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Jansåker F, Sundquist J, Sundquist K, Li X. Association between neighborhood deprivation and mortality in patients with schizophrenia and bipolar disorder-A nationwide follow-up study. Bipolar Disord 2023; 25:489-498. [PMID: 36751995 DOI: 10.1111/bdi.13309] [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] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The aim was to explore the association between neighborhood deprivation and all-cause mortality and cause-specific mortalities in patients with schizophrenia and bipolar disorder. A better understanding of this potential relationship may help to identify patients with schizophrenia and bipolar disorder with an increased mortality risk. METHODS This nationwide study included practically all adults (≥30 years) diagnosed with schizophrenia (n = 34,544) and bipolar disorder (n = 64,035) in Sweden (1997-2017). The association between neighborhood deprivation and mortality was explored using Cox regression. All models were conducted in both men and women and adjusted for individual-level sociodemographic factors and comorbidities. RESULTS There was an association between level of neighborhood deprivation and all-cause mortality in both groups. The adjusted hazard ratios for all-cause mortality associated with high compared to low neighborhood deprivation were 1.18 (95% confidence interval 1.11-1.25) in patients with schizophrenia and 1.33 (1.26-1.41) in patients with bipolar disorder. The two most common mortality causes in both groups were coronary heart disease and cancer. The mortality due to coronary heart disease increased when neighborhood deprivation increased and reached 1.37 (1.18-1.60) in patients with schizophrenia and 1.70 (1.44-2.01) in patients with bipolar disorder living in the most deprived neighborhoods. CONCLUSIONS This study shows that neighborhood deprivation is an important risk factor for all-cause mortality and most cause-specific mortalities among patients with schizophrenia and bipolar disorder. These findings could serve as aid to policymakers when allocating healthcare resources and to clinicians who encounter patients with these conditions in deprived neighborhoods.
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Affiliation(s)
- Filip Jansåker
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Center of Diagnostic Investigations, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Lund, Sweden
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Longitudinal factors associated with mortality in older patients with mood disorders. J Affect Disord 2021; 278:12500. [PMID: 33035948 DOI: 10.1016/j.jad.2020.09.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/05/2020] [Accepted: 09/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND To clarify the longitudinal risk factors for mortality in older people with bipolar disorder (BD) and major depressive disorder (MDD). METHODS This study is a national cohort study of older patients with mood disorders. Patients were identified from Taiwan's National Health Insurance Research Database and followed from 2008 to 2011. We determined the mortality rates and standardized mortality ratios (SMRs) in this study population. Survival analyses were conducted to examine factors and healthcare utilization patterns associated with mortality during the 3-year follow-up period. RESULTS 26,570 patients aged ≥ 65 years and diagnosed with and treated for BD or MDD in 2008 were enrolled (5,854 and 20,716 with BD and MDD, respectively). Within the 3-year follow-up period, 15.24% (n=4048) of the enrolled patients died, including 1003 (17.13%) in the BD and 3045 (14.70%) in the MDD groups. The SMRs for BD and MDD were 1.65 (1.56-1.76), and 1.26 (1.21-1.32), respectively. Among the examined comorbidities, dementia, diabetes mellitus and renal diseases each constituted an elevated relative mortality risk. By contrast, hypertension and hyperlipidemia were associated with a lower risk of mortality. LIMITATION In Taiwan's National Health Insurance program, specific medications are prescribed for specific diagnoses and confounding by indication should be kept in mind. CONCLUSION Older patients with mood disorders had a relatively high mortality risk over the 3-year follow-up period. Early detection, risk prevention, and better management of comorbid physical and mental disorders can improve the health outcomes of older patients with BD and MDD.
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Clinical correlates of socioeconomic status in adolescent bipolar disorder. Compr Psychiatry 2020; 101:152186. [PMID: 32504872 DOI: 10.1016/j.comppsych.2020.152186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/21/2020] [Accepted: 05/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lower socioeconomic status (SES) is associated with symptomatic severity, comorbidity, and functional impairment in adults with bipolar disorder (BD). Little is known about clinical correlates of SES in adolescents with BD. METHODS Participants included 195 adolescents, 13-20 years old, with BD type I, II or not otherwise specified (NOS). Diagnoses were determined by standardized semi-structured interviews. Based on the Hollingshead scale, participants were divided into "low" (SES 1-3) and the "high" (SES 4-5) SES groups. Demographic and clinical correlates of SES were evaluated in univariate analyses; significant variables were evaluated in a logistic regression model. RESULTS Compared to participants in the high SES group (n = 150), participants in the low SES group (n = 45) were significantly younger, less likely to be of Caucasian race and living with natural parents. In the logistic regression model, controlling for age and race, the low SES group had higher risk of police contact or arrest (OR = 2.41, 95% CI:1.14-5.11, p = 0.022), less treatment with stimulants(OR = 0.20 95% CI: 0.06-0.67, p = 0.009), and more post-traumatic stress disorder (PTSD) (OR = 4.08, 95% CI:1.33-12.46, p = 0.014) compared to the high SES group. In sensitivity analyses that further controlled for intact family, the finding of higher rates of police contact or arrest was no longer significant. LIMITATIONS Cross-sectional design; higher-skewed SES sample. CONCLUSIONS Lower SES in adolescent BD is associated with higher legal risk, increased PTSD, and under-treatment of attention-deficit/hyperactivity disorder (ADHD). Future studies are needed to evaluate the inter-relationships of these correlates, using prospective designs that can evaluate the direction of these associations. Further studies incorporating neurobiological markers are also needed to explore mechanisms underlying SES-related differences in BD.
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Himmerich H, Hotopf M, Shetty H, Schmidt U, Treasure J, Hayes RD, Stewart R, Chang CK. Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa. Soc Psychiatry Psychiatr Epidemiol 2019; 54:813-821. [PMID: 30756148 DOI: 10.1007/s00127-019-01667-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality. METHODS We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score. RESULTS A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates. CONCLUSIONS These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D Hayes
- Department of Psychological Medicine, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- Department of Psychological Medicine, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Jhongcheng Rd, Shilin District, Taipei, 111, Taiwan.
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Himmerich H, Hotopf M, Shetty H, Schmidt U, Treasure J, Hayes RD, Stewart R, Chang CK. Psychiatric comorbidity as a risk factor for mortality in people with anorexia nervosa. Eur Arch Psychiatry Clin Neurosci 2019; 269:351-359. [PMID: 30120534 DOI: 10.1007/s00406-018-0937-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/09/2018] [Indexed: 12/27/2022]
Abstract
Anorexia nervosa (AN) is found associated with increased mortality. Frequent comorbidities of AN include substance use disorders (SUD), affective disorders (AD) and personality disorders (PD). We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders in the observation window between January 2007 and March 2016 for 1970 people with AN, using data from the case register of the South London and Maudsley (SLaM) NHS Foundation Trust, an almost monopoly-secondary mental healthcare service provider in southeast London. We retrieved data from its Clinical Records Interactive Search (CRIS) system as data source. Mortality was ascertained through nationwide tracing by the UK Office for National Statistics (ONS) linked to CRIS database on a monthly basis. A total of 43 people with AN died during the observation period. Standardized Mortality Ratio (SMR) with England and Wales population in 2012 as standard population for our study cohort was 5.21 (95% CI 3.77, 7.02). In univariate analyses, the comorbidity of SUD or PD was found to significantly increase the relative risks of mortality (HRs = 3.10, 95% CI 1.21, 7.92; and 2.58, 95% CI 1.23, 5.40, respectively). After adjustment for demographic and socioeconomic covariates as confounders, moderately but not significantly elevated risks were identified for SUD (adjusted HR = 1.39, 95% CI 0.53, 3.65) and PD (adjusted HR = 1.58, 95% CI 0.70, 3.56). These results suggest an elevated mortality in people with AN, which might be, at least partially, explained by the existence of the comorbidities SUD or PD.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D Hayes
- Department of Psychological Medicine, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- Department of Psychological Medicine, King's College London, London, UK. .,South London and Maudsley NHS Foundation Trust, London, UK. .,Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Jhongcheng Rd, Shilin District, Taipei, 111, Taiwan.
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Pan YJ, Kuo KH, Yeh LL. Healthcare cost, service use and mortality in major psychiatric disorders in Taiwan. J Affect Disord 2019; 246:112-120. [PMID: 30580196 DOI: 10.1016/j.jad.2018.12.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/06/2018] [Accepted: 12/16/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND We aimed to examine the differences in the cost distributions, service use, and mortality outcomes, across major psychiatric disorders in Taiwan. METHOD A national cohort of adult patients (n = 68,068) who had newly received a diagnosis of schizophrenia, bipolar disorder, and major depressive disorder (MDD) was identified from the National Health Insurance Research Database and followed for the subsequent three years. Variations in the 1-year and 3-year healthcare cost distributions and mortality outcomes were examined according to age group (18-64 years, ≥65 years) and diagnosis. RESULTS Regardless of age group, individuals with schizophrenia had the highest total and psychiatric healthcare costs. Healthcare costs for psychiatric services accounted for 84.25%, 60%, and 29.62% of the 1-year total healthcare costs for younger patients with a diagnosis of schizophrenia, bipolar disorder, and MDD, respectively. Psychiatric inpatient care costs constituted a major part of the 1-year psychiatric healthcare costs, e.g., 85.86% for schizophrenia patients aged 18-64 years, while psychiatric medication costs contributed to a relatively smaller part. For those older than 65 years, costs of other specialties for comorbid physical conditions were more prominent. LIMITATIONS The perspective of the current analysis was limited to healthcare services, and we were not able to analyse wider economic impacts. CONCLUSIONS Psychiatric inpatient care costs contributed to a significant share of psychiatric expenditures, emphasizing the need of developing strategies to reduce rehospitalisations. For those aged 65 years or older, efforts to improve interdisciplinary service care for comorbid physical conditions may be required.
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Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Kuei-Hong Kuo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Medical Image, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ling-Ling Yeh
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
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Łaszewska A, Österle A, Wancata J, Simon J. Prevalence of mental diseases in Austria : Systematic review of the published evidence. Wien Klin Wochenschr 2018; 130:141-150. [PMID: 29368240 PMCID: PMC5816100 DOI: 10.1007/s00508-018-1316-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/08/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Addressing the growing burden of mental diseases is a public health priority. Nevertheless, many countries lack reliable estimates of the proportion of the population affected, which are crucial for health and social policy planning. This study aimed to collect existing evidence on the prevalence of mental diseases in Austria. METHODS A systematic review was conducted using MeSH, EMTREE and free-text terms in seven bibliographic databases. In addition, the references of included papers and relevant Austria-specific websites were searched. Articles published after 1996 pertaining to the Austrian adult population and presenting prevalence data for mental diseases were included in the analysis. RESULTS A total of 2612 records were identified in the database search, 19 of which were included in the analysis, 13 were community-based studies and 6 examined institutionalized populations. Sample sizes ranged from 200 to 15,474. The evidence was centered around depression (n = 6, 32%), eating disorders (n = 4, 21%) and alcohol dependence (n = 3, 16%). While most studies (n = 10, 53%) used questionnaires and scales to identify mental diseases, seven studies used structured clinical interviews, and two studies examined use of psychotropic drugs. Due to the diversity of methodologies, no statistical pooling of prevalence estimates was possible. CONCLUSION Information on the prevalence of mental diseases in Austria is limited and comparability between studies is restricted. A variety of diagnostic instruments, targeted populations and investigated diseases contribute to discrepancies in the prevalence rates. A systematic, large-scale study on the prevalence of mental diseases in Austria is needed for comprehensive and robust epidemiological evidence.
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Affiliation(s)
- Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
| | - August Österle
- Institute for Social Policy, Vienna University of Economics and Business, Welthandelsplatz 1, 1020 Vienna, Austria
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
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Ortiz A, Bradler K, Hintze A. Episode forecasting in bipolar disorder: Is energy better than mood? Bipolar Disord 2018; 20:470-476. [PMID: 29356281 DOI: 10.1111/bdi.12603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 09/27/2017] [Accepted: 12/15/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Bipolar disorder is a severe mood disorder characterized by alternating episodes of mania and depression. Several interventions have been developed to decrease high admission rates and high suicides rates associated with the illness, including psychoeducation and early episode detection, with mixed results. More recently, machine learning approaches have been used to aid clinical diagnosis or to detect a particular clinical state; however, contradictory results arise from confusion around which of the several automatically generated data are the most contributory and useful to detect a particular clinical state. Our aim for this study was to apply machine learning techniques and nonlinear analyses to a physiological time series dataset in order to find the best predictor for forecasting episodes in mood disorders. METHODS We employed three different techniques: entropy calculations and two different machine learning approaches (genetic programming and Markov Brains as classifiers) to determine whether mood, energy or sleep was the best predictor to forecast a mood episode in a physiological time series. RESULTS Evening energy was the best predictor for both manic and depressive episodes in each of the three aforementioned techniques. This suggests that energy might be a better predictor than mood for forecasting mood episodes in bipolar disorder and that these particular machine learning approaches are valuable tools to be used clinically. CONCLUSIONS Energy should be considered as an important factor for episode prediction. Machine learning approaches provide better tools to forecast episodes and to increase our understanding of the processes that underlie mood regulation.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Kamil Bradler
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON, Canada
| | - Arend Hintze
- Department of Integrative Biology, Michigan State University, East Lansing, MI, USA
- Department of Computer Science and Engineering, Michigan State University, East Lansing, MI, USA
- BEACON Center for studying Evolution in Action, Michigan State University, East Lansing, MI, USA
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Pan YJ, Yeh LL, Chan HY, Chang CK. Transformation of excess mortality in people with schizophrenia and bipolar disorder in Taiwan. Psychol Med 2017; 47:2483-2493. [PMID: 28443526 DOI: 10.1017/s0033291717001040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Given the concerns regarding the adverse health outcomes associated with weight gain and metabolic syndrome in relation to use of second-generation antipsychotics (SGAs), we aimed in this study to explore whether the increase in the use of SGAs would have any impacts on the trend of excess mortality in people with schizophrenia and bipolar disorder (BPD). METHOD Two nationwide samples of individuals with schizophrenia and BPD were identified in Taiwan's National Health Insurance Research Database in 2003 and in 2008, respectively. Age- and gender-standardized mortality ratios (SMRs) were calculated for each of the 3-year observation periods. The SMRs were compared between the calendar year cohorts, by disease group, and by causes of death. RESULTS The mortality gap for people with schizophrenia decreased slightly, revealing an SMR of 3.40 (95% CI 3.30-3.50) for the 2003 cohort and 3.14 (3.06-3.23) for the 2008 cohort. The mortality gap for BPD individuals remained relatively stable with only those aged 15-44 years having an SMR rising significantly from 7.04 (6.38-7.76) to 9.10 (8.44-9.79). Additionally, in this group of BPD patients aged 15-44 years, the natural-cause-SMR increased from 5.65 (4.93-6.44) to 7.16 (6.46-7.91). CONCLUSIONS Compared with the general population, the gap in the excess mortality for people with schizophrenia reduced slightly. However, the over 200% difference between the cohorts in the excess mortality for BPD individuals aged 15-44 years could be a warning sign. Future research to further examine the related factors underlying those changes is warranted.
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Affiliation(s)
- Y-J Pan
- Department of Psychiatry,Far Eastern Memorial Hospital,New Taipei City,Taiwan
| | - L-L Yeh
- Department of Healthcare Administration,College of Health Science,Asia University,Taichung,Taiwan
| | - H-Y Chan
- Department of General Psychiatry,Taoyuan Psychiatric Center,Taoyuan,Taiwan
| | - C-K Chang
- Department of Psychological Medicine,King's College London (Institute of Psychiatry, Psychology, and Neuroscience),London,UK
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Pan YJ, Yeh LL, Chen YC, Chan HY. Three-year mortality in relation to early hospitalization and number of outpatient clinic visits in people with newly diagnosed bipolar disorder. Gen Hosp Psychiatry 2016; 43:32-37. [PMID: 27796255 DOI: 10.1016/j.genhosppsych.2016.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Whether the early treatment pattern in people with bipolar disorder (BD) could influence later mortality remains to be determined. We aimed to explore the potential effects of early hospitalization and number of outpatient clinic visits on the 3-year mortality in patients with newly diagnosed BD. METHOD Adult participants with newly diagnosed BD were identified in Taiwan's National Health Insurance Research Database in 2008. Survival analyses were performed with this national cohort to examine the associations between the first-year treatment pattern (hospitalization and number of outpatient clinic visits) and mortality over a follow-up period of 3 years (2008-2011). RESULTS A total of 15,254 participants were included. The mean age was 44.9 (S.D.=16.7) years and around 39.9% were male. The average follow-up time was 1055 days. Compared to BD patients with ≥7 times outpatient clinic visits within the first year, the risk of mortality was found elevated [hazard ratio=1.74; 95% confidence interval (CI), 1.40-2.15] for those who needed inpatient treatment. Number of outpatient clinic visits within the first year was found to be negatively associated with later mortality. Besides cancer (hazard ratio=2.14; 95% CI, 1.74-2.63), diabetes mellitus (hazard ratio=1.61; 95% CI, 1.38-1.89) and renal disease (hazard ratio=1.65; 95% CI, 1.36-2.00) were associated with the highest risk of mortality among the physical comorbidities. Substance use disorder stood out as the single comorbid mental illness associated with the highest mortality risk (hazard ratio=1.74; 95% CI, 1.37-2.21). CONCLUSIONS Early treatment pattern, including hospitalization and number of outpatient clinic visits, was associated with later mortality in BD patients. Special care should be given to enhance treatment adherence and to give psychoeducation to those with certain comorbid mental/physical illnesses to reduce health harming behavior and to improve health outcome.
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Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan; Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Ling Yeh
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Yu-Chun Chen
- Department of Medical Research and Education, National Yang-Ming University Hospital, Yilan, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
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