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Martínez-Cao C, García-Fernández A, González-Blanco L, Sáiz PA, Bobes J, García-Portilla MP. Anticholinergic load: A commonly neglected and preventable risk to cognition during schizophrenia treatment? Schizophr Res Cogn 2024; 37:100317. [PMID: 38745931 PMCID: PMC11092394 DOI: 10.1016/j.scog.2024.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
Background Cognitive impairment is a widespread feature of schizophrenia, affecting nearly 80 % of patients. Prior research has linked the anticholinergic burden of psychiatric medications to these cognitive deficits. However, the impact of the anticholinergic burden from medications for physical morbidity remains underexplored. This study aimed to evaluate the anticholinergic burden of psychiatric and physical medications in patients with schizophrenia and assess its impact on cognitive function. Methods A total of 178 patients with schizophrenia were recruited. The assessments included an ad hoc questionnaire for collecting demographic and clinical data. Anticholinergic burden was evaluated using the cumulative Drug Burden Index (cDBI) for each participant, and cognitive function was assessed using MATRICS. Psychopathology was measured using the PANSS, CDSS, CAINS, and the CGI-S. Statistical analysis included Student's t-tests, ANOVA, Pearson correlations, and multiple linear regressions. Results The average cDBI was 1.3 (SD = 0.9). The model developed explained 40.80 % of the variance. The variable with the greatest weight was the cDBI (B = -11.148, p = 0.010). Negative-expression (B = -2.740, p = 0.011) and negative-experiential (B = -1.175, p = 0.030) symptoms were also associated with lower global cognitive score. However, more years of education (B = 5.140, p < 0.001) and cigarettes per day (B = 1.331, p < 0.001) predicted a better global cognitive score. Conclusion This study identified specific predictors of global cognition in schizophrenia, with anticholinergic burden emerging as the strongest factor. Our findings underscore the importance of considering the anticholinergic burden of treatments, in addition to negative symptoms, when designing interventions to optimize or maintain cognitive function in patients with schizophrenia.
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Affiliation(s)
- Clara Martínez-Cao
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
| | - Ainoa García-Fernández
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
| | - Leticia González-Blanco
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - Pilar A. Sáiz
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - María Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
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McBride KE, Torzillo J, Davis R, Steffens D, Wand T, Sanders RD, Glozier N, Solomon MJ. Mental illness comorbidity significantly impacts surgical outcomes for emergency surgical patients. ANZ J Surg 2024; 94:1341-1348. [PMID: 38661075 DOI: 10.1111/ans.19008] [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: 11/06/2023] [Revised: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Whilst both mental illness comorbidity and the delivery of emergency surgery are commonplace in Australia, there is little evidence investigating any link between them. As such, this study examines the emergency surgical outcomes for patients with mental illness compared to other surgical patients within the Australian public surgical system. METHODS Retrospective cohort study involving adult emergency and elective surgical patients treated at three public hospitals in Sydney, Australia between 2018 and 2019. Patients were identified using ICD-10 diagnosis codes, and grouped by those with decompensated mental illness, chronic depression, or those without mental illness. Outcome measures included those within the emergency department (ED), along with in-hospital mortality and surgical outcomes. RESULTS Of 48 338 total patients, 31 890 (66.0%) had elective and 16 448 (34.0%) had emergency surgery. For patients with decompensated mental illness, only 228 (0.7%) had elective whilst 425 (2.6%) had emergency surgery. Their outcomes for this surgery type included being triaged significantly higher (Cat 1 or 2, 34% vs. 15%) and longer ED stays (8.3 vs. 6.6 h). They also had significantly more post-operative complications (26% vs. 8%) and total days in hospital (33.8 vs. 8.5 days). There was no significant difference for in-hospital mortality. CONCLUSION Patients with mental illness are significantly more likely to have emergency surgery including presenting to the ED with more acute physical illness and to experience worse surgical outcomes compared to other surgical patients for every measure analyzed except mortality. There is considerable opportunity to further investigate how these differences might be improved.
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Affiliation(s)
- Kate E McBride
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
| | - Judith Torzillo
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Davis
- Emegency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Tim Wand
- Emegency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Robert D Sanders
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Anaesthetics Department, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Nick Glozier
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre Sydney, New South Wales, Australia
| | - Michael J Solomon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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3
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Hemingway J, Kunz J, Draney D, Martin DE, Sukpraprut-Braaten S. Evaluating Stigmatization Toward Mental Illnesses Among Resident Physicians. Cureus 2024; 16:e61648. [PMID: 38966471 PMCID: PMC11223569 DOI: 10.7759/cureus.61648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
Background Individuals with mental illness are stigmatized by peers in societal, workplace, and healthcare settings. The stigmatization individuals experience from healthcare providers is well documented and pervasive, often being a detriment to the quality of healthcare these individuals receive. Objective Recognizing and addressing stigmatization toward individuals with mental illnesses is imperative during residency training in Graduate Medical Education (GME) programs and throughout professional practice. We hope that this cross-sectional study will cultivate mindfulness and improve the healthcare outcomes of stigmatized individuals. Methodology A cross-sectional study using a web-based Attitude to Mental Illness Questionnaire (AMIQ) with additional scenarios was utilized to assess stigma among resident physicians in differing specialties in a hospital training system. The research investigators collected anonymous data on demographics, characteristics, specialties, and the AMIQ. In eight vignettes, participants responded to five items using a five-point Likert scale assessing attitudes toward individuals. Results Of the 104 resident physicians enrolled in the hospital training system where the study was conducted, 58 (56%) volunteered to participate. The participating residents markedly exhibited negative attitudes toward the individual in the vignette with multiple inpatient psychiatric admissions. Residents also exhibited more negative attitudes toward individuals with schizophrenia, self-harm by way of overdose, psychedelic users, cannabis users, and alcohol problems compared to diabetic and Christian individuals. Conclusions Residents exhibited negative attitudes toward individuals with mental illness. Additional research would further our understanding of the reasons for physician bias. Moreover, GME programs and medical educators can play a crucial role in mitigating stigma among future physicians, thereby enhancing care for individuals with mental illness.
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Sara G, Hamer J, Gould P, Curtis J, Ramanuj P, O’Brien TA, Burgess P. Greater need but reduced access: a population study of planned and elective surgery rates in adult mental health service users. Epidemiol Psychiatr Sci 2024; 33:e12. [PMID: 38494985 PMCID: PMC10951789 DOI: 10.1017/s2045796024000131] [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: 09/02/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 03/19/2024] Open
Abstract
AIMS Timely access to surgery is an essential part of healthcare. People living with mental health (MH) conditions may have higher rates of chronic illness requiring surgical care but also face barriers to care. There is limited evidence about whether unequal surgical access contributes to health inequalities in this group. METHODS We examined 1.22 million surgical procedures in public and private hospitals in New South Wales (NSW), Australia, in 2019. In a cross-sectional study of 76,320 MH service users aged 18 and over, surgical procedure rates per 1,000 population were compared to rates for 6.23 million other NSW residents after direct standardisation for age, sex and socio-economic disadvantage. Rates were calculated for planned and emergency surgery, for major specialty groups, for the top 10 procedure blocks in each specialty group and for 13 access-sensitive procedures. Subgroup analyses were conducted for hospital and insurance type and for people with severe or persistent MH conditions. RESULTS MH service users had higher rates of surgical procedures (adjusted incidence rate ratio [aIRR]: 1.53, 95% CI: 1.51-1.56), due to slightly higher planned procedure rates (aIRR: 1.22, 95% CI: 1.19-1.24) and substantially higher emergency procedure rates (aIRR: 3.60, 95% CI: 3.51-3.70). Emergency procedure rates were increased in all block groups with sufficient numbers for standardisation. MH service users had very high rates (aIRR > 4.5) of emergency cardiovascular, skin and plastics and respiratory procedures, higher rates of planned coronary artery bypass grafting, coronary angiography and cholecystectomy but lower rates of planned ophthalmic surgery, cataract repair, shoulder reconstruction, knee replacement and some plastic surgery procedures. CONCLUSIONS Higher rates of surgery in MH service users may reflect a higher prevalence of conditions requiring surgical care, including cardiac, metabolic, alcohol-related or smoking-related conditions. The striking increase in emergency surgery rates suggests that this need may not be being met, particularly for chronic and disabling conditions which are often treated by planned surgery in private hospital settings in the Australian health system. A higher proportion of emergency surgery may have serious personal and health system consequences.
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Affiliation(s)
- G. Sara
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, Sydney, NSW, Australia
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | - J. Hamer
- Mid North Coast Local Health District, Coffs Harbour, NSW, Australia
| | - P. Gould
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, Sydney, NSW, Australia
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | - J. Curtis
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | - P. Ramanuj
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, UK
- RAND Europe, London, UK
| | - T. A. O’Brien
- Cancer Institute NSW, Sydney, NSW, Australia
- Medicine & Science, University of New South Wales, Sydney, NSW, Australia
| | - P. Burgess
- School of Public Health, University of Queensland, Brisbane, NSW, Australia
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Chu RST, Chong RCH, Chang DHH, Shan Leung AL, Chan JKN, Wong CSM, Chang WC. The risk of stroke and post-stroke mortality in people with schizophrenia: A systematic review and meta-analysis study. Psychiatry Res 2024; 332:115713. [PMID: 38183926 DOI: 10.1016/j.psychres.2024.115713] [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: 07/13/2023] [Revised: 10/14/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024]
Abstract
Sources of heterogeneity in risk of stroke and mortality risk following acute-stroke in schizophrenia are understudied. We systematically searched four electronic-databases until 1-November-2022, and conducted meta-analysis to synthesize estimates of stroke-risk and post-stroke mortality for schizophrenia patients relative to non-schizophrenia counterparts. Subgroup-analyses and meta-regression models stratified by sex, nature of sample (incident/prevalent), geographical region, study-period and time-frame following stroke were conducted when applicable. Fifteen and 5 studies were included for meta-analysis of stroke-risk (n=18,368,253; 129,095 schizophrenia patients) and all-cause post-stroke mortality (n=289,231; 4,477 schizophrenia patients), respectively. Schizophrenia patients exhibited elevated stroke-risk (relative-risk =1.55[95% CI:1.31-1.84]) relative to non-schizophrenia controls. Schizophrenia was associated with increased stroke-risk in both sexes, study-periods of 1990s and 2000s, and irrespective of nature of sample and geographical regions. Meta-regression revealed regional differences in relative-risk for stroke, but limited by small number of studies. After removal of an outlier study, meta-analysis demonstrated that schizophrenia was associated with increased overall (hazard-ratio=1.37[1.30-1.44]), short-term (≤90 days; 1.29[1.14-1.46]) and longer-term (≥1 year; 1.45[1.32-1.60]) post-stroke mortality rates. Raised post-stroke mortality rate for schizophrenia was observed irrespective of nature of sample, geographical regions and study-periods. Taken together, schizophrenia is associated with increased stroke-risk and post-stroke mortality. Multilevel-interventions are required to reduce these physical-health disparities.
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Affiliation(s)
- Ryan Sai Ting Chu
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ryan Chi Hin Chong
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Don Ho Hin Chang
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Alice Lok Shan Leung
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Joe Kwun Nam Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
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Fond G, Falissard B, Nuss P, Collin C, Duret S, Rabbani M, De Chefdebien I, Tonelli I, Llorca PM, Boyer L. How can we improve the care of patients with schizophrenia in the real-world? A population-based cohort study of 456,003 patients. Mol Psychiatry 2023; 28:5328-5336. [PMID: 37479782 DOI: 10.1038/s41380-023-02154-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/06/2023] [Accepted: 06/19/2023] [Indexed: 07/23/2023]
Abstract
An important step to improve outcomes for patients with schizophrenia is to understand treatment patterns in routine practice. The aim of the current study was to describe the long-term management of patients with schizophrenia treated with antipsychotics (APs) in real-world practice. This population-based study included adults with schizophrenia and who had received ≥3 deliveries of an AP from 2012-2017, identified using a National Health Data System. Primary endpoints were real-life prescription patterns, patient characteristics, healthcare utilization, comorbidities and mortality. Of the 456,003 patients included, 96% received oral APs, 17.5% first-generation long-acting injectable APs (LAIs), and 16.1% second generation LAIs. Persistence rates at 24 months after treatment initiation were 23.9% (oral APs), 11.5% (first-generation LAIs) and 20.8% (second-generation LAIs). Median persistence of oral APs, first-generation LAIs and second-generation LAIs was 5.0, 3.3, and 6.1 months, respectively. Overall, 62.1% of patients were administered anxiolytics, 45.7% antidepressants and 28.5% anticonvulsants, these treatments being more frequently prescribed in women and patients aged ≥50 years. Dyslipidemia was the most frequent metabolic comorbidity (16.2%) but lipid monitoring was insufficient (median of one occasion). Metabolic comorbidities were more frequent in women. Standardized patient mortality remained consistently high between 2013 and 2015 (3.3-3.7 times higher than the general French population) with a loss of life expectancy of 17 years for men and 8 years for women. Cancer (20.2%) and cardiovascular diseases (17.2%) were the main causes of mortality, and suicide was responsible for 25.4% of deaths among 18-34-year-olds. These results highlight future priorities for care of schizophrenia patients. The global persistence of APs used in this population was low, whereas rates of psychiatric hospitalization remain high. More focus on specific populations is needed, such as patients aged >50 years to prevent metabolic disturbances and 18-34-year-olds to reduce suicide rates.
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Affiliation(s)
- Guillaume Fond
- Centre for Studies and Research on Health Services and Quality of Life (CEReSS), AP-HM, Aix-Marseille University, Marseille, France.
| | - Bruno Falissard
- Universite Paris-Saclay, UVSQ, Inserm, Developmental Psychiatry, CESP, Villejuif, France
| | - Philippe Nuss
- AP-HP, Service de Psychiatrie et de Psychologie Médicale, Paris, France
| | | | | | | | | | | | | | - Laurent Boyer
- Centre for Studies and Research on Health Services and Quality of Life (CEReSS), AP-HM, Aix-Marseille University, Marseille, France
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Richards-Belle A, Poole N, Osborn DP, Bell V. Longitudinal associations between stroke and psychosis: a population-based study. Psychol Med 2023; 53:7698-7706. [PMID: 37272367 PMCID: PMC10755233 DOI: 10.1017/s0033291723001575] [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: 12/02/2022] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The co-occurrence of stroke and psychosis is a serious neuropsychiatric condition but little is known about the course of this comorbidity. We aimed to estimate longitudinal associations between stroke and psychosis over 10 years. METHODS A 10-year population-based study using data from the English Longitudinal Study of Ageing. A structured health assessment recorded (i) first-occurrence stroke and (ii) psychosis, at each wave. Each were considered exposures and outcomes in separate analyses. Logistic and Cox proportional hazards regression and Kaplan-Meier methods were used. Models were adjusted for demographic and health behaviour covariates, with missing covariates imputed using random forest multiple imputation. RESULTS Of 19 808 participants, 24 reported both stroke and psychosis (median Wave 1 age 63, 71% female, 50% lowest quintile of net financial wealth) at any point during follow-up. By 10 years, the probability of an incident first stroke in participants with psychosis was 21.4% [95% confidence interval (CI) 12.1-29.6] compared to 8.3% (95% CI 7.8-8.8) in those without psychosis (absolute difference: 13.1%; 95% CI 20.8-4.3, log rank p < 0.001; fully-adjusted hazard ratio (HR): 3.57; 95% CI 2.18-5.84). The probability of reporting incident psychosis in participants with stroke was 2.3% (95% CI 1.4-3.2) compared to 0.9% (95% CI 0.7-1.1) in those without (absolute difference: 1.4%; 95% CI 0.7-2.1, log rank p < 0.001; fully-adjusted HR: 4.98; 95% CI 2.55-9.72). CONCLUSIONS Stroke is an independent predictor of psychosis (and vice versa), after adjustment for potential confounders.
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Affiliation(s)
- Alvin Richards-Belle
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Norman Poole
- Department of Neuropsychiatry, South West London and St George's Mental Health NHS Trust, London, UK
| | | | - Vaughan Bell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Green CR, Elwyn R, Hill N, Johnston-Ataata K, Kokanović R, Maylea C, McLoughlan G, Roberts R, Thomas SDM. A critical review of research into mental health consumers' perspectives on their physical health: Is there an absence of consumers in the design, conduct, analysis and reporting of this research? Front Public Health 2023; 10:982339. [PMID: 36814954 PMCID: PMC9939465 DOI: 10.3389/fpubh.2022.982339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/28/2022] [Indexed: 02/08/2023] Open
Abstract
We conducted a critical review, using systematic methods, of the literature examining mental health consumer perspectives on their physical and mental health in academic research published between 2005 and 2021. This review examined the inclusion, extent, type and centrality of consumer perspectives regarding their mental and physical health. The search produced 1,865 papers from which 116 met the inclusion criteria. Studies predominantly focused on consumers' individual experiences of their physical and mental health, including but not limited to their understandings and experiences of medication and associated risk factors. They also captured some social aspects of mental health consumers' physical health, including factors that impacted individual agency, stigma, and social and interpersonal factors. Structural factors affecting physical and mental health, such as accessibility of services and financial constraints, were also identified. The review revealed that in comparison to clinician perspectives, the direct representation of consumer perspectives was lacking. Similarly, while clinician and carer perspectives on structural factors were investigated, the consumer perspective in this area was missing. The review also found few genuine codesigned or coproduced research studies. To better identify and respond to the health needs as prioritized by consumers, this paper argues it is imperative that future studies prioritize codesigned and coproduced research. It is argued that a focus on "services as provided" rather than "services as received" has contributed to a lack of progress in addressing the life expectancy gap for consumers. It is recommended that journals, ethics committees and research policy organizations develop guidelines and standards to inform best practice in research on consumer perspectives and experience and to support the implementation of codesigned and/or coproduced approaches in future research. Respecting and including consumers as equal partners in the research process will lead to more meaningful insights to inform policy and practice and reduce the life expectancy gap for people living with mental health concerns.
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Affiliation(s)
- Chloe R. Green
- School of Law, La Trobe University, Melbourne, VIC, Australia
| | - Rosiel Elwyn
- Psychology and Social Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Nicholas Hill
- School of Social and Political Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Kate Johnston-Ataata
- School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia
| | - Renata Kokanović
- School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia
| | - Chris Maylea
- School of Law, La Trobe University, Melbourne, VIC, Australia
| | - Grace McLoughlan
- School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia
| | - Russell Roberts
- School of Business, Charles Sturt University, Bathurst, NSW, Australia
| | - Stuart D. M. Thomas
- School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia
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Colorectal cancer treatment in people with severe mental illness: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2022; 31:e82. [PMID: 36384819 PMCID: PMC9706308 DOI: 10.1017/s2045796022000634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIMS People with severe mental illness (SMI) have a greater risk of dying from colorectal cancer (CRC), even though the incidence is lower or similar to that of the general population This pattern is unlikely to be solely explained by lifestyle factors, while the role of differences in cancer healthcare access or treatment is uncertain. METHODS We undertook a systematic review and meta-analysis on access to guideline-appropriate care following CRC diagnosis in people with SMI including the receipt of surgery, chemo- or radiotherapy. We searched for full-text articles indexed by PubMed, EMBASE, PsychInfo and CINAHL that compared CRC treatment in those with and without pre-existing SMI (schizophrenia, schizoaffective, bipolar and major affective disorders). Designs included cohort or population-based case-control designs. RESULTS There were ten studies (sample size = 3501-591 561). People with SMI had a reduced likelihood of surgery (RR = 0.90, 95% CI 0.92-0.97; p = 0.005; k = 4). Meta-analyses were not possible for the other outcomes but in results from individual studies, people with SMI were less likely to receive radiotherapy, chemotherapy or sphincter-sparing procedures. The disparity in care was greatest for those who had been psychiatric inpatients. CONCLUSIONS People with SMI, including both psychotic and affective disorders, receive less CRC care than the general population. This might contribute to higher case-fatality rates for an illness where the incidence is no higher than that of the general population. The reasons for this require further investigation, as does the extent to which differences in treatment access or quality contribute to excess CRC mortality in people with SMI.
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Launders N, Dotsikas K, Marston L, Price G, Osborn DPJ, Hayes JF. The impact of comorbid severe mental illness and common chronic physical health conditions on hospitalisation: A systematic review and meta-analysis. PLoS One 2022; 17:e0272498. [PMID: 35980891 PMCID: PMC9387848 DOI: 10.1371/journal.pone.0272498] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background People with severe mental illness (SMI) are at higher risk of physical health conditions compared to the general population, however, the impact of specific underlying health conditions on the use of secondary care by people with SMI is unknown. We investigated hospital use in people managed in the community with SMI and five common physical long-term conditions: cardiovascular diseases, COPD, cancers, diabetes and liver disease. Methods We performed a systematic review and meta-analysis (Prospero: CRD42020176251) using terms for SMI, physical health conditions and hospitalisation. We included observational studies in adults under the age of 75 with a diagnosis of SMI who were managed in the community and had one of the physical conditions of interest. The primary outcomes were hospital use for all causes, physical health causes and related to the physical condition under study. We performed random-effects meta-analyses, stratified by physical condition. Results We identified 5,129 studies, of which 50 were included: focusing on diabetes (n = 21), cardiovascular disease (n = 19), COPD (n = 4), cancer (n = 3), liver disease (n = 1), and multiple physical health conditions (n = 2). The pooled odds ratio (pOR) of any hospital use in patients with diabetes and SMI was 1.28 (95%CI:1.15–1.44) compared to patients with diabetes alone and pooled hazard ratio was 1.19 (95%CI:1.08–1.31). The risk of 30-day readmissions was raised in patients with SMI and diabetes (pOR: 1.18, 95%CI:1.08–1.29), SMI and cardiovascular disease (pOR: 1.27, 95%CI:1.06–1.53) and SMI and COPD (pOR:1.18, 95%CI: 1.14–1.22) compared to patients with those conditions but no SMI. Conclusion People with SMI and five physical conditions are at higher risk of hospitalisation compared to people with that physical condition alone. Further research is warranted into the combined effects of SMI and physical conditions on longer-term hospital use to better target interventions aimed at reducing inappropriate hospital use and improving disease management and outcomes.
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Affiliation(s)
- Naomi Launders
- Division of Psychiatry, UCL, London, United Kingdom
- * E-mail:
| | | | - Louise Marston
- Department of Primary Care and Population Health, UCL, London, United Kingdom
| | - Gabriele Price
- Health Improvement Directorate, Public Health England, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| | - Joseph F. Hayes
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
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11
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Chan JKN, Chu RST, Hung C, Law JWY, Wong CSM, Chang WC. Mortality, Revascularization, and Cardioprotective Pharmacotherapy After Acute Coronary Syndrome in Patients With Severe Mental Illness: A Systematic Review and Meta-analysis. Schizophr Bull 2022; 48:981-998. [PMID: 35786737 PMCID: PMC9434477 DOI: 10.1093/schbul/sbac070] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND HYPOTHESIS People with severe mental illness (SMI) may experience excess mortality and inequitable treatment following acute coronary syndrome (ACS). However, cardioprotective pharmacotherapy and SMI diagnoses other than schizophrenia are rarely examined in previous reviews. We hypothesized that SMI including bipolar disorder (BD) is associated with increased post-ACS mortality, decreased revascularization, and cardioprotective medication receipt relative to those without SMI. STUDY DESIGN We performed a meta-analysis to quantitatively synthesize estimates of post-ACS mortality, major adverse cardiac events (MACEs), and receipt of invasive coronary procedures and cardioprotective medications in patients with SMI, comprising schizophrenia, BD, and other nonaffective psychoses, relative to non-SMI counterparts. Subgroup analyses stratified by SMI subtypes (schizophrenia, BD), incident ACS status, and post-ACS time frame for outcome evaluation were conducted. STUDY RESULTS Twenty-two studies were included (n = 12 235 501, including 503 686 SMI patients). SMI was associated with increased overall (relative risk [RR] = 1.40 [95% confidence interval = 1.21-1.62]), 1-year (1.68 [1.42-1.98]), and 30-day (1.26 [1.05-1.51]) post-ACS mortality, lower receipt of revascularization (odds ratio = 0.57 [0.49-0.67]), and cardioprotective medications (RR = 0.89 [0.85-0.94]), but comparable rates of any/specific MACEs relative to non-SMI patients. Incident ACS status conferred further increase in post-ACS mortality. Schizophrenia was associated with heightened mortality irrespective of incident ACS status, while BD was linked to significantly elevated mortality only in incident ACS cohort. Both schizophrenia and BD patients had lower revascularization rates. Post-ACS mortality risk remained significantly increased with mild attenuation after adjusting for revascularization. CONCLUSIONS SMI is associated with increased post-ACS mortality and undertreatment. Effective multipronged interventions are urgently needed to reduce these physical health disparities.
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Affiliation(s)
- Joe Kwun Nam Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ryan Sai Ting Chu
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chun Hung
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jenny Wai Yiu Law
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- To whom correspondence should be addressed; Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; tel: (852) 22554486, fax: (852) 28551345, e-mail:
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12
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Iturralde E, Fazzolari L, Shia M, Slama N, Leang J, Awsare S, Nguyen LT. Closing the Care Gap for People with Severe and Persistent Mental Illness: Collaborative Care, Telehealth, and Clinical Pharmacy. NEJM CATALYST INNOVATIONS IN CARE DELIVERY 2022; 3:10.1056/CAT.21.0417. [PMID: 36569369 PMCID: PMC9788801 DOI: 10.1056/cat.21.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
People with severe and persistent mental illness (SPMI) frequently struggle to maintain their recovery from recurring suicidality, psychosis, and debilitating mood episodes. They also face a high risk of chronic health conditions. Traditional - often short-term - psychiatric care is ill-equipped to meet the health needs of people with SPMI. Patients often require regular and sustained follow-up to support medication effectiveness and adherence and to screen for and treat cardiovascular disease and other common health risks. Kaiser Permanente Northern California has implemented a novel telehealth-based collaborative care program, SPMI Population Care, led by advanced practice clinical pharmacists, to improve the mental and physical health of its patients with SPMI. Although the individual program components of telehealth, collaborative care, and clinical pharmacy service have been employed successfully in the past for mental health care, the SPMI Population Care model combines the components and extends this approach to individuals at the most severe end of the psychiatric illness spectrum.
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Affiliation(s)
- Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lisa Fazzolari
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
| | - Macy Shia
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
| | - Natalie Slama
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jessica Leang
- Department of Psychiatry, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | - Sameer Awsare
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, USA
| | - Lily T. Nguyen
- Department of Psychiatry, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
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13
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Luo J, Collier W, Magno-Padron D, Tieman J, Pires G, Moss W, Rosales M, Kim J, Agarwal JP, Kwok AC. Characteristics of Nonelderly Adult Health Care Persistent Super Utilizers in Utah. Popul Health Manag 2022; 25:472-479. [PMID: 35353618 DOI: 10.1089/pop.2021.0275] [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: 11/13/2022] Open
Abstract
In the United States, the top 1% and top 5% of health care spenders account for 23% and 50% of total health care spending, respectively. These high spenders have been coined the term super utilizers (SU). The aim of this study was to identify the characteristics associated with these patients to aid in developing public health interventions aimed at transitioning patients out of the SU category and thus ultimately helping to control health care costs. The authors utilized the Utah All-Payer Claims Database and Utah Population Database from 2013 to 2015 to identify demographics, comorbid conditions, health care utilization, and cost characteristics of persistent super utilizers (PSU) (≥3 hospitalizations per year for 3 years) of health care compared with persistent nonsuper utilizers (PNSU) (<3 hospitalizations per year for 3 years). Multivariable logistic regression was utilized to identify the characteristics associated with PSU versus PNSU. Higher outpatient/Emergency Department/noninpatient (eg, visits with imaging and Centers for Medicare & Medicaid Services preventive visits) health care utilization and spending, and prevalence of comorbid disease and psychosocial conditions were associated with PSU. In multivariable analysis, factors such as heart disease, chronic kidney disease (CKD), diabetes, alcohol abuse, and depression were statistically significantly associated with higher odds of PSU, with the most noteworthy being CKD (odds ratio [OR] 6.85, 95% confidence interval [95% CI] 5.84-8.02; P < 0.001), alcohol abuse (OR 5.90, 95% CI 4.49-7.69; P < 0.001), and heart diseases (OR 4.41, 95% CI 3.74-5.18; P < 0.001). The annual health care cost of a PSU is about 11.5 times greater than a PNSU ($54,776 vs. $4801; P < 0.001).
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Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Willem Collier
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Magno-Padron
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joshua Tieman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Giovanna Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Whitney Moss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, and CTSI Health Economics Core, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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14
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Mehbodniya A, Khan IR, Chakraborty S, Karthik M, Mehta K, Ali L, Nuagah SJ. Data Mining in Employee Healthcare Detection Using Intelligence Techniques for Industry Development. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6462657. [PMID: 35047155 PMCID: PMC8763559 DOI: 10.1155/2022/6462657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Even in today's environment, when there is a plethora of information accessible, it may be difficult to make appropriate choices for one's well-being. Data mining, machine learning, and computational statistics are among the most popular arenas of training today, and they are all aimed at secondary empowered person in making good decisions that will maximize the outcome of whatever working area they are involved with. Because the degree of rise in the number of patient roles is directly related to the rate of people growth and lifestyle variations, the healthcare sector has a significant need for data processing services. When it comes to cancer, the prognosis is an expression that relates to the possibility of the patient surviving in general, but it may also be used to describe the severity of the sickness as it will present itself in the patient's future timeline. Methodology. The proposed technique consists of three stages: input data acquisition, preprocessing, and classification. Data acquisition consists of input raw data which is followed by preprocessing to eliminate the missed data and the classification is carried out using ensemble classifier to analyze the stages of cancer. This study explored the combined influence of the prominent labels in conjunction with one another utilizing the multilabel classifier approach, which is successful. Finally, an ensemble classifier model has been constructed and experimentally validated to increase the accuracy of the classifier model, which has been previously shown. The entire performance of the recommended and tested models demonstrates a steady development of 2% to 6% over the baseline presentation on the baseline performance. RESULTS Providing a good contribution to the general health welfare of noncommercial potential workers in the healthcare sector is an opportunity provided by this recommended job outcome. It is anticipated that alternative solutions to these constraints, as well as automation of the whole process flow of all five phases, will be the key focus of the work to be carried out shortly. Predicting health status of employee in industry or information trends is made easier by these data patterns. The proposed classifier achieves the accuracy rate of 93.265%.
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Affiliation(s)
- Abolfazl Mehbodniya
- Department of Electronics and Communication Engineering, Kuwait College of Science and Technology (KCST), Doha, Kuwait
| | | | - Sudeshna Chakraborty
- Department of Computer Science and Engineering, Lloyd Institute of Engineering and Technology, Greater Noida, Uttar Pradesh, India
| | - M. Karthik
- Department of Electrical and Electronics Engineering, Kongu Engineering College, Erode, Tamil Nadu, India
| | - Kamakshi Mehta
- Amity College of Commerce, Amity University, Gurgaon, Haryana, India
| | - Liaqat Ali
- Department of Electrical Engineering, University of Science and Technology Bannu, Bannu, Pakistan
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15
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Kisely S, Lalloo R. A state-wide study of dental comorbidities in psychiatric disorders resulting in avoidable emergency department presentations. Aust Dent J 2021; 66:423-429. [PMID: 34325489 DOI: 10.1111/adj.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Attendances at emergency departments (EDs) for dental conditions are unnecessary and come at a significant cost to health services. METHODS A population-based record-linkage analysis of a retrospective cohort over 2 years across state-based facilities in Queensland. This was to determine if people with mental illness were more likely than the general population to attend EDs for a range of non-traumatic or avoidable dental conditions. RESULTS There were 1 381 428 individuals in the linked database, of whom 177 157 (13%) had a psychiatric history and 22 046 (1.5%) had one or more avoidable dental presentations. These were toothache (n = 9619), dental abscesses (n = 8449), caries (n = 1826), stomatitis (n = 1213) and gum disease (n = 939). After adjusting for confounders, psychiatric patients were significantly more likely to present with toothache, dental abscesses and caries but not stomatitis or gum disease. Depending on the dental outcome, other risk factors were male sex, lower income, rurality and Indigenous status. CONCLUSIONS Given these findings, possible interventions should include an increased emphasis on assessing oral health in mental health or primary care, especially in non-metropolitan areas, as well as early dental referral. Service planning for this population should including easier navigation of dental services, availability outside normal office hours and free outreach dental clinics.
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Affiliation(s)
- S Kisely
- School of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia.,Addiction and Mental Health Services, Metro South Health, Woolloongabba, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - R Lalloo
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
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16
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Weissinger GM, Brooks Carthon JM, Ahmed C, Brawner BM. Experiences of Hospitalization of Patients With Psychotic Disorders on Medical-Surgical Units: A Thematic Analysis. J Am Psychiatr Nurses Assoc 2021; 27:306-321. [PMID: 31795792 PMCID: PMC9254133 DOI: 10.1177/1078390319892313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND:Individuals with psychotic disorders are more likely to have nonpsychiatric hospitalizations than the general population. Moreover, they experience worse outcomes in terms of rehospitalization, adverse events, in-hospital mortality, and longer length of stay. AIM: A patient-centered understanding of inpatient medical-surgical hospitalization experiences could shed light on disparities in hospital outcomes among individuals with psychotic disorders. METHOD: This article reports findings from Phase 1 (Qualitative) of a mixed methods, exploratory sequential study of nonpsychiatric hospitalizations of patients with psychotic disorders. Patients on medical-surgical units with diagnosed psychotic disorders (n = 20) were interviewed about their experiences of hospitalization, and a thematic analysis was conducted of transcripts, case notes, and setting notes. RESULTS: Five themes emerged from analysis: (1) managing through hard times (subthemes: intense emotions, medically complex with many symptoms, strategies for self-management), (2) ignored and treated unfairly, (3) actively involved in health (subthemes: seeking health education, suggesting changes), (4) appreciation of caring providers, and (5) violence: expected and enacted. Participants connected the difficult nature of their hospitalization experiences with a variety of sources and outcomes, including strong emotions, variable relationships with providers and a struggle to receive health education. CONCLUSIONS: Nurses who care for patients with psychotic disorders in medical-surgical settings can better meet patients' needs by concentrating on relationship building, especially during initial interactions, and helping patients better manage their medical and psychiatric symptoms through both pharmaceutical and nursing interventions.
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Affiliation(s)
- Guy M Weissinger
- Guy M. Weissinger II, MPhil, PhD, RN, Drexel University, Philadelphia, PA, USA
| | - J Margo Brooks Carthon
- J. Margo Brooks Carthon, PhD, RN, FAAN, University of Pennsylvania, Philadelphia, PA, USA
| | - Charisse Ahmed
- Charisse Ahmed, BSN, University of Pennsylvania, Philadelphia, PA, USA
| | - Bridgette M Brawner
- Bridgette M. Brawner, MDiv, PhD, APRN, University of Pennsylvania, Philadelphia, PA, USA
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17
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Kapral MK, Kurdyak P, Casaubon LK, Fang J, Porter J, Sheehan KA. Stroke care and case fatality in people with and without schizophrenia: a retrospective cohort study. BMJ Open 2021; 11:e044766. [PMID: 34112641 PMCID: PMC8194334 DOI: 10.1136/bmjopen-2020-044766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Schizophrenia is associated with an increased risk of death following stroke; however, the magnitude and underlying reasons for this are not well understood. OBJECTIVE To determine the association between schizophrenia and stroke case fatality, adjusting for baseline characteristics, stroke severity and processes of care. DESIGN Retrospective cohort study used linked clinical and administrative databases. SETTING All acute care institutions (N=152) in the province of Ontario, Canada. PARTICIPANTS All patients (N=52 473) hospitalised with stroke between 1 April 2002 and 31 March 2013 and included in the Ontario Stroke Registry. Those with schizophrenia (n=612) were identified using validated algorithms. MAIN OUTCOMES AND MEASURES We compared acute stroke care in those with and without schizophrenia and used Cox proportional hazards models to examine the association between schizophrenia and mortality, adjusting for demographics, comorbidity, stroke severity and processes of care. RESULTS Compared with those without schizophrenia, people with schizophrenia were less likely to undergo thrombolysis (10.1% vs 13.4%), carotid imaging (66.3% vs 74.0%), rehabilitation (36.6% vs 46.6% among those with disability at discharge) or be treated with antihypertensive, lipid-lowering or anticoagulant therapies. After adjustment for age and other factors, schizophrenia was associated with death from any cause at 1 year (adjusted HR (aHR) 1.33, 95% CI 1.14 to 1.54). This was mainly attributable to early deaths from stroke (aHR 1.47, 95% CI 1.20 to 1.80, with survival curves separating in the first 30 days), and the survival disadvantage was particularly marked in those aged over 70 years (1-year mortality 46.9% vs 35.0%). CONCLUSIONS Schizophrenia is associated with increased stroke case fatality, which is not fully explained by stroke severity, measurable comorbid conditions or processes of care. Future work should focus on understanding this mortality gap and on improving acute stroke and secondary preventive care in people with schizophrenia.
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Affiliation(s)
- Moira K Kapral
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Leanne K Casaubon
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Kathleen A Sheehan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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18
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Impact of severe mental illness on healthcare use and health outcomes for people with type 2 diabetes: a longitudinal observational study in England. Br J Gen Pract 2021; 71:e565-e573. [PMID: 33571951 PMCID: PMC8252859 DOI: 10.3399/bjgp.2020.0884] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/05/2021] [Indexed: 11/05/2022] Open
Abstract
Background People with severe mental illnesses (SMIs) have reduced life expectancy compared with the general population. Diabetes is a contributor to this disparity, with higher prevalence and poorer outcomes in people with SMI. Aim To determine the impact of SMI on healthcare processes and outcomes for people with type 2 diabetes (T2DM). Design and setting Retrospective, observational, matched, nested, case–control study conducted in England using patient records from the Clinical Practice Research Datalink, linked to Hospital Episode Statistics. Method A range of healthcare processes (primary care consultations, physical health checks, and metabolic measurements) and outcomes (prevalence and hospitalisation for cardiovascular disease [CVD], and mortality risk) were compared for 2192 people with SMI and T2DM (cases) with 7773 people who had diabetes alone (controls). Sociodemographics, comorbidity, and medication prescription were covariates in regression models. Results When compared with results for participants with T2DM only, SMI was associated with increased risk of all-cause mortality (hazard ratio [HR] 1.919, 95% confidence interval [CI] = 1.602 to 2.300) and CVD-specific mortality (HR 2.242, 95% CI = 1.547 to 3.250), higher primary care physician consultation rates (incidence rate ratio [IRR] 1.149, 95% CI = 1.111 to 1.188), more-frequent checks of blood pressure (IRR 1.024, 95% CI = 1.003 to 1.046) and cholesterol (IRR 1.038, 95% CI = 1.019 to 1.058), lower prevalence of angina (odds ratio 0.671, 95% CI = 0.450 to 1.001), more emergency admissions for angina (IRR 1.532, 95% CI = 1.069 to 2.195), and fewer elective admissions for ischaemic heart disease (IRR 0.682, 95% CI = 0.508 to 0.915). Conclusion Monitoring of metabolic measurements was comparable for people with T2DM who did, and did not, have SMI. Increased mortality rates observed in people with SMI may be attributable to underdiagnosis of CVD and delays in treatment.
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Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder. Glob Ment Health (Camb) 2021; 8:e2. [PMID: 33889419 PMCID: PMC8057364 DOI: 10.1017/gmh.2020.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 11/14/2020] [Accepted: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There are few studies on the impact of out-of-pocket mental health care expenditures and sociodemographic factors on the probability of Mexican households to incur catastrophic healthcare expenditures (CHE). OBJECTIVE The goal of the present study was to estimate the incidence of CHE and its main determinants among the households of persons with mental disorders (MD) in Mexico. METHODS A cross-sectional survey was conducted, including 387 households of persons with MD. The estimation of the CHE was obtained by the health expenditure distribution method. A Logistic Regression (LR) was used to identify the determinants of probability variation of CHE occurrence. Since we expected a proportion of CHE between 20% and 80%, we assume linearity in the probability function, therefore we additionally used an Ordinary Least Squares (OLS) model. RESULTS In our sample, the incidence of CHE was 34.8%. The two mental illnesses most frequently associated with CHE were schizophrenia and hyperactive disorder (35.5% and 32.6% of CHE cases, respectively). The regression coefficients showed that for each unit (US$53.77) increase in income, the probability of CHE was reduced by 8.6%, while for each unit increase in hospitalization or medication expenditures, the probability of CHE increased by 12.9% or 19%, respectively. For each additional household member, the probability of CHE increased by 3%, and households with a male patient had a 7% greater probability of CHE. CONCLUSION Household income, household size, hospitalization and medication expenses, and sex of the patient were significant predictors of CHE for households caring for a person with MD.
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20
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Hauck TS, Liu N, Wijeysundera HC, Kurdyak P. Mortality and Revascularization among Myocardial Infarction Patients with Schizophrenia: A Population-Based Cohort Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:454-462. [PMID: 32013569 PMCID: PMC7298580 DOI: 10.1177/0706743720904845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular disease is a major source of mortality in schizophrenia, and access to care after acute myocardial infarction (AMI) is poor for these patients. AIMS To understand the relationship between schizophrenia and access to coronary revascularization and the impact of revascularization on mortality among individuals with schizophrenia and AMI. METHOD This study used a retrospective cohort of AMI in Ontario between 2008 and 2015. The exposure was a diagnosis of schizophrenia, and patients were followed 1 year after AMI discharge. The primary outcome was all-cause mortality within 1 year. Secondary outcomes were cardiac catheterization and revascularization (percutaneous coronary intervention or coronary artery bypass graft). Cox proportional hazard regression models were used to study the relationship between schizophrenia and mortality, and the time-varying effect of revascularization. RESULTS A total of 108,610 cases of incident AMI were identified, among whom 1,145 (1.1%) had schizophrenia. Schizophrenia patients had increased mortality, with a hazard ratio (HR) of 1.55 (95% CI, 1.37 to 1.77) when adjusted for age, sex, income, rurality, geographic region, and comorbidity. After adjusting for time-varying revascularization, the HR reduced to 1.38 (95% CI, 1.20 to 1.58). The impact of revascularization on mortality was similar among those with and without schizophrenia (HR: 0.42; 95% CI, 0.41 to 0.44 vs. HR: 0.40; 95% CI, 0.26 to 0.61). CONCLUSIONS In this sample of AMI, mortality in schizophrenia is increased, and treatment with revascularization reduces the HR of schizophrenia. The higher mortality rate yet similar survival benefit of revascularization among individuals with schizophrenia relative to those without suggests that increasing access to revascularization may reduce the elevated mortality observed in individuals with schizophrenia.
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Affiliation(s)
- Tanya S. Hauck
- Department of Psychiatry, Centre for Addiction and Mental Health,
University of Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of
Toronto, Ontario, Canada
| | - Ning Liu
- Institute of Health Policy, Management and Evaluation, University of
Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
| | - Harindra C. Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of
Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
- Department of Medicine, Schulich Heart Centre, Sunnybrook Research
Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Department of Psychiatry, Centre for Addiction and Mental Health,
University of Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of
Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
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21
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Chang WC, Chan JKN, Wong CSM, Hai JSH, Or PCF, Chen EYH. Mortality, Revascularization, and Cardioprotective Pharmacotherapy After Acute Coronary Syndrome in Patients With Psychotic Disorders: A Population-Based Cohort Study. Schizophr Bull 2020; 46:774-784. [PMID: 32083305 PMCID: PMC7342096 DOI: 10.1093/schbul/sbaa013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ischemic heart disease is the leading cause of mortality in psychotic disorders. There is a paucity of research comprehensively evaluating short-term mortality, cardiovascular complications, and treatment inequality after cardiac events in patients with psychotic disorders. This population-based cohort study examined 30-day and 1-year all-cause mortality, cardiovascular complication rates, 30-day and 1-year receipt of invasive cardiac procedures, and 90-day post-discharge cardioprotective medication treatment following admission for first-recorded acute coronary syndrome (ACS) among patients with psychotic disorders (n = 703) compared with patients without psychotic disorders (n = 66 989) between January 2006 and December 2016 in Hong Kong (HK). Study data were retrieved from territory-wide medical record database of public healthcare services to 7.5 million HK residents. Multivariate regression analyses (ORs and 95% CIs), adjusting for demographics and medical comorbidities, were conducted to evaluate associations between psychotic disorders and post-ACS outcomes. Our results showed that patients with psychotic disorders had higher 30-day (OR: 1.99 [95% CI: 1.65-2.39]) and 1-year (2.13 [1.79-2.54]) mortality, and cardiovascular complication rates (1.20 [1.02-1.41]), lower receipt of cardiac catheterization (30-d: 0.54 [0.43-0.68]; 1-y: 0.46 [0.38-0.56]), percutaneous coronary intervention (30-d: 0.55 [0.44-0.70]; 1-y: 0.52 [0.42-0.63]) and reduced β-blockers (0.81 [0.68-0.97]), statins (0.54 [0.44-0.66]), and clopidogrel prescriptions (0.66 [0.55-0.80]). Associations between psychotic disorder and increased mortality remained significant even after complications and treatment receipt were additionally adjusted. Our findings indicate that psychotic disorders are associated with increased risks of short-term post-ACS mortality, cardiovascular complications, and inferior treatment. Excess mortality is not substantially explained by treatment inequality. Further investigation is warranted to clarify factors for suboptimal cardiac-care and elevated mortality in psychotic disorders to enhance post-ACS outcome.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,To whom correspondence should be addressed; Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; tel: 852-22554486, fax: 852-28551345, e-mail:
| | - Joe Kwun Nam Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - JoJo Siu Han Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Philip Chi Fai Or
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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22
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Heiberg IH, Nesvåg R, Balteskard L, Bramness JG, Hultman CM, Næss Ø, Reichborn‐Kjennerud T, Ystrom E, Jacobsen BK, Høye A. Diagnostic tests and treatment procedures performed prior to cardiovascular death in individuals with severe mental illness. Acta Psychiatr Scand 2020; 141:439-451. [PMID: 32022895 PMCID: PMC7317477 DOI: 10.1111/acps.13157] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine whether severe mental illnesses (i.e., schizophrenia or bipolar disorder) affected diagnostic testing and treatment for cardiovascular diseases in primary and specialized health care. METHODS We performed a nationwide study of 72 385 individuals who died from cardiovascular disease, of whom 1487 had been diagnosed with severe mental illnesses. Log-binomial regression analysis was applied to study the impact of severe mental illnesses on the uptake of diagnostic tests (e.g., 24-h blood pressure, glucose/HbA1c measurements, electrocardiography, echocardiography, coronary angiography, and ultrasound of peripheral vessels) and invasive cardiovascular treatments (i.e., revascularization, arrhythmia treatment, and vascular surgery). RESULTS Patients with and without severe mental illnesses had similar prevalences of cardiovascular diagnostic tests performed in primary care, but patients with schizophrenia had lower prevalences of specialized cardiovascular examinations (prevalence ratio (PR) 0.78; 95% CI 0.73-0.85). Subjects with severe mental illnesses had lower prevalences of invasive cardiovascular treatments (schizophrenia, PR 0.58; 95% CI 0.49-0.70, bipolar disorder, PR 0.78; 95% CI 0.66-0.92). The prevalence of invasive cardiovascular treatments was similar in patients with and without severe mental illnesses when cardiovascular disease was diagnosed before death. CONCLUSION Better access to specialized cardiovascular examinations is important to ensure equal cardiovascular treatments among individuals with severe mental illnesses.
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Affiliation(s)
- I. H. Heiberg
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway
| | - R. Nesvåg
- Norwegian Medical AssociationOsloNorway,Department of Clinical MedicineUiT – The Arctic University of NorwayTromsøNorway
| | - L. Balteskard
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway
| | - J. G. Bramness
- Department of Clinical MedicineUiT – The Arctic University of NorwayTromsøNorway,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health DisordersInnlandet Hospital TrustHamarNorway
| | - C. M. Hultman
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden,Icahn School of MedicineMt Sinai HospitalNew YorkNYUSA
| | - Ø. Næss
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Institute of Health and SocietyUniversity of OsloOsloNorway
| | - T. Reichborn‐Kjennerud
- Institute of Clinical MedicineUniversity of OsloOsloNorway,Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway
| | - E. Ystrom
- Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway,Department of PsychologyPROMENTA Research CenterUniversity of OsloOsloNorway,PharmacoEpidemiology and Drug Safety Research GroupSchool of PharmacyUniversity of OsloOsloNorway
| | - B. K. Jacobsen
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway,Department of Community MedicineUiT – The Arctic University of NorwayTromsøNorway,Department of Community MedicineCentre for Sami Health ResearchUiT – The Arctic University of NorwayTromsøNorway
| | - A. Høye
- Center for Clinical Documentation and Evaluation (SKDE)TromsøNorway,Department of Clinical MedicineUiT – The Arctic University of NorwayTromsøNorway,Division of Mental Health and Substance AbuseUniversity Hospital of North NorwayTromsøNorway
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23
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Yung NCL, Wong CSM, Chan JKN, Or PCF, Chen EYH, Chang WC. Mortality in patients with schizophrenia admitted for incident ischemic stroke: A population-based cohort study. Eur Neuropsychopharmacol 2020; 31:152-157. [PMID: 31883653 DOI: 10.1016/j.euroneuro.2019.12.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/21/2019] [Accepted: 12/08/2019] [Indexed: 01/03/2023]
Abstract
Evidence shows that schizophrenia is associated with increased incidence of stroke. However, relationship between schizophrenia and short-term mortality risk is understudied, and mixed findings were observed. In this retrospective population-based cohort study, we identified individuals admitted for incident ischemic stroke between 2006 and 2016 using a territory-wide electronic medical record database of public healthcare system in Hong Kong to examine 30-day and 1-year mortality rates in 817 schizophrenia patients compared with 8170 patients without psychotic disorder (10:1 matched to schizophrenia patients on demographics, treatment sites and calendar-period for index admission). Multivariate regression analyses adjusting for medical comorbidities revealed that schizophrenia patients experienced elevated 1-year (16.9% vs 12.1%; p < 0.001) and 30-day mortality (7.2% vs 5.3%; p = 0.053) relative to control group. Additional age- and gender-stratified analyses revealed even more pronounced effect of schizophrenia on raised mortality risk, as indicated by higher odds, in younger-age (<65 years) group and men. Our results indicate that schizophrenia is associated with heightened short-term mortality following incident ischemic stroke. Further research is warranted to identify factors contributing to excess post-stroke deaths among schizophrenia patients to facilitate development of effective interventions for mortality risk reduction.
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Affiliation(s)
| | - Corine Sau Man Wong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Joe Kwun Nam Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Philip Chi Fai Or
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
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24
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Welsh J, Korda RJ, Joshy G, Greaves K, Banks E. Variation in coronary angiography and revascularisation procedures in relation to psychological distress among patients admitted to hospital with myocardial infarction or angina. J Psychosom Res 2019; 125:109794. [PMID: 31445320 DOI: 10.1016/j.jpsychores.2019.109794] [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: 12/21/2018] [Revised: 07/24/2019] [Accepted: 08/03/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cardiac patients with psychological distress have a poorer prognosis than patients without distress; which may in part reflect differences in treatment. We quantified variation in coronary angiography and revascularisation procedures according to psychological distress among patients admitted with incident acute myocardial infarction (AMI) or angina. METHODS Questionnaire data (collected 2006-09) from 45 and Up Study participants were linked to hospitalisation and mortality data, to 30 June 2016. Among patients free from ischaemic heart disease at baseline and subsequently hospitalised with AMI or angina, Cox regression was used to model the association between distress (Kessler-10 scores: low [10-<12], mild [12-<16], moderate [16-<22] and high [22-50]) - assessed on the questionnaire - and coronary angiography and revascularisation procedures (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) within 30 days of admission, adjusting for personal characteristics, including physical functioning. RESULTS Proportions receiving angiography and PCI/CABG were 71.4% and 51.7% following AMI (n = 3749), and 61.3% and 31.3% for angina patients (n = 3772), respectively. Following AMI, age-sex-adjusted rates of PCI/CABG were lower with higher levels of distress (test for trend: p = .037), as were rates of angiography and PCI/CABG (p < .01) following admission with angina. After additional adjustment for personal characteristics, associations between distress and procedure rates attenuated substantively and were no longer significant, except that PCI/CABG rates remained lower among angina patients with high versus low distress (HR = 0.76, 95%CI: 0.59-0.99). CONCLUSION Distress-related variation in coronary procedures largely reflects differences in personal characteristics. Whether lower revascularisation rates among angina patients with high compared to low distress are clinically appropriate or represent under-treatment remains unclear.
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Affiliation(s)
- Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia.
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia.
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia.
| | - Kim Greaves
- Sunshine Coast University Hospital, Australia; Griffith University, Australia.
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia; The Sax Institute, Australia.
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25
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Barcella CA, Mohr GH, Kragholm K, Blanche P, Gerds TA, Wissenberg M, Hansen SM, Bundgaard K, Lippert FK, Folke F, Torp-Pedersen C, Kessing LV, Gislason GH, Søndergaard KB. Out-of-hospital cardiac arrest in patients with psychiatric disorders — Characteristics and outcomes. Resuscitation 2019; 143:180-188. [DOI: 10.1016/j.resuscitation.2019.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/20/2019] [Accepted: 07/06/2019] [Indexed: 01/08/2023]
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26
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Stone EM, Chen LN, Daumit GL, Linden S, McGinty EE. General Medical Clinicians' Attitudes Toward People with Serious Mental Illness: A Scoping Review. J Behav Health Serv Res 2019; 46:656-679. [PMID: 30887413 PMCID: PMC7251232 DOI: 10.1007/s11414-019-09652-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Individuals with serious mental illness (SMI) experience significant premature mortality due to somatic conditions but often receive sub-optimal somatic care, but little research has been done to understand how general medical clinicians' attitudes may affect care provision or health outcomes. This review describes general medical clinicians' attitudes toward people with SMI, compares these attitudes to attitudes among mental health clinicians or toward individuals without SMI, and examines the relationship between attitudes and clinical decision making. Seventeen studies were reviewed. General medical clinicians reported negative attitudes toward individuals with SMI. These attitudes were generally more negative than attitudes among mental health clinicians and were consistently more negative when compared to attitudes toward individuals without SMI. Four studies suggest that these negative attitudes have an adverse effect on clinician decision making.
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Affiliation(s)
- Elizabeth M Stone
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Room 2-620, Baltimore, MD, USA.
| | - Lisa Nawei Chen
- Division of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Room 2-620, Baltimore, MD, USA
| | - Sarah Linden
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Room 2-620, Baltimore, MD, USA
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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27
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Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 738] [Impact Index Per Article: 147.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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28
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Cameron CM, Cumsille Nazar J, Ehrlich C, Kendall E, Crompton D, Liddy AM, Kisely S. General practitioner management of chronic diseases in adults with severe mental illness: a community intervention trial. AUST HEALTH REV 2019; 41:665-671. [PMID: 27977388 DOI: 10.1071/ah16151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to assess the effects of a community intervention aimed at general practitioners (GPs) by comparing Medicare claims data from patients with severe mental illness (SMI) of GPs exposed to the intervention and controls that were not. Methods A comparison was made of primary care consultation and pathology data of people with SMI from intervention and control areas. Negative binomial regression models were used to compare the frequency and length of GP consultations, as well as the number and type of pathology examinations. Results Records of 103 people from intervention area and 98 controls were obtained. Intervention and control areas were not different at baseline in terms of age and claims data, but females had higher consultation rates. After adjusting for gender, people from intervention areas had more GP consultations, especially long consultations (adjusted incidence rate ratio 1.56; 95% confidence interval 1.28-1.91). They also had more pathology screening for chronic diseases, in accordance with implemented guideline recommendations. These benefits persisted after the end of the intervention. Conclusion These findings suggest that the ACTIVATE program aimed at training GPs to screen and better manage chronic diseases in adults with SMI had a positive effect up to 6 months after the trial, with demonstrated desired changes in medical management practices by GPs in the intervention area during that time. What is known about the topic? People with an SMI have higher mortality and poorer physical health than the general population. What does this paper add? The community intervention had a significant and sustained effect, with demonstrated desired changes in screening and medical management by GPs for adults with SMI in the intervention area. What are the implications for practitioners? GPs are ideally placed to assist in the prevention and better management of health conditions, thereby reducing avoidable illness and deaths in vulnerable populations, such as adults with SMI. Ongoing professional training and dissemination of clinical guidelines are critical for raising awareness about the physical and oral health care needs of people with SMI.
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Affiliation(s)
- Cate M Cameron
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia.
| | - Jose Cumsille Nazar
- School of Health Services and Social Work, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Carolyn Ehrlich
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia.
| | - Elizabeth Kendall
- Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia.
| | - David Crompton
- School of Health Services and Social Work, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Ann Maree Liddy
- General Practice Queensland t/a CheckUP Australia, PO Box 3205, South Brisbane, Qld 4101, Australia. Email
| | - Steve Kisely
- School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia. Email
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29
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Bongiorno DM, Daumit GL, Gottesman RF, Faigle R. Patients with stroke and psychiatric comorbidities have lower carotid revascularization rates. Neurology 2019; 92:e2514-e2521. [PMID: 31053663 DOI: 10.1212/wnl.0000000000007565] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/25/2019] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE We investigated whether mental illness is associated with lower rates of carotid endarterectomy (CEA)/carotid artery stenting (CAS) after stroke due to carotid stenosis. METHODS In this retrospective cross-sectional study, ischemic stroke cases due to carotid stenosis were identified in the 2007-2014 Nationwide (National) Inpatient Sample. Psychiatric conditions were identified by secondary ICD-9-CM diagnosis codes for schizophrenia/psychoses, bipolar disorder, depression, anxiety, or substance use disorders. Using logistic regression, we tested the association between psychiatric conditions and CEA/CAS, controlling for demographic, clinical, and hospital factors. RESULTS Among 37,474 included stroke cases, 6,922 (18.5%) had a psychiatric comorbidity. The presence of any psychiatric condition was associated with lower odds of CEA/CAS (adjusted odds ratio [OR] 0.84, 95% confidence interval [CI] 0.78-0.90). Schizophrenia/psychoses (OR 0.72, 95% CI 0.55-0.93), depression (OR 0.83, 95% CI 0.75-0.91), and substance use disorders (OR 0.73, 95% CI 0.65-0.83) were each associated with lower odds of CEA/CAS. The association of mental illness and CEA/CAS was dose-dependent: compared to patients without mental illness, patients with multiple psychiatric comorbidities (OR 0.74, 95% CI 0.62-0.87) had lower odds of CEA/CAS than those with only one psychiatric comorbidity (OR 0.86, 95% CI 0.79-0.92; p value for trend <0.001). CONCLUSION The odds of carotid revascularization after stroke is lower in patients with mental illness, particularly those with schizophrenia/psychoses, depression, substance use disorders, and multiple psychiatric diagnoses.
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Affiliation(s)
- Diana M Bongiorno
- From the Johns Hopkins University School of Medicine (D.M.B.); and Division of General Internal Medicine (G.L.D.) and Department of Neurology (R.F.G., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gail L Daumit
- From the Johns Hopkins University School of Medicine (D.M.B.); and Division of General Internal Medicine (G.L.D.) and Department of Neurology (R.F.G., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F Gottesman
- From the Johns Hopkins University School of Medicine (D.M.B.); and Division of General Internal Medicine (G.L.D.) and Department of Neurology (R.F.G., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roland Faigle
- From the Johns Hopkins University School of Medicine (D.M.B.); and Division of General Internal Medicine (G.L.D.) and Department of Neurology (R.F.G., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Willers C, Sunnerhagen KS, Lekander I, von Euler M. The Association of Pre-stroke Psychosis and Post-stroke Levels of Health, Resource Utilization, and Care Process: A Register-Based Study. Front Neurol 2018; 9:1042. [PMID: 30559711 PMCID: PMC6287012 DOI: 10.3389/fneur.2018.01042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/19/2018] [Indexed: 01/25/2023] Open
Abstract
Background: While approximately one percent of the global population is formally diagnosed with psychosis or schizophrenia, the actual number is expected to be significantly higher. These patients often consume more healthcare resources and have poorer somatic health. In this study, we analyze potential differences in health, resources, and care process between stroke patients with and without a previous diagnosis of psychosis or schizophrenia. Methods: Ischemic stroke patients from seven regions in Sweden were identified via ICD-10 codes (I63.0-9) in regional administrative systems and the Swedish Stroke Register, and approximately 70% of all ischemic stroke cases in Sweden during 2008–2011 were included (n = 46,350). Relevant patient-level data from national registries were linked to enable multivariate regression analysis, including data on socioeconomics, mortality, municipality services, and filled prescriptions. History of psychosis or schizophrenia was defined via ICD-10 codes F20-29 (n = 389). Results: Patient-reported functional outcomes at 3 months and 1 year were significantly lower in the psychosis subgroup, and stroke recurrence was higher. Patients with pre-stroke psychosis did not receive the same levels of reperfusion treatment as the non-psychosis group. Time at the stroke unit was the same, as were first-year levels of somatic care, but dispensation of antihypertensives was less common. Conclusion: Our findings emphasize the importance of taking mental comorbidity into account during stroke treatment as well as when evaluating indicators for health, resources, and the care process, since mental comorbidity such as psychosis or schizophrenia may have a significant impact the year preceding and the year succeeding the stroke event.
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Affiliation(s)
- Carl Willers
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Karolinska Institutet Stroke Research Network at Södersjukhuset, Solna, Sweden.,Ivbar Institute AB, Stockholm, Sweden
| | - Katharina S Sunnerhagen
- Rehabilitation Medicine, Institute of Neuroscience and Physiology, The Sahlgenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Lekander
- Ivbar Institute AB, Stockholm, Sweden.,Medical Management Centre, Karolinska Institutet, Solna, Sweden
| | - Mia von Euler
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Karolinska Institutet Stroke Research Network at Södersjukhuset, Solna, Sweden.,Department of Medicine, Karolinska Institutet, Solna, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, Solna, Sweden
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Affiliation(s)
- Ellis Onwordi
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, UK.,Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Camberwell, London, UK
| | - Oliver Howes
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, UK.,Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Camberwell, London, UK
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Lavie-Ajayi M, Moran GS, Levav I, Porat R, Reches T, Goldfracht M, Gal G. Using the capabilities approach to understand inequality in primary health-care services for people with severe mental illness. Isr J Health Policy Res 2018; 7:49. [PMID: 30145980 PMCID: PMC6109982 DOI: 10.1186/s13584-018-0236-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiological studies show disparities in the provision of physical health-care for people with severe mental illness. This observation includes countries with universal health insurance. However, there is limited in-depth data regarding the barriers preventing equality of physical health-care provision for this population. This study applied the capabilities approach to examine the interface between general practitioners and patients with severe mental illness. The capabilities approach provides a framework for health status which conceptualizes the internal and external factors relating to the available options (capabilities) and subsequent health outcomes (functioning). METHODS Semi-structured in-depth interviews were conducted with 10 general practitioners and 15 patients with severe mental illness, and then thematically analyzed. RESULTS We identified factors manifesting across three levels: personal, relational-societal, and organizational. At the personal level, the utilization of physical health services was impaired by the exacerbation of psychiatric symptoms. At the relational level, both patients and physicians described the importance of a long-term and trusting relationship, and provided examples demonstrating the implications of relational ruptures. Finally, two structural-level impediments were described by the physicians: the absence of continuous monitoring of patients with severe mental illness, and the shortfall in psychosocial interventions. CONCLUSION The capability approach facilitated the identification of barriers preventing equitable health-care provision for patients with severe mental illness. Based on our findings, we propose a number of practical suggestions to improve physical health-care for this population: 1. A proactive approach in monitoring patients' health status and utilization of services. 2. Acknowledgment of people with severe mental illness as a vulnerable population at risk, that need increased time for physician-patient consultations. 3. Training and support for general practitioners. 4. Increase collaboration between general practitioners and mental-health professionals. 5. Educational programs for health professionals to reduce prejudice against people with severe mental illness.
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Affiliation(s)
- Maya Lavie-Ajayi
- The Israeli Center for Qualitative Research of People and Societies, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel. .,The Spitzer Department of Social Work, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel.
| | - Galia S Moran
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel
| | - Itzhak Levav
- Department of Community Mental Health, University of Haifa, 199 Aba Khoushy Ave, Haifa, Israel
| | - Rotem Porat
- The Israeli Center for Qualitative Research of People and Societies, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel
| | - Tal Reches
- The Israeli Center for Qualitative Research of People and Societies, Ben-Gurion University of the Negev, P.O.B. 653, 8410501, Beer-Sheva, Israel
| | | | - Gilad Gal
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
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Oakley P, Kisely S, Baxter A, Harris M, Desoe J, Dziouba A, Siskind D. Increased mortality among people with schizophrenia and other non-affective psychotic disorders in the community: A systematic review and meta-analysis. J Psychiatr Res 2018; 102:245-253. [PMID: 29723811 DOI: 10.1016/j.jpsychires.2018.04.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is increasing evidence of excess mortality in schizophrenia but less information on other non-affective psychoses. We therefore generated standardised mortality ratios (SMRs) for community-dwelling people with schizophrenia and other non-affective psychoses, relative to the general population, and examined changes to the SMR over time. METHODS We conducted a systematic review in which Pubmed, CINAHL, EMBASE, Google Scholar and PsycINFO were searched for publications that reported SMRs for all-cause mortality among community-dwelling people with schizophrenia and psychotic disorders. Meta-analyses of SMRs were conducted, pooled across genders and then separately by gender. Sub-group analyses were conducted for diagnostic group, global region, decade and risk of study bias. RESULTS We were able to include 34 studies covering 1,724,906 participants. The gender pooled SMR for schizophrenia and psychotic disorders was 3.08 (95%CI 2.88-3.31). Schizophrenia and broader psychotic disorders had similar SMRs. Stratification by decade of observation suggests that the difference in SMR is not declining and may possibly be widening. Analyses showed high levels of heterogeneity. CONCLUSIONS The appearance of a static or widening mortality gap over time between people with schizophrenia and psychotic disorders and the general population is of concern. However, whether it is an increase over time is unclear, as there are insufficient studies to confirm this.
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Affiliation(s)
- Padraig Oakley
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Steve Kisely
- Metro South Addiction and Mental Health Service, Brisbane, Australia; University of Queensland School of Medicine, Brisbane, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - Amanda Baxter
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Meredith Harris
- Queensland Centre for Mental Health Research, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Jocelyne Desoe
- University of Queensland School of Medicine, Brisbane, Australia
| | - Alyona Dziouba
- University of Queensland School of Medicine, Brisbane, Australia
| | - Dan Siskind
- Queensland Centre for Mental Health Research, Brisbane, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia; University of Queensland School of Medicine, Brisbane, Australia.
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Murphy AL, Gardner DM, Jacobs LM. Patient care activities by community pharmacists in a capitation funding model mental health and addictions program. BMC Psychiatry 2018; 18:192. [PMID: 29898682 PMCID: PMC6000927 DOI: 10.1186/s12888-018-1746-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Community pharmacists are autonomous, regulated health care professionals located in urban and rural communities in Canada. The accessibility, knowledge, and skills of community pharmacists can be leveraged to increase mental illness and addictions care in communities. METHODS The Bloom Program was designed, developed, and implemented based on the Behaviour Change Wheel and a program of research in community pharmacy mental healthcare capacity building. We evaluated the Bloom Program as a demonstration project using mixed methods. A retrospective chart audit was conducted to examine outcomes and these are reported in this paper. RESULTS We collected 201 patient charts from 23 pharmacies in Nova Scotia with 182 patients having at least one or more follow-up visits. Anxiety (n = 126, 69%), depression (n = 112, 62%), and sleep disorders (n = 64, 35%) were the most frequent mental health problems. Comorbid physical health problems were documented in 57% (n = 104). The average number of prescribed medications was 5.5 (range 0 to 24). Sixty seven percent (n = 122) were taking multiple psychotropics and 71% (n = 130) reported taking more than one medication for physical health problems. Treatment optimization was the leading reason for enrollment with more than 80% seeking improvements in symptom management and daily functioning. There were a total of 1233 patient-care meetings documented, of which the duration was recorded in 1098. The median time for enrolling, assessing, and providing follow-up care by pharmacists was 142 min (mean 176, SD 128) per patient. The median follow-up encounter duration was 15 min. A total of 146 patient care encounters were 60 min or longer, representing 13.3% of all timed encounters. CONCLUSIONS Pharmacists work with patients with lived experience of mental illness and addictions to improve medication related outcomes including those related to treatment optimization, reducing polytherapy, and facilitating withdrawal from medications. Pharmacists can offer their services frequently and routinely without the need for an appointment while affording patient confidentiality and privacy. Important roles for pharmacists around the deprescribing of various medications (e.g., benzodiazepines) have previously been supported and should be optimized and more broadly implemented. Further research on the best mechanisms to incentivize pharmacists in mental illness and addiction's care should be explored.
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Affiliation(s)
- Andrea L. Murphy
- 0000 0004 1936 8200grid.55602.34College of Pharmacy and Department of Psychiatry, Dalhousie University, 5968 College St, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - David M. Gardner
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry and College of Pharmacy, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans’ Memorial Lane, Halifax, NS B3H 2E2 Canada
| | - Lisa M. Jacobs
- Independent Evaluator, Contact Consulting, Halifax, NS Canada
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Reeves E, Henshall C, Hutchinson M, Jackson D. Safety of service users with severe mental illness receiving inpatient care on medical and surgical wards: A systematic review. Int J Ment Health Nurs 2018; 27:46-60. [PMID: 29318771 DOI: 10.1111/inm.12426] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 11/28/2022]
Abstract
This review aimed to synthesize the evidence on the likelihood of harm and mortality on medical and surgical inpatient wards for people with severe mental illness (SMI). From 937 results identified through database searching, and a further 10 papers identified through citation searching and hand searching, 11 papers met the criteria for inclusion in the final review. This review did not find strong evidence for higher in-hospital mortality in people with SMI. There was evidence that adverse events are higher in people with SMI. A higher likelihood of emergency instead of planned care, and poorer access to treatment were identified as potential contributing factors to these adverse events. In addition, service users with SMI were more likely to have a longer length of stay, associated with a higher cost of care. The severity of the mental illness increased the likelihood of harm or death, and people with schizophrenia were more likely than people with other mental illnesses to experience these adverse outcomes. There is evidence that people with SMI are provided with lower-quality health care, whereas higher-quality, better-planned care is required to overcome the inequalities in access faced by this vulnerable population.
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Affiliation(s)
- Ella Reeves
- Oxford Institute of Nursing, Midwifery and Allied Health Research - OxINMAHR, Oxford Brookes University, Oxford, UK
| | - Catherine Henshall
- Oxford Institute of Nursing, Midwifery and Allied Health Research - OxINMAHR, Oxford Brookes University, Oxford, UK
| | | | - Debra Jackson
- Oxford Institute of Nursing, Midwifery and Allied Health Research - OxINMAHR, Oxford Brookes University, Oxford, UK.,University of Technology, Sydney, New South Wales, Australia
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Bongiorno DM, Daumit GL, Gottesman RF, Faigle R. Comorbid Psychiatric Disease Is Associated With Lower Rates of Thrombolysis in Ischemic Stroke. Stroke 2018; 49:738-740. [PMID: 29374106 DOI: 10.1161/strokeaha.117.020295] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 11/29/2017] [Accepted: 12/21/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Intravenous thrombolysis (IVT) improves outcomes after acute ischemic stroke but is underused in certain patient populations. Mental illness is pervasive in the United States, and patients with comorbid psychiatric disease experience inequities in treatment for a range of conditions. We aimed to determine whether comorbid psychiatric disease is associated with differences in IVT use in acute ischemic stroke. METHODS Acute ischemic stroke admissions between 2007 and 2011 were identified in the Nationwide Inpatient Sample. Psychiatric disease was defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes for secondary diagnoses of schizophrenia or other psychoses, bipolar disorder, depression, or anxiety. Using logistic regression, we tested the association between IVT and psychiatric disease, controlling for demographic, clinical, and hospital factors. RESULTS Of the 325 009 ischemic stroke cases meeting inclusion criteria, 12.8% had any of the specified psychiatric comorbidities. IVT was used in 3.6% of those with, and 4.4% of those without, psychiatric disease (P<0.001). Presence of any psychiatric disease was associated with lower odds of receiving IVT (adjusted odds ratio, 0.80; 95% confidence interval, 0.76-0.85). When psychiatric diagnoses were analyzed separately individuals with schizophrenia or other psychoses, anxiety, or depression each had significantly lower odds of IVT compared to individuals without psychiatric disease. CONCLUSIONS Acute ischemic stroke patients with comorbid psychiatric disease have significantly lower odds of IVT. Understanding barriers to IVT use in such patients may help in developing interventions to increase access to evidence-based stroke care.
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Affiliation(s)
- Diana M Bongiorno
- From the Johns Hopkins University School of Medicine, Baltimore, MD (D.M.B.); and Division of General Internal Medicine (G.L.D.) and Department of Neurology (R.F.G., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gail L Daumit
- From the Johns Hopkins University School of Medicine, Baltimore, MD (D.M.B.); and Division of General Internal Medicine (G.L.D.) and Department of Neurology (R.F.G., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F Gottesman
- From the Johns Hopkins University School of Medicine, Baltimore, MD (D.M.B.); and Division of General Internal Medicine (G.L.D.) and Department of Neurology (R.F.G., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roland Faigle
- From the Johns Hopkins University School of Medicine, Baltimore, MD (D.M.B.); and Division of General Internal Medicine (G.L.D.) and Department of Neurology (R.F.G., R.F.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Gal G, Munitz H, Levav I. Double disparities in the health care for people with schizophrenia of an ethnic-national minority. Isr J Health Policy Res 2017; 6:47. [PMID: 29031281 PMCID: PMC5641401 DOI: 10.1186/s13584-017-0166-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/07/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Studies have shown health care disparities among persons of minority status, including in countries with universal health care. Yet, a dearth of studies have addressed disparities resulting from the combined effect of two minority status groups: severe mental illness and ethnic-national sector filiation. This study aimed to compare the differential health care of Jewish- and Arab-Israelis with schizophrenia in a country with a universal health insurance. METHOD This study builds on a large case-control epidemiological sample (N = 50,499) of Jewish- (92.9%) and Arab-Israelis (7.1%) service users with (n = 16,833) and without schizophrenia (n = 33,666). Health services records were collected in the years 2000-2009. Diabetes and cardiovascular disease (CVD) served as sentinel diseases. We compared annual number of LDL tests and visits to specialists in the entire sample, Hemoglobin-A1C test among people diagnosed with diabetes, and cardiac surgical interventions for those diagnosed with CVD. RESULTS Service users with schizophrenia were less likely to meet identical indexes of care as their study counterparts: 95% of cholesterol tests (p < .001), and 92% visits to specialists (p < .001). These differences were greater among Arab- compared to Jewish-Israelis. Annual frequency of Hemoglobin-A1C test among people diagnosed with diabetes was lower (94%) in people with schizophrenia (p < 0.01), but no ethnic-national differences were identified. Among service users with CVD less surgical interventions were done in people with schizophrenia (70%) compared to their counterparts, with no ethnic-national disparities. CONCLUSIONS In Israel, service users with schizophrenia fail to receive equitable levels of medical and cardiac surgical care for CVD and regular laboratory tests for diabetes. Although disparities in some health indicators were enhanced among Arab-Israelis, schizophrenia was a greater source of disparities than ethnic-national filiation.
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Affiliation(s)
- Gilad Gal
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Rabenu Yeruham St, Tel Aviv, Israel.
| | | | - Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
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38
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Jørgensen M, Mainz J, Egstrup K, Johnsen SP. Quality of Care and Outcomes of Heart Failure Among Patients With Schizophrenia in Denmark. Am J Cardiol 2017; 120:980-985. [PMID: 28774428 DOI: 10.1016/j.amjcard.2017.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/26/2017] [Accepted: 06/13/2017] [Indexed: 11/15/2022]
Abstract
Research on the association between schizophrenia and the quality of care and clinical outcomes of heart failure (HF) remains sparse. This nationwide study compared the quality of care and clinical outcomes of HF among Danish patients with and without schizophrenia. In a population-based cohort study, we identified 36,718 patients with incident HF with hospital contacts, including 108 with schizophrenia, using Danish registries between 2004 and 2013. High quality of HF care was defined as receiving ≥ 80% guideline-recommended process-performance measures of care. Potential predictors of HF care among patients with schizophrenia included patient-specific factors (age, gender, Global Assessment of Functioning [GAF] score, alcohol or drug abuse, duration of schizophrenia); provider-specific factors (quality of schizophrenia care); and system-specific factors (patient-volume defined as hospital departments and clinics yearly average patient-volume of patients with incident HF). Clinical outcomes included 4-week all-cause readmission and 1-year all-cause mortality after a first-time hospital contact with incident HF. Results showed that compared with patients with incident HF who have no schizophrenia, patients with incident HF who have schizophrenia had a lower chance of receiving high-quality HF care (relative risk 0.66, 95% confidence interval 0.48 to 0.91). A high GAF score was associated with a higher chance of receiving high-quality HF care among patients with incident HF who have schizophrenia. Patients with incident HF who have schizophrenia had a higher risk of 1-year mortality (adjusted hazard ratio 2.83, 95% confidence interval 1.59 to 5.04), but not a higher risk of readmission than patients with incident HF who have no schizophrenia. In conclusion, efforts are warranted to reduce the high mortality among patients with incident HF who have schizophrenia.
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Affiliation(s)
| | - Jan Mainz
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | | | - Søren P Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Wilson CL, Rhodes KM, Payne RA. Financial incentives improve recognition but not treatment of cardiovascular risk factors in severe mental illness. PLoS One 2017; 12:e0179392. [PMID: 28598998 PMCID: PMC5466340 DOI: 10.1371/journal.pone.0179392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 05/30/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives Severe mental illness (SMI) is associated with premature cardiovascular disease, prompting the UK primary care payment-for-performance system (Quality and Outcomes Framework, QOF) to incentivise annual physical health reviews. This study aimed to assess the QOF’s impact on detection and treatment of cardiovascular risk factors in people with SMI. Methods A retrospective open cohort study of UK general practice was conducted between 1996 and 2014, using segmented logistic regression with 2004 and 2011 as break points, reflecting the introduction of relevant QOF incentives in these years. 67239 SMI cases and 359951 randomly-selected unmatched controls were extracted from the Clinical Practice Research Datalink (CPRD). Results There was strong evidence (p≤0.015) the 2004 QOF indicator (general health) resulted in an immediate increase in recording of elevated cholesterol (odds ratio 1.37 (95% confidence interval 1.24 to 1.51)); obesity (OR 1.21 (1.06 to 1.38)); and hypertension (OR 1.19 (1.04 to 1.38)) in the SMI group compared with the control group, which was sustained in subsequent years. Similar findings were found for diabetes, although the evidence was weaker (p = 0.059; OR 1.21 (0.99 to 1.49)). There was evidence (p<0.001) of a further, but unsustained, increase in recording of elevated cholesterol and obesity in the SMI group following the 2011 QOF indicator (cardiovascular specific). There was no clear evidence that the QOF indicators affected the prescribing of lipid modifying medications or anti-diabetic medications. Conclusion Incentivising general physical health review for SMI improves identification of cardiovascular risk factors, although the additional value of specifically incentivising cardiovascular risk factor assessment is unclear. However, incentives do not affect pharmacological management of these risks.
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Affiliation(s)
- Carol L. Wilson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Rupert A. Payne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
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40
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Beaulieu T, Patten S, Knaak S, Weinerman R, Campbell H, Lauria-Horner B. Impact of Skill-Based Approaches in Reducing Stigma in Primary Care Physicians: Results from a Double-Blind, Parallel-Cluster, Randomized Controlled Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:327-335. [PMID: 28095259 PMCID: PMC5459227 DOI: 10.1177/0706743716686919] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Most interventions to reduce stigma in health professionals emphasize education and social contact-based strategies. We sought to evaluate a novel skill-based approach: the British Columbia Adult Mental Health Practice Support Program. We sought to determine the program's impact on primary care providers' stigma and their perceived confidence and comfort in providing care for mentally ill patients. We hypothesized that enhanced skills and increased comfort and confidence on the part of practitioners would lead to diminished social distance and stigmatization. Subsequently, we explored the program's impact on clinical outcomes and health care costs. These outcomes are reported separately, with reference to this article. METHODS In a double-blind, cluster randomized controlled trial, 111 primary care physicians were assigned to intervention or control groups. A validated stigma assessment tool, the Opening Minds Scale for Health Care Providers (OMS-HC), was administered to both groups before and after training. Confidence and comfort were assessed using scales constructed from ad hoc items. RESULTS In the primary analysis, no significant differences in stigma were found. However, a subscale assessing social distance showed significant improvement in the intervention group after adjustment for a variable (practice size) that was unequally distributed in the randomization. Significant increases in confidence and comfort in managing mental illness were observed among intervention group physicians. A positive correlation was found between increased levels of confidence/comfort and improvements in overall stigma, especially in men. CONCLUSIONS This study provides some preliminary evidence of a positive impact on health care professionals' stigma through a skill-building approach to management of mild to moderate depression and anxiety in primary care. The intervention can be used as a primary vehicle for enhancing comfort and skills in health care providers and, ultimately, reducing an important dimension of stigma: preference for social distance.
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Affiliation(s)
- Tara Beaulieu
- 1 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | - Scott Patten
- 2 Department of Community Health Services and Department of Psychiatry, University of Calgary, Calgary, Alberta
| | - Stephanie Knaak
- 3 Opening Minds Anti-Stigma Initiative, Mental Health Commission of Canada, Ottawa, Ontario
| | - Rivian Weinerman
- 4 Vancouver Island Health Authority, Vancouver, British Columbia.,5 Faculty of Medicine, University of British Columbia, Victoria, British Columbia
| | - Helen Campbell
- 4 Vancouver Island Health Authority, Vancouver, British Columbia.,5 Faculty of Medicine, University of British Columbia, Victoria, British Columbia
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Gal G, Munitz H, Levav I. Health Care and Mortality among Persons with Severe Mental Illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:259-267. [PMID: 27573257 PMCID: PMC5407547 DOI: 10.1177/0706743716666997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Reports show disparities in the health care of persons with severe mental illness (SMI), including in countries with universal health insurance. However, the moderating effect on disparities of specific mental health legislation is yet to be studied. The study aimed to investigate equality of health care for people with SMI in a country with a national health insurance and a comprehensive rehabilitation law for persons with mental disabilities. METHOD A case-control epidemiological study compared health services (laboratory tests, visits to specialists, and medications) provided to users with and without a history of schizophrenia and bipolar disorder ( N = 52,131) and with regard to a subgroup of users with diabetes ( n = 16,280). In addition, we examined the mortality rates of the study population. RESULTS While service users with schizophrenia were somewhat less likely to meet the same indexes of care as controls, those with bipolar disorder did not differ from their counterparts. Yet, mortality risk among service users with schizophrenia and bipolar disorder was 2.4 and 1.7 times higher, respectively. Rates of services to persons with SMI and comorbid diabetes did not differ from their counterparts. CONCLUSIONS In Israel, a country with a national health insurance and a rehabilitation law for persons with mental disabilities, service users with bipolar disorder receive equitable levels of general health care. For users with schizophrenia, the disparities exist in some of the health care measures but to a smaller extent than in other countries with universal health insurance. In contrast, mortality rates are elevated in persons with SMI.
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Affiliation(s)
- Gilad Gal
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
| | | | - Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
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Lambert TJ, Reavley NJ, Jorm AF, Oakley Browne MA. Royal Australian and New Zealand College of Psychiatrists expert consensus statement for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness. Aust N Z J Psychiatry 2017; 51:322-337. [PMID: 28343435 DOI: 10.1177/0004867416686693] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To use expert consensus to inform the development of policy and guidelines for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness. METHOD The Delphi method was used. A systematic search of websites, books and journal articles was conducted to develop a 416-item survey containing strategies that health professionals should use to treat, manage and monitor the physical health of people with an enduring psychotic illness. Three panels of Australian experts (55 clinicians, 21 carers and 20 consumers) were recruited and independently rated the items over three rounds, with strategies reaching consensus on a priori-defined levels of importance written into the expert consensus statement. RESULTS The participation rate for the clinicians across all three rounds was 65%, with consumers and carers only completing one round due to high endorsement rates. Finally, 386 strategies were endorsed as essential or important by one or all panels. The endorsed strategies provided information on engagement and collaborative partnerships; clinical governance; risk factors, morbidity and mortality in people with enduring psychotic illness; assessment, including initial and follow-up assessments; barriers to care; strategies to improve care of people with enduring psychotic illness; education and training; treatment recommendations; medication side effects; and the role of health professionals. CONCLUSION The consensus statement is intended to be used by health professionals, people with an enduring psychotic illness and their families and carers. The next step needed is an implementation strategy by the Royal Australian and New Zealand College of Psychiatrists and other stakeholders.
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Affiliation(s)
- Timothy Jr Lambert
- 1 Collaborative Centre for Cardiometabolic Health in Psychosis, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.,2 Sydney Medical School and the Discipline of Psychiatry, Sydney, Australia
| | - Nicola J Reavley
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Anthony F Jorm
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Mark A Oakley Browne
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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Kisely S. On Adjusting for Life's Confounding. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:182-185. [PMID: 27432824 PMCID: PMC5317017 DOI: 10.1177/0706743716660710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Steve Kisely
- 1 Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada.,2 School of Medicine, University of Queensland, Queensland, Australia
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Liu NH, Daumit GL, Dua T, Aquila R, Charlson F, Cuijpers P, Druss B, Dudek K, Freeman M, Fujii C, Gaebel W, Hegerl U, Levav I, Munk Laursen T, Ma H, Maj M, Elena Medina‐Mora M, Nordentoft M, Prabhakaran D, Pratt K, Prince M, Rangaswamy T, Shiers D, Susser E, Thornicroft G, Wahlbeck K, Fekadu Wassie A, Whiteford H, Saxena S. Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry 2017; 16:30-40. [PMID: 28127922 PMCID: PMC5269481 DOI: 10.1002/wps.20384] [Citation(s) in RCA: 409] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio-environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.
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Affiliation(s)
- Nancy H. Liu
- World Health OrganizationGenevaSwitzerland,University of CaliforniaBerkeleyCAUSA
| | | | - Tarun Dua
- World Health OrganizationGenevaSwitzerland
| | | | - Fiona Charlson
- Queensland Centre for Mental Health ResearchWacolQLDAustralia
| | - Pim Cuijpers
- Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | | | | - Chiyo Fujii
- National Institute of Mental HealthTokyoJapan
| | | | | | | | | | - Hong Ma
- Institute of Mental HealthBeijingP.R. China
| | - Mario Maj
- Department of PsychiatryUniversity of Naples SUNNaplesItaly
| | | | | | | | | | - Martin Prince
- Institute of Psychiatry, King's College LondonLondonUK
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Health care disparities among persons with comorbid schizophrenia and cardiovascular disease: a case-control epidemiological study. Epidemiol Psychiatr Sci 2016; 25:541-547. [PMID: 26423605 PMCID: PMC7137664 DOI: 10.1017/s2045796015000852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS Studies showed health care disparities among persons with comorbid schizophrenia and cardiovascular disease (CVD), including in countries with universal health care. However, the potential positive effect of specific mental health legislation has not been reported. This study aimed to investigate the health care of persons with comorbid schizophrenia and CVD in a country with both a national health insurance and a comprehensive rehabilitation law for persons with mental disabilities. METHOD This study builds on a large case-control epidemiological sample (N = 52 189) of service users. Within the sample we identified a sub-group of persons with CVD diagnoses (n = 8208) and compared service users with and without schizophrenia on drug utilisation, laboratory tests, visits to specialists and surgical interventions. RESULTS Service users with schizophrenia were less likely to meet similar indexes of care as their counterparts: 91% cholesterol tests (p < 0.001), 60% stress tests (p < 0.001), 93% visits to specialists (p = 0.001), 93% drug utilisation (p < 0.001) and 55% CVD surgical interventions (odds ratio 0.55, 95% confidence intervals 0.49-0.61). CONCLUSIONS In Israel, a country with a national health insurance and a rehabilitation law specific for persons with mental disabilities, service users with schizophrenia still fail to receive equitable levels of health care for CVD. However, the disparities appear to be smaller than in other countries with universal health insurance.
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From personal crisis care to convenience shopping: an interpretive description of the experiences of people with mental illness and addictions in community pharmacies. BMC Health Serv Res 2016; 16:569. [PMID: 27729051 PMCID: PMC5059973 DOI: 10.1186/s12913-016-1817-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of community pharmacists is changing globally with pharmacists engaging in more clinically-oriented roles, including in mental health care. Pharmacists' interventions have been shown to improve mental health related outcomes but various barriers can limit pharmacists in their care of patients. We aimed to explore the experiences of people with lived experience of mental illness and addictions in community pharmacies to generate findings to inform practice improvements. METHODS We used interpretive description methodology with analytic procedures of thematic analysis to explore the experiences of people with lived experience of mental illness and addictions with community pharmacy services. Participants were recruited through multiple mechanisms (e.g., paper and online advertisements), offered honorarium for their time, and given the option of a focus group or interview for participation in our study. Data were gathered during July to September of 2012. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed by two researchers. RESULTS We collected approximately nine hours of audio data from 18 individuals in two focus groups (n = 12) and six individual interviews. Fourteen participants were female and the average age was 41 years (range 24 to 57 years). Expectations, decision-making, and supports were identified as central themes underlying the community pharmacy experiences of people with lived experience of mental illness and addictions. Eight subthemes were identified including: relationships with pharmacy staff; patient's role in the pharmacist-patient relationship; crisis and triage; privacy and confidentiality; time; stigma and judgment; medication-related and other services; and transparency. CONCLUSIONS People with lived experience of mental illness and addictions demonstrate a high regard and respect for pharmacist's knowledge and abilities but hold conservative expectations of pharmacy health services shaped by experience, observations, and assumptions. To some extent, expectation management occurs with the recognition of the demands on pharmacists and constraints inherent to community pharmacy practice. Relationships with pharmacy staff are critical to people with lived experience and influence their decision-making. Research in the area of pharmacists' roles in crises and triage, especially in the area of suicide assessment and mitigation, is needed urgently.
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Abstract
Individuals with serious mental illnesses such as psychosis still experience higher mortality rates than the general population, decades after data have linked the gap to increased rates of physical illness, delayed diagnosis, low treatment rates and worse outcomes from treatment received. The nature of the relationship between psychosis and comorbid physical illness is complex. Multiple strategies directed at different levels of disease process, health care systems and stakeholder culture are likely required to make sustained progress in reducing the mortality gap. Evidence for strategies that effectively reduce the burden of physical co-morbidity and lead to improved health outcomes are still in their infancy but growing at a reassuringly fast rate. This editorial considers the existing evidence base and makes suggestions for the development and future direction of this urgent research agenda and how this knowledge can be implemented in clinical practice.
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Affiliation(s)
- M. Docherty
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - B. Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - F. Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
- Collaborative Leadership in Applied Heath Research Centre and Care, South London, UK
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Abstract
Psychiatric disorders are common in many neurological disorders, including epilepsy, migraine, Alzheimer's disease, Parkinson's disease, essential tremor, and stroke. These comorbidities increase disease burden and may complicate the treatment of the combined disorders. Initial studies of the comorbidity of psychiatric and neurological disorders were cross-sectional, and time order of the associations was impossible to elucidate. More recent work has clarified time associations between psychiatric disorders and neurological disorders, particularly in epilepsy and stroke where epidemiological evidence suggests that there is a bidirectional relationship. This article takes an epidemiological approach to understanding these relationships and focuses mostly on epilepsy. Although, these relationships are understood in many neurological disorders, routine screening for psychiatric disorders in neurological disorders is infrequent, mostly due to the lack of partnerships between psychiatrists and neurologists and the paucity of neuropsychiatrists. Much more needs to be done to improve the detection and treatment of patients affected by neurological and psychiatric disorders. Understanding the scope of this overlap may inspire collaborations to improve the lives of people affected by both disorders.
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Schulman-Marcus J, Goyal P, Swaminathan RV, Feldman DN, Wong SC, Singh HS, Minutello RM, Bergman G, Kim LK. Comparison of Trends in Incidence, Revascularization, and In-Hospital Mortality in ST-Elevation Myocardial Infarction in Patients With Versus Without Severe Mental Illness. Am J Cardiol 2016; 117:1405-10. [PMID: 26956637 DOI: 10.1016/j.amjcard.2016.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
Patients with severe mental illness (SMI), including schizophrenia and bipolar disorder, are at elevated risk of ST-elevation myocardial infarction (STEMI) but have previously been reported as less likely to receive revascularization. To study the persistence of these findings over time, we examined trends in STEMI incidence, revascularization, and in-hospital mortality for patients with and without SMI in the National Inpatient Sample from 2003 to 2012. We further used multivariate logistic regression analysis to assess the odds of revascularization and in-hospital mortality. SMI was present in 29,503 of 3,058,697 (1%) of the STEMI population. Patients with SMI were younger (median age 58 vs 67 years), more likely to be women (44% vs 38%), and more likely to have several co-morbidities, including diabetes, chronic pulmonary disease, substance abuse, and obesity (p <0.001 for all). Over time, STEMI incidence significantly decreased in non-SMI (p for trend <0.001) but not in SMI (p for trend 0.14). Revascularization increased in all subgroups (p for trend <0.001) but remained less common in SMI. In-hospital mortality decreased in non-SMI (p for trend = 0.004) but not in SMI (p for trend 0.10). After adjustment, patients with SMI were less likely to undergo revascularization (odds ratio 0.59, 95% CI 0.52 to 0.61, p <0.001), but SMI was not associated with increased in-hospital mortality (odds ratio 0.97, 95% CI 0.93 to 1.01, p = 0.16). In conclusion, in contrast to the overall population, the incidence of STEMI is not decreasing in patients with SMI. Despite changes in the care of STEMI, patients with SMI remain less likely to receive revascularization therapies.
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Affiliation(s)
- Joshua Schulman-Marcus
- Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York.
| | - Parag Goyal
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Rajesh V Swaminathan
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Dmitriy N Feldman
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Shing-Chiu Wong
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Harsimran S Singh
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Robert M Minutello
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Geoffrey Bergman
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Luke K Kim
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
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Baxter AJ, Harris MG, Khatib Y, Brugha TS, Bien H, Bhui K. Reducing excess mortality due to chronic disease in people with severe mental illness: meta-review of health interventions. Br J Psychiatry 2016; 208:322-9. [PMID: 26941263 DOI: 10.1192/bjp.bp.115.163170] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 09/21/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND People with severe mental illness (SMI) have high rates of chronic disease and premature death. AIMS To explore the strength of evidence for interventions to reduce risk of mortality in people with SMI. METHOD In a meta-review of 16 systematic reviews of controlled studies, mortality was the primary outcome (8 reviews). Physiological health measures (body mass index, weight, glucose levels, lipid profiles and blood pressure) were secondary outcomes (14 reviews). RESULTS Antipsychotic and antidepressant medications had some protective effect on mortality, subject to treatment adherence. Integrative community care programmes may reduce physical morbidity and excess deaths, but the effective ingredients are unknown. Interventions to improve unhealthy lifestyles and risky behaviours can improve risk factor profiles, but longer follow-up is needed. Preventive interventions and improved medical care for comorbid chronic disease may reduce excess mortality, but data are lacking. CONCLUSIONS Improved adherence to pharmacological and physical health management guidelines is indicated.
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Affiliation(s)
- Amanda J Baxter
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Meredith G Harris
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Yasmin Khatib
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Traolach S Brugha
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Heidrun Bien
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Kamaldeep Bhui
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
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