlesex University, London, United Kingdom
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Edoardo G Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Caroline Zangani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Rosario Aronica
- Psychiatry Unit, Department of Neurosciences and Mental Health, Ospedale Maggiore Policlinico Ca' Granda, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Bridget Dwyer
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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15
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Serrano-Gimeno V, Diestre A, Agustin-Alcain M, Portella MJ, de Diego-Adeliño J, Tiana T, Cheddi N, Distefano A, Dominguez G, Arias M, Cardoner V, Puigdemont D, Perez V, Cardoner N. Non-fatal suicide behaviours across phases in the COVID-19 pandemic: a population-based study in a Catalan cohort. Lancet Psychiatry 2024; 11:348-358. [PMID: 38631785 DOI: 10.1016/s2215-0366(24)00065-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The COVID-19 pandemic has been extensively discussed in the context of its effect on mental health. Although global suicide rates have remained stable during the pandemic, the specific effect on non-fatal suicide behaviours during and after the pandemic remains underexplored. This study aims to investigate patterns of non-fatal suicide behaviours before, during, and after the pandemic. METHODS In this cohort study, we used data from all hospitals in Catalonia, Spain, collected through the Catalan Suicide Risk Code, which is a specifically designed suicide attempt surveillance protocol, involving a face-to-face, in-depth psychiatric evaluation, after a Catalan resident presents any suicide risk behaviour in any public health-care setting. This evaluation centralises data from suicide registries across the territory. We included non-fatal suicide behaviours, meaning suicidal ideation or attempts that did not result in death, and excluded self-harm behaviours not judged to be linked with suicidal ideation. We considered three periods: the pre-confinement period (Jan 1, 2018, to the enforcement of the lockdown in Spain on March 14, 2020); the confinement period (March 14, 2020, to the end of lockdown on June 21, 2020); and the post-confinement period (June 21, 2020, to Dec 31, 2022). We used Bayesian structural time series models to assess the effect of pandemic phases on non-fatal suicide behaviours, and we ran stratified analyses by sex and age to identify distinct patterns among demographic cohorts. FINDINGS We obtained 26 482 records from Jan 1, 2018, to Dec 31, 2022. The mean age was 37·94 years (SD 18·07), and the sample included 17 584 (66·4%) women and 8898 (33·6%) men. Data on ethnicity were not collected. Temporal trends showed a mild increase in non-fatal suicide behaviours from Jan 1, 2018, to March 13, 2020; a reduction during the confinement period; and a subsequent rise after confinement. Bayesian models suggested a significant causal effect of lockdown easing, resulting in a 50·77% increase in non-fatal suicide behaviours (95% credible interval [CrI] 26·62-76·58; p<0·0001). Stratified analyses indicated that the easing of lockdown resulted in a significant increase in non-fatal suicide behaviours among women (25·92%; 6·71-44·72; p=0·011) and among individuals aged 18 years and younger (72·75%; 38·81-108·11; p<0·0001). INTERPRETATION This study provides a comprehensive examination of non-fatal suicide behaviours in Catalonia, Spain, emphasising the dynamics of different COVID-19 pandemic phases. The initial reduction during strict lockdown aligns with Joiner's Interpersonal Theory of Suicide, whereas the post-confinement rise reflects complex factors, including social isolation and economic challenges. Sex-specific and age-specific analyses underscore distinct vulnerabilities, emphasising the need for targeted preventive strategies. FUNDING Centro de Investigación Biomédica en Red de Salud Mental annual budget of G21, Agència de Gestió d'Ajuts Universitaris i de Recerca of the Generalitat de Catalunya. TRANSLATIONS For the Catalan and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Víctor Serrano-Gimeno
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Diestre
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Maria J Portella
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Javier de Diego-Adeliño
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thaïs Tiana
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Nora Cheddi
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alejandro Distefano
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Guillermo Dominguez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Dolors Puigdemont
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor Perez
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Narcís Cardoner
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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16
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Stas P, Hoorelbeke K, De Jaegere E, Pauwels K, Portzky G. Suicide risk, related factors and the impact of COVID-19 amongst suicide prevention helpline callers: A network analysis. J Affect Disord 2024; 351:372-380. [PMID: 38302063 DOI: 10.1016/j.jad.2024.01.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The COVID-19 pandemic brought along many known risk factors for suicide. It is important to map out contributing and protective factors for suicide risk and examine possible changes in these associations during pandemics such as COVID-19. The current study aimed to examine how information on risk and protective factors obtained through a suicide prevention helpline is linked to the assessed suicide risk and the possible impact of the COVID-19 pandemic. METHODS Data on 9474 calls registered by operators of the suicide prevention helpline of Flanders (i.e., part of Belgium) were analysed using network analysis. Using network analyses allowed for a data-driven examination of direct and indirect pathways through which risk and protective factors are associated to perceived suicide risk. The network before and during COVID-19 were compared to examine the possible impact of the pandemic. RESULTS Our findings suggest that different vulnerability and protective factors contribute to perceived suicide risk. Experiencing a break-up, abuse, previous attempt(s), experienced difficulties with the healthcare system and availability of resources were directly and uniquely associated with perceived suicide risk before and during COVID-19. LIMITATIONS Main limitations of this study are the possible bias of operator assessment accuracy, absence of several important psychological risk factors and the use of cross-sectional data. CONCLUSIONS The current study provides insight in the effect of COVID-19 on suicidality and its risk and protective factors amongst suicide prevention helpline users, a population with high risk of suicide. Implications for suicide prevention helplines are discussed.
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Affiliation(s)
- Pauline Stas
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium.
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eva De Jaegere
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Kirsten Pauwels
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium; Suicide Prevention Centre, Brussels, Belgium
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
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17
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Wienand D, Wijnen LI, Heilig D, Wippel C, Arango C, Knudsen GM, Goodwin GM, Simon J. Comorbid physical health burden of serious mental health disorders in 32 European countries. BMJ MENTAL HEALTH 2024; 27:e301021. [PMID: 38580438 PMCID: PMC11021748 DOI: 10.1136/bmjment-2024-301021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Mental health disorders (MHDs) are associated with physical health disparities, but underlying excess risk and health burden have not yet been comprehensively assessed. OBJECTIVE To assess the burden of comorbid physical health conditions (PHCs) across serious MHDs in Europe. METHODS We estimated the relative prevalence risk of PHCs associated with alcohol use disorders (AUD), bipolar disorder (BD), depressive disorders (DD) and schizophrenia (SZ) across working-age populations of 32 European countries in 2019 based on a targeted literature review. Excess physical health burden was modelled using population-attributable fractions and country-level prevalence data. FINDINGS We screened 10 960 studies, of which 41 were deemed eligible, with a total sample size of over 18 million persons. Relative prevalence of PHCs was reported in 54%, 20%, 15%, 5% and 7% of studies, respectively, for SZ, DD, BD, AUD or mixed. Significant relative risk estimates ranged from 1.44 to 3.66 for BD, from 1.43 to 2.21 for DD, from 0.81 to 1.97 for SZ and 3.31 for AUD. Excess physical health burden ranged between 27% and 67% of the total, corresponding to 84 million (AUD), 67 million (BD), 66 million (DD) and 5 million (SZ) PHC diagnoses in Europe. A 1% reduction in excess risk assuming causal inference could result in two million fewer PHCs across investigated MHDs. CONCLUSIONS This is the first comprehensive study of the physical health burden of serious MHDs in Europe. The methods allow for updates, refinement and extension to other MHDs or geographical areas. CLINICAL IMPLICATIONS The results indicate potential population health benefits achievable through more integrated mental and physical healthcare and prevention approaches.
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Affiliation(s)
- Dennis Wienand
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Lena I Wijnen
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Daniel Heilig
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Christoph Wippel
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Department of Psychiatry, University of Oxford, Oxford, UK
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18
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Mortier P, Amigo F, Bhargav M, Conde S, Ferrer M, Flygare O, Kizilaslan B, Latorre Moreno L, Leis A, Mayer MA, Pérez-Sola V, Portillo-Van Diest A, Ramírez-Anguita JM, Sanz F, Vilagut G, Alonso J, Mehlum L, Arensman E, Bjureberg J, Pastor M, Qin P. Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project. BMC Psychiatry 2024; 24:220. [PMID: 38509500 PMCID: PMC10956300 DOI: 10.1186/s12888-024-05659-6] [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] [Received: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Self-harm presents a significant public health challenge. Emergency departments (EDs) are crucial healthcare settings in managing self-harm, but clinician uncertainty in risk assessment may contribute to ineffective care. Clinical Decision Support Systems (CDSSs) show promise in enhancing care processes, but their effective implementation in self-harm management remains unexplored. METHODS PERMANENS comprises a combination of methodologies and study designs aimed at developing a CDSS prototype that assists clinicians in the personalized assessment and management of ED patients presenting with self-harm. Ensemble prediction models will be constructed by applying machine learning techniques on electronic registry data from four sites, i.e., Catalonia (Spain), Ireland, Norway, and Sweden. These models will predict key adverse outcomes including self-harm repetition, suicide, premature death, and lack of post-discharge care. Available registry data include routinely collected electronic health record data, mortality data, and administrative data, and will be harmonized using the OMOP Common Data Model, ensuring consistency in terminologies, vocabularies and coding schemes. A clinical knowledge base of effective suicide prevention interventions will be developed rooted in a systematic review of clinical practice guidelines, including quality assessment of guidelines using the AGREE II tool. The CDSS software prototype will include a backend that integrates the prediction models and the clinical knowledge base to enable accurate patient risk stratification and subsequent intervention allocation. The CDSS frontend will enable personalized risk assessment and will provide tailored treatment plans, following a tiered evidence-based approach. Implementation research will ensure the CDSS' practical functionality and feasibility, and will include periodic meetings with user-advisory groups, mixed-methods research to identify currently unmet needs in self-harm risk assessment, and small-scale usability testing of the CDSS prototype software. DISCUSSION Through the development of the proposed CDSS software prototype, PERMANENS aims to standardize care, enhance clinician confidence, improve patient satisfaction, and increase treatment compliance. The routine integration of CDSS for self-harm risk assessment within healthcare systems holds significant potential in effectively reducing suicide mortality rates by facilitating personalized and timely delivery of effective interventions on a large scale for individuals at risk of suicide.
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Grants
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- ESF+; CP21/00078 ISCIII-FSE Miguel Servet co-funded by the European Social Fund Plus
- PI22/00107 ISCIII and co-funded by the European Union
- PI22/00107 ISCIII and co-funded by the European Union
- PI22/00107 ISCIII and co-funded by the European Union
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- FI23/00004 PFIS ISCIII
- FI23/00004 PFIS ISCIII
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- ERAPERMED2022 the Health Research Board Ireland
- ERAPERMED2022 the Health Research Board Ireland
- no. 2022-00549 the Swedish Innovation Agency
- no. 2022-00549 the Swedish Innovation Agency
- project no. 342386 the Research Council of Norway
- project no. 342386 the Research Council of Norway
- project no. 342386 the Research Council of Norway
- the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- CIBER of Epidemiology & Public Health
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Affiliation(s)
- Philippe Mortier
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain.
| | - Franco Amigo
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Madhav Bhargav
- School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Susana Conde
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Montse Ferrer
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Busenur Kizilaslan
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura Latorre Moreno
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Angela Leis
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel Angel Mayer
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Víctor Pérez-Sola
- Neuropsychiatry and Drug Addiction Institute, Barcelona MAR Health Park Consortium PSMAR, Barcelona, Spain
- CIBER of Mental Health and Carlos III Health Institute (CIBERSAM, ISCIII), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ana Portillo-Van Diest
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- National Bioinformatics Institute - ELIXIR-ES (IMPaCT-Data-ISCIII), Barcelona, Spain
| | - Gemma Vilagut
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Jordi Alonso
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ella Arensman
- School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Manuel Pastor
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Solmi M, Croatto G, Fornaro M, Schneider LK, Rohani-Montez SC, Fairley L, Smith N, Bitter I, Gorwood P, Taipale H, Tiihonen J, Cortese S, Dragioti E, Rietz ED, Nielsen RE, Firth J, Fusar-Poli P, Hartman C, Holt RIG, Høye A, Koyanagi A, Larsson H, Lehto K, Lindgren P, Manchia M, Nordentoft M, Skonieczna-Żydecka K, Stubbs B, Vancampfort D, Boyer L, De Prisco M, Vieta E, Correll CU. Regional differences in mortality risk and in attenuating or aggravating factors in schizophrenia: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2024; 80:55-69. [PMID: 38368796 DOI: 10.1016/j.euroneuro.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 02/20/2024]
Abstract
People with schizophrenia die prematurely, yet regional differences are unclear. PRISMA 2020-compliant systematic review/random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) versus any control group, and moderators, in people with ICD/DSM-defined schizophrenia, comparing countries and continents. We conducted subgroup, meta-regression analyses, and quality assessment. The primary outcome was all-cause mortality. Secondary outcomes were suicide-, /natural-cause- and other-cause-related mortality. We included 135 studies from Europe (n = 70), North-America (n = 29), Asia (n = 33), Oceania (n = 2), Africa (n = 1). In incident plus prevalent schizophrenia, differences across continents emerged for all-cause mortality (highest in Africa, RR=5.98, 95 %C.I.=4.09-8.74, k = 1, lowest in North-America, RR=2.14, 95 %C.I.=1.92-2.38, k = 16), suicide (highest in Oceania, RR=13.5, 95 %C.I.=10.08-18.07, k = 1, lowest in North-America, RR=4.4, 95 %C.I.=4.07-4.76, k = 6), but not for natural-cause mortality. Europe had the largest association between antipsychotics and lower all-cause mortality/suicide (Asia had the smallest or no significant association, respectively), without differences for natural-cause mortality. Higher country socio-demographic index significantly moderated larger suicide-related and smaller natural-cause-related mortality risk in incident schizophrenia, with reversed associations in prevalent schizophrenia. Antipsychotics had a larger/smaller protective association in incident/prevalent schizophrenia regarding all-cause mortality, and smaller protective association for suicide-related mortality in prevalent schizophrenia. Additional regional differences emerged in incident schizophrenia, across countries, and secondary outcomes. Significant regional differences emerged for all-cause, cause-specific and suicide-related mortality. Natural-cause death was homogeneously increased globally. Moderators differed across countries. Global initiatives are needed to improve physical health in people with schizophrenia, local studies to identify actionable moderators.
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Affiliation(s)
- Marco Solmi
- SCIENCES lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
| | - Giovanni Croatto
- Mental Health Department, AULSS 3 Serenissima, Mestre, Venice, Italy
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Dentistry, Federico II University of Naples, Naples, Italy
| | | | | | | | | | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Philip Gorwood
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France; GHU Paris Psychiatrie et Neurosciences (CMME, Sainte-Anne Hospital), Université de Paris, Paris, France
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA; DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari Aldo Moro, Bari, Italy
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece; Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rene Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Italy; Outreach and Support in South-London (OASIS) service, South London and Maudlsey (SLaM) NHS Foundation Trust, UK; Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University (LMU), Munich, Germany
| | - Catharina Hartman
- University of Groningen, University Medical Center Groningen, Interdisciplinary Centre Psychopathology and Emotion regulation
| | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anne Høye
- Department of Clinical Medicine, UiT The Arctic University of Norway and Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; The Swedish Institute for Health Economics, Lund, Sweden
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Department of Clinical Medicine, Copenhagen University Hospital, Denmark
| | | | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Centre KU Leuven, Kortenberg, Leuven, Belgium
| | - Laurent Boyer
- AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France; FondaMental Foundation, Creteil, France
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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20
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Vancampfort D, Mugisha J, Van Damme T. People with mental health problems attending primary care settings report less suicidal ideation following physical activity counselling: Findings from a low income country. J Affect Disord 2024; 347:66-68. [PMID: 37992769 DOI: 10.1016/j.jad.2023.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; University Psychiatric Centre KU Leuven, Leuven-Kortenberg, Belgium.
| | - James Mugisha
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda
| | - Tine Van Damme
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; University Psychiatric Centre KU Leuven, Leuven-Kortenberg, Belgium
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21
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Mesa-Vieira C, Didden C, Schomaker M, Mouton JP, Folb N, van den Heuvel LL, Gastaldon C, Cornell M, Tlali M, Kassanjee R, Franco OH, Seedat S, Haas AD. Post-traumatic stress disorder as a risk factor for major adverse cardiovascular events: a cohort study of a South African medical insurance scheme. Epidemiol Psychiatr Sci 2024; 33:e5. [PMID: 38314538 PMCID: PMC10894700 DOI: 10.1017/s2045796024000052] [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] [Received: 07/24/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
AIMS Prior research, largely focused on US male veterans, indicates an increased risk of cardiovascular disease among individuals with post-traumatic stress disorder (PTSD). Data from other settings and populations are scarce. The objective of this study is to examine PTSD as a risk factor for incident major adverse cardiovascular events (MACEs) in South Africa. METHODS We analysed reimbursement claims (2011-2020) of a cohort of South African medical insurance scheme beneficiaries aged 18 years or older. We calculated adjusted hazard ratios (aHRs) for associations between PTSD and MACEs using Cox proportional hazard models and calculated the effect of PTSD on MACEs using longitudinal targeted maximum likelihood estimation. RESULTS We followed 1,009,113 beneficiaries over a median of 3.0 years (IQR 1.1-6.0). During follow-up, 12,662 (1.3%) persons were diagnosed with PTSD and 39,255 (3.9%) had a MACE. After adjustment for sex, HIV status, age, population group, substance use disorders, psychotic disorders, major depressive disorder, sleep disorders and the use of antipsychotic medication, PTSD was associated with a 16% increase in the risk of MACEs (aHR 1.16, 95% confidence interval (CI) 1.05-1.28). The risk ratio for the effect of PTSD on MACEs decreased from 1.59 (95% CI 1.49-1.68) after 1 year of follow-up to 1.14 (95% CI 1.11-1.16) after 8 years of follow-up. CONCLUSION Our study provides empirical support for an increased risk of MACEs in males and females with PTSD from a general population sample in South Africa. These findings highlight the importance of monitoring cardiovascular risk among individuals diagnosed with PTSD.
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Affiliation(s)
- Cristina Mesa-Vieira
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Christiane Didden
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Sociology, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Michael Schomaker
- Department of Statistics, Ludwig-Maximilians-Universität Munich, Munich, Germany
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Johannes P. Mouton
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Leigh L. van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Chiara Gastaldon
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Reshma Kassanjee
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Global Public Health & Bioethics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Andreas D. Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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22
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Ali S, Wright E, Charlson F. Using a systems thinking approach to explore the complex relationships between schizophrenia and premature mortality. Int J Soc Psychiatry 2024; 70:70-79. [PMID: 37644696 PMCID: PMC10860352 DOI: 10.1177/00207640231194477] [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: 08/31/2023]
Abstract
BACKGROUND People with schizophrenia have a higher risk of mortality compared to the general population, which has not improved over time. The majority of premature deaths are due to comorbid physical diseases, driven by interrelated factors operating at the individual level, through health systems and influenced by social determinants of health. A holistic understanding of this problem and the causal pathways linking these factors together is lacking. AIMS This study aims to understand why the mortality gap between people with schizophrenia and the general population is not improving by developing a causal loop diagram (CLD), a systems thinking approach which enables empirical research and theoretical knowledge to be combined into a visual representation of causal relationships and feedback loops. METHOD The CLD was constructed using published literature, including both quantitative and qualitative studies, to identify key variables and relationships, and refined through consultation with experts in the topic area. RESULTS A total of 21 variables and 68 connections were included in the CLD, with 23 distinct feedback loops identified. Stigma and social support had the most connections, while unemployment was involved in the greatest number of feedback loops. Most feedback mechanisms served to reinforce behavioural risk factors, inadequate healthcare and social disadvantage. CONCLUSIONS The CLD has created a holistic and dynamic understanding of the causal pathways driving the mortality gap between people with schizophrenia and the general population, providing insights into why it has persisted over time. One of the key findings was the critical role of social determinants in shaping health outcomes, highlighting the need for person-centred models of care and multisectoral government action.
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Affiliation(s)
- Suhailah Ali
- School of Public Health, The University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Eryn Wright
- School of Public Health, The University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Fiona Charlson
- School of Public Health, The University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, Brisbane, Australia
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23
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Fernández de la Cruz L, Isomura K, Lichtenstein P, Larsson H, Kuja-Halkola R, Chang Z, D'Onofrio BM, Brikell I, Rück C, Sidorchuk A, Mataix-Cols D. All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study. BMJ 2024; 384:e077564. [PMID: 38233033 PMCID: PMC10792686 DOI: 10.1136/bmj-2023-077564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To estimate the risk of all cause and cause specific mortality in people with obsessive-compulsive disorder (OCD) compared with matched unaffected people from the general population and with their unaffected siblings. DESIGN Population based matched cohort and sibling cohort study. SETTING Register linkage in Sweden. PARTICIPANTS Population based cohort including 61 378 people with OCD and 613 780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34 085 people with OCD and 47 874 unaffected full siblings. Cohorts were followed up for a median time of 8.1 years during the period from 1 January 1973 to 31 December 2020. MAIN OUTCOME MEASURES All cause and cause specific mortality. RESULTS 4787 people with OCD and 30 619 unaffected people died during the study period (crude mortality rate 8.1 and 5.1 per 1000 person years, respectively). In stratified Cox proportional hazards models adjusted for birth year, sex, county, migrant status (born in Sweden versus abroad), and sociodemographic variables (latest recorded education, civil status, and family income), people with OCD had an increased risk of all cause mortality (hazard ratio 1.82, 95% confidence interval 1.76 to 1.89) and mortality due to natural causes (1.31, 1.27 to 1.37) and unnatural causes (3.30, 3.05 to 3.57). Among the natural causes of death, those due to endocrine, nutritional, and metabolic diseases, mental and behavioural disorders, and diseases of the nervous, circulatory, respiratory, digestive, and genitourinary systems were higher in the OCD cohort. Conversely, the risk of death due to neoplasms was lower in the OCD cohort compared with the unaffected cohort. Among the unnatural causes, suicide showed the highest hazard ratio, followed by accidents. The results were robust to adjustment for psychiatric comorbidities and familial confounding. CONCLUSIONS Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD. Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.
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Affiliation(s)
- Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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24
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Kamau-Mitchell C, Lopes B. Importance of occupational support for NHS patients with mental illness. Occup Med (Lond) 2023; 73:528-531. [PMID: 37967382 DOI: 10.1093/occmed/kqad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Unemployment is a structural inequality which raises the risk of premature deaths among people with mental illness. AIMS This study examined whether UK National Health Service (NHS) patients with mental illness get support to find or keep a job because reducing unemployment rates can reduce the risk of premature mortality. METHODS This study analysed recently released data from 54 NHS trusts which randomly sampled patients for a Care Quality Commission survey. This study assessed 11 001 working-age patients with mental illness, of whom 50% are long-term service users (6+ years). RESULTS Perceived access to occupational support was poor with 46% of patients who wanted the support saying that they did not get help finding or returning to work. Perceived occupational support for physical co-morbidities needed improvement because 40% of patients with physical co-morbidities did not receive support for physical health needs. Twenty-five per cent said that medication side effects were not discussed, and 24% lacked medication follow-up although 87% of patients found medication beneficial to their mental health. Occupational support significantly benefited overall patient satisfaction to an equivalent extent as the main treatment (i.e. receiving medication and talking therapies), and it was a more consistent predictor of patient satisfaction than talking therapies. CONCLUSIONS Improved access to schemes which reduce unemployment among NHS patients with mental illness is needed (e.g. individual placement and support programmes), although limited availability might be due to funding constraints. As well as addressing unemployment, occupational support should address other risk factors for premature mortality, for example, poverty, stigma, discrimination and social exclusion.
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Affiliation(s)
- C Kamau-Mitchell
- Centre for Medical Humanities, Birkbeck, University of London, London, UK
| | - B Lopes
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention, University of Coimbra, Coimbra, Portugal
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25
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Stephan NM, van Sprang ED, Wiebenga JXM, Dickhoff J, Schirmbeck F, de Haan L, van Amelsvoort T, Veling W, Alizadeh BZ, Simons CJP, Heering HD. Risk factors for suicidality across psychosis vulnerability spectrum. Schizophr Res 2023; 261:152-160. [PMID: 37769453 DOI: 10.1016/j.schres.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/14/2023] [Accepted: 09/09/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Suicide is a leading cause of death in individuals with psychotic disorders. Risk factors for suicidality across the psychosis vulnerability spectrum are insufficiently known. METHODS For patients (n = 830), siblings (n = 664) and controls (n = 444), suicidality was assessed by the use of a clinical interview. Multilevel modelling was used to investigate risk factors of suicidality. Lastly, risk factor × familial risk interaction effects were examined. RESULTS Multivariable models revealed a significant relation between suicidality and depressive symptoms across all three groups, and childhood trauma in patients and siblings. The association between suicidality and psychotic-like experiences is more pronounced in siblings compared to controls. CONCLUSION Across the psychosis vulnerability spectrum, depressive symptoms and childhood trauma have been associated with suicidality. Clinicians should pay attention to suicidality in individuals at high familial risk for psychosis with psychotic-like experiences.
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Affiliation(s)
| | - Eleonore Dorothée van Sprang
- Amsterdam UMC, Location VUMC, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jasper Xiao Ming Wiebenga
- Amsterdam UMC, Location VUMC, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
| | - Justine Dickhoff
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands
| | - Frederike Schirmbeck
- Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Department of Public Mental Health, Central Institute of Mental Health, Faculty Medicine Mannheim, Heidelberg University Mannheim, Germany
| | - Lieuwe de Haan
- Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, the Netherlands
| | - Claudia J P Simons
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Henriëtte Dorothée Heering
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Department of Research, 113 Suicide Prevention, the Netherlands.
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26
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Chan JKN, Correll CU, Wong CSM, Chu RST, Fung VSC, Wong GHS, Lei JHC, Chang WC. Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102294. [PMID: 37965432 PMCID: PMC10641487 DOI: 10.1016/j.eclinm.2023.102294] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Mental disorders are associated with premature mortality. There is increasing research examining life expectancy and years-of-potential-life-lost (YPLL) to quantify the disease impact on survival in people with mental disorders. We aimed to systematically synthesize studies to estimate life expectancy and YPLL in people with any and specific mental disorders across a broad spectrum of diagnoses. Methods In this systematic review and meta-analysis, we searched Embase, MEDLINE, PsychINFO, WOS from inception to July 31, 2023, for published studies reporting life expectancy and/or YPLL for mental disorders. Criteria for study inclusion were: patients of all ages with any mental disorders; reported data on life expectancy and/or YPLL of a mental-disorder cohort relative to the general population or a comparison group without mental disorders; and cohort studies. We excluded non-cohort studies, publications containing non-peer-reviewed data or those restricted to population subgroups. Survival estimates, i.e., life expectancy and YPLL, were pooled (based on summary data extracted from the included studies) using random-effects models. Subgroup analyses and random-effects meta-regression analyses were performed to explore sources of heterogeneity. Risk-of-bias assessment was evaluated using the Newcastle-Ottawa Scale. This study is registered with PROSPERO (CRD42022321190). Findings Of 35,865 studies identified in our research, 109 studies from 24 countries or regions including 12,171,909 patients with mental disorders were eligible for analysis (54 for life expectancy and 109 for YPLL). Pooled life expectancy for mental disorders was 63.85 years (95% CI 62.63-65.06; I2 = 100.0%), and pooled YPLL was 14.66 years (95% CI 13.88-15.98; I2 = 100.0%). Disorder-stratified analyses revealed that substance-use disorders had the shortest life expectancy (57.07 years [95% CI 54.47-59.67]), while neurotic disorders had the longest lifespan (69.51 years [95% CI 67.26-71.76]). Substance-use disorders exhibited the greatest YPLL (20.38 years [95% CI 18.65-22.11]), followed by eating disorders (16.64 years [95% CI 7.45-25.82]), schizophrenia-spectrum disorders (15.37 years [95% CI 14.18-16.55]), and personality disorders (15.35 years [95% CI 12.80-17.89]). YPLLs attributable to natural and unnatural deaths in mental disorders were 4.38 years (95% CI 3.15-5.61) and 8.11 years (95% CI 6.10-10.13; suicide: 8.31 years [95% CI 6.43-10.19]), respectively. Stratified analyses by study period suggested that the longevity gap persisted over time. Significant cross-study heterogeneity was observed. Interpretation Mental disorders are associated with substantially reduced life expectancy, which is transdiagnostic in nature, encompassing a wide range of diagnoses. Implementation of comprehensive and multilevel intervention approaches is urgently needed to rectify lifespan inequalities for people with mental disorders. Funding None.
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Affiliation(s)
- Joe Kwun Nam Chan
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corine Sau Man Wong
- LKS Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ryan Sai Ting Chu
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Vivian Shi Cheng Fung
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Gabbie Hou Sem Wong
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Janet Hiu Ching Lei
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
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Konings SRA, Mierau JO, Visser E, Bruggeman R, Feenstra TL. Life years lost for users of specialized mental healthcare. Acta Psychiatr Scand 2023; 148:338-346. [PMID: 37697672 DOI: 10.1111/acps.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Mental disorders are burdensome and are associated with increased mortality. Mortality has been researched for various mental disorders, especially in countries with national registries, including the Nordic countries. Yet, knowledge gaps exist around national differences, while also relatively less studies compare mortality of those seeking help for mental disorders in specialized mental healthcare (SMH) by diagnosis. Additional insight into such mortality distributions for SMH users would be beneficial for both policy and research purposes. We aim to describe and compare the mortality in a population of SMH users with the mortality of the general population. Additionally, we aim to investigate mortality differences between sexes and major diagnosis categories: anxiety, depression, schizophrenia spectrum and other psychotic disorders, and bipolar disorder. METHODS Mortality and basic demographics were available for a population of N = 10,914 SMH users in the north of The Netherlands from 2010 until 2017. To estimate mortality over the adult lifespan, parametric Gompertz distributions were fitted on observed mortality using interval regression. Life years lost were computed by calculating the difference between integrals of the survival functions for the general population and the study sample, thus correcting for age. Survival for the general population was obtained from Statistics Netherlands (CBS). RESULTS SMH users were estimated to lose 9.5 life years (95% CI: 9.4-9.6). Every major diagnosis category was associated with a significant loss of life years, ranging from 7.2 (95% CI: 6.4-7.9) years for anxiety patients to 11.7 (95% CI: 11.0-12.5) years for bipolar disorder patients. Significant differences in mortality were observed between male SMH users and female SMH users, with men losing relatively more life years: 11.0 (95% CI: 10.9-11.2) versus 8.3 (95% CI: 8.2-8.4) respectively. This difference was also observed between sexes within every diagnosis, although the difference was insignificant for bipolar disorder. CONCLUSION There were significant differences in mortality between SMH users and the general population. Substantial differences were observed between sexes and between diagnoses. Additional attention is required, and possibly specific interventions are needed to reduce the amount of life years lost by SMH users.
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Affiliation(s)
- Stefan R A Konings
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Rob Giel Research center, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Jochen O Mierau
- Faculty of Economics and Business, Department of Economics, Econometrics & Finance, University of Groningen, Groningen, The Netherlands
- Team Strategy & External Relations, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Lifelines, Groningen, The Netherlands
| | - Ellen Visser
- Rob Giel Research center, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research center, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Talitha L Feenstra
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Center for Nutrition, Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Kamau-Mitchell C, Lopes B. Mental illness and unemployment-related mortality. Lancet Psychiatry 2023; 10:583-584. [PMID: 37479337 DOI: 10.1016/s2215-0366(23)00201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 07/23/2023]
Affiliation(s)
| | - Barbara Lopes
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention, University of Coimbra, Coimbra, Portugal
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Byrne P. Meeting the challenges of rising premature mortality in people with severe mental illness. Future Healthc J 2023; 10:98-102. [PMID: 37786630 PMCID: PMC10540805 DOI: 10.7861/fhj.2023-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
People with severe mental illness are 4.5 times more likely to die prematurely than the general UK population. We review the drivers of poorer physical health across mental health conditions and propose some practical approaches to addressing this in the clinic.
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Affiliation(s)
- Peter Byrne
- Royal London Hospital, London, UK, and co-director, Public Mental Health Implementation Centre, Royal College of Psychiatrists, UK
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