Ethnicity and excess mortality in severe mental illness: a cohort study

BackgroundPeople with severe mental illness (SMI) have high rates of chronic disease and premature death.AimsTo explore the strength of evidence for interventions to reduce risk of mortality in people with SMI.MethodIn 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).ResultsAntipsychotic 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.ConclusionsImproved adherence to pharmacological and physical health management guidelines is indicated.

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Characteristics of trafficked adults and children with severe mental illness: a historical cohort study

The Lancet Psychiatry ◽

10.1016/s2215-0366(15)00290-4 ◽

2015 ◽

Vol 2 (12) ◽

pp. 1084-1091 ◽

Cited By ~ 46

Author(s):

Siân Oram ◽

Mizanur Khondoker ◽

Melanie Abas ◽

Matthew Broadbent ◽

Louise M Howard

Keyword(s):

Mental Illness ◽

Cohort Study ◽

Severe Mental Illness ◽

Historical Cohort ◽

Historical Cohort Study ◽

Adults And Children

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Residential mobility among individuals with severe mental illness: cohort study of UK700 participants

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-009-0115-4 ◽

2009 ◽

Vol 45 (8) ◽

pp. 767-777 ◽

Cited By ~ 12

Author(s):

Alex D. Tulloch ◽

Paul Fearon ◽

Tom Fahy ◽

Anthony David

Keyword(s):

Mental Illness ◽

Cohort Study ◽

Severe Mental Illness ◽

Residential Mobility

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Association of severe mental illness with stroke outcomes and process-of-care quality indicators: nationwide cohort study

The British Journal of Psychiatry ◽

10.1192/bjp.2021.120 ◽

2021 ◽

pp. 1-8

Author(s):

Kelly Fleetwood ◽

Sarah H. Wild ◽

Daniel J. Smith ◽

Stewart W. Mercer ◽

Kirsty Licence ◽

...

Keyword(s):

Bipolar Disorder ◽

Mental Illness ◽

Cohort Study ◽

Major Depression ◽

Severe Mental Illness ◽

Quality Indicators ◽

Care Quality ◽

Process Of Care ◽

Vascular Events ◽

Stroke Outcomes

Background Severe mental illness (SMI) is associated with increased stroke risk, but little is known about how SMI relates to stroke prognosis and receipt of acute care. Aims To determine the association between SMI and stroke outcomes and receipt of process-of-care quality indicators (such as timely admission to stroke unit). Method We conducted a cohort study using routinely collected linked data-sets, including adults with a first hospital admission for stroke in Scotland during 1991–2014, with process-of-care quality indicator data available from 2010. We identified pre-existing schizophrenia, bipolar disorder and major depression from hospital records. We used logistic regression to evaluate 30-day, 1-year and 5-year mortality and receipt of process-of-care quality indicators by pre-existing SMI, adjusting for sociodemographic and clinical factors. We used Cox regression to evaluate further stroke and vascular events (stroke and myocardial infarction). Results Among 228 699 patients who had had a stroke, 1186 (0.5%), 859 (0.4%), 7308 (3.2%) had schizophrenia, bipolar disorder and major depression, respectively. Overall, median follow-up was 2.6 years. Compared with adults without a record of mental illness, 30-day mortality was higher for schizophrenia (adjusted odds ratio (aOR) = 1.33, 95% CI 1.16–1.52), bipolar disorder (aOR = 1.37, 95% CI 1.18–1.60) and major depression (aOR = 1.11, 95% CI 1.05–1.18). Each disorder was also associated with marked increased risk of 1-year and 5-year mortality and further stroke and vascular events. There were no clear differences in receipt of process-of-care quality indicators. Conclusions Pre-existing SMI was associated with higher risks of mortality and further vascular events. Urgent action is needed to better understand and address the reasons for these disparities.

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COVID ‐19 vaccination uptake in people with severe mental illness: a UK ‐based cohort study

World Psychiatry ◽

10.1002/wps.20945 ◽

2022 ◽

Vol 21 (1) ◽

pp. 153-154

Author(s):

Lamiece Hassan ◽

Chelsea Sawyer ◽

Niels Peek ◽

Karina Lovell ◽

Andre F. Carvalho ◽

...

Keyword(s):

Mental Illness ◽

Cohort Study ◽

Severe Mental Illness ◽

Vaccination Uptake

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Disparities in Intensive Care Unit Admission and Mortality Among Patients With Schizophrenia and COVID-19: A National Cohort Study

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa158 ◽

2020 ◽

Cited By ~ 1

Author(s):

Guillaume Fond ◽

Vanessa Pauly ◽

Marc Leone ◽

Pierre-Michel Llorca ◽

Veronica Orleans ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Mental Illness ◽

Cohort Study ◽

Intensive Care ◽

Hospital Mortality ◽

Severe Mental Illness ◽

Vulnerable Population ◽

Icu Admission ◽

Risk Of Death

Abstract Patients with schizophrenia (SCZ) represent a vulnerable population who have been understudied in COVID-19 research. We aimed to establish whether health outcomes and care differed between patients with SCZ and patients without a diagnosis of severe mental illness. We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. Cases were patients who had a diagnosis of SCZ. Controls were patients who did not have a diagnosis of severe mental illness. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. A total of 50 750 patients were included, of whom 823 were SCZ patients (1.6%). The SCZ patients had an increased in-hospital mortality (25.6% vs 21.7%; adjusted OR 1.30 [95% CI, 1.08–1.56], P = .0093) and a decreased ICU admission rate (23.7% vs 28.4%; adjusted OR, 0.75 [95% CI, 0.62–0.91], P = .0062) compared with controls. Significant interactions between SCZ and age for mortality and ICU admission were observed (P = .0006 and P < .0001). SCZ patients between 65 and 80 years had a significantly higher risk of death than controls of the same age (+7.89%). SCZ patients younger than 55 years had more ICU admissions (+13.93%) and SCZ patients between 65 and 80 years and older than 80 years had less ICU admissions than controls of the same age (−15.44% and −5.93%, respectively). Our findings report the existence of disparities in health and health care between SCZ patients and patients without a diagnosis of severe mental illness. These disparities differed according to the age and clinical profile of SCZ patients, suggesting the importance of personalized COVID-19 clinical management and health care strategies before, during, and after hospitalization for reducing health disparities in this vulnerable population.

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