Hospital-based Psychiatric Service Utilization and Morbidity in Multiple Sclerosis

ABSTRACT:Background:Despite the common association of psychiatric morbidity and multiple sclerosis (MS), population-based prevalence estimates of these disorders are limited. Such estimates are of particular importance to those conducting trials of interventions for the treatment of MS. This study examined the prevalence of bipolar disorder, depression, and attempted suicide among hospital service utilizers in Nova Scotia and compared these measures for the MS and non-MS population.Methods:Data regarding diagnosis and utilization were extracted from two linked databases which included all hospital separation records for Nova Scotia over a 3 year period (1992/93-1994/95).Results:The prevalence of bipolar disorder in hospitalized MS patients was 1.97% and depression was 4.27%. These rates were significantly higher than the 0.92% and 2.04%, respectively, for the non-MS hospital utilizers. These diagnoses also accounted for more than half of the primary diagnostic codes for psychiatric service separations by MS patients. The proportion of total hospital utilization which was accounted for by psychiatric services did not differ between MS and non-MS utilizers. While suicide attempts were rare, the estimated frequency of suicide attempts in the total MS population was more than three times that of the general population.Conclusions:Bipolar disorder and depression were twice as prevalent in hospitalized MS patients as in the general population of hospital utilizers while the estimated frequency of suicide attempts was at least three times greater. These results illustrate that psychiatric morbidity and service utilization are important considerations in the care of MS patients.

Download Full-text

Association between inflammatory bowel disease and psychiatric morbidity and suicide: A Swedish nationwide population-based cohort study with sibling comparisons

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab039 ◽

2021 ◽

Author(s):

Jonas F Ludvigsson ◽

Ola Olén ◽

Henrik Larsson ◽

Jonas Halfvarson ◽

Catarina Almqvist ◽

...

Keyword(s):

General Population ◽

Psychiatric Disorders ◽

Suicide Attempts ◽

Psychiatric Morbidity ◽

Population Based ◽

First Year ◽

Adult Onset ◽

Increased Risk ◽

Elderly Onset

Abstract Background and Aims Inflammatory bowel disease (IBD) is linked to psychiatric morbidity, but few studies have assessed general population comparators. We aimed to investigate the risk of psychiatric morbidity and suicide in adult-onset IBD patients. Methods Nationwide population-based cohort study in Sweden (1973-2013). We studied the risk of psychiatric disorders and suicide in 69,865 adult-onset IBD patients (ulcerative colitis, UC: n=43,557; Crohn’s disease, CD: n=21,245; and IBD-unclassified: n=5063) compared to 3,472,913 general population references and 66,292 siblings. Results During a median follow-up of 11 years, we found 7,465 (10.7%) first psychiatric disorders in IBD (incidence rate, IR/1000 person-years 8.4) and 306,911 (9.9%) in the general population (IR 6.6), resulting in 1.8 extra psychiatric morbidity per 100 patients followed-up for 10 years and a hazard ratio (HR) of 1.3 (95% confidence interval, 95%CI=1.2-1.3). The highest risk of overall psychiatric morbidity was seen in the first year after IBD diagnosis (HR=1.4, 95%CI=1.2-1.6) and in patients with extraintestinal manifestations (HR=1.6, 95%CI=1.5-1.7). Psychiatric morbidity was more common in all IBD subtypes (HRs 1.3 to 1.5). An increased risk of suicide attempts was observed among all IBD types (HRs=1.2 to 1.4), whereas completed suicide was explicitly associated with CD (HR=1.5) and elderly-onset (diagnosed at the age of >60 years) IBD (HR=1.7). Conclusion Adult-onset IBD was associated with an increased risk of psychiatric disorders and suicide attempts. Psychological follow-up should be provided to patients with IBD, especially those with extraintestinal manifestations and elderly-onset IBD. This follow-up should transpire within the first year after IBD diagnosis.

Download Full-text

Association of prior depressive symptoms and suicide attempts with subsequent victimization: analysis of population-based data from the Adult Psychiatric Morbidity Survey

European Psychiatry ◽

10.1192/j.eurpsy.2020.50 ◽

2020 ◽

Vol 63 (1) ◽

Author(s):

Vishal Bhavsar ◽

Stephani L Hatch ◽

Kimberlie Dean ◽

Sally McManus

Keyword(s):

Depressive Symptoms ◽

General Population ◽

Suicide Attempt ◽

Partner Violence ◽

Suicide Attempts ◽

Psychiatric Morbidity ◽

Population Based ◽

The United Kingdom ◽

Nationally Representative

Abstract Background: Symptoms of mental disorder, particularly schizophrenia, predispose to victimization. Much less is known about the relationship between depressive symptoms and later victimization in the general population, the influence of these symptoms on types of subsequent victimization, or the role of symptom severity. We investigated this in nationally representative data from the United Kingdom. Methods: Data were from the Adult Psychiatric Morbidity Survey 2007. Multivariable logistic regressions estimated association between (a) prior depressive symptoms, (b) prior depressive symptoms with suicide attempt, and types of more recent victimization. Gender-specific associations were estimated using multiplicative interactions. Results: Prior depressive symptoms were associated with greater odds of any recent intimate partner violence (IPV), emotional IPV, sexual victimization, workplace victimization, any victimization, and cumulative victimization (adjusted odds ratio [aOR] for increasing types of recent victimization: 1.47, 95% confidence interval [CI]: 1.14, 1.89). Prior depressive symptoms with suicide attempt were associated with any recent IPV, emotional IPV, any victimization, and cumulative victimization (aOR for increasing types of recent victimization: 2.33, 95% CI: 1.22, 4.44). Self reported recalled data on previous depressive symptoms may have limited accuracy. Small numbers of outcomes for some comparisons results in imprecision of these estimates. Conclusions: Aside from severe mental illness such as schizophrenia, previous depressive symptoms in the general population are associated with greater subsequent victimization. Men and women with prior depressive symptoms may be vulnerable to a range of types of victimization, and may benefit from interventions to reduce this vulnerability.

Download Full-text

Conjugal multiple sclerosis in Isfahan, Iran: a population-based study

Multiple Sclerosis Journal ◽

10.1177/1352458506072092 ◽

2007 ◽

Vol 13 (5) ◽

pp. 673-675 ◽

Cited By ~ 3

Author(s):

A.H. Maghzi ◽

M. Etemadifar ◽

V. Shaygannejad ◽

M. Saadatnia ◽

M. Salehi ◽

...

Keyword(s):

Multiple Sclerosis ◽

General Population ◽

Environmental Factors ◽

Adult Life ◽

Marital Relationship ◽

Population Based ◽

Rare Form ◽

Population Based Study ◽

Increased Risk ◽

Estimated Risk

Conjugal multiple sclerosis (MS) is a rare form of MS in which both spouses are affected, and at least one is affected after marriage. Among 1606 definite MS patients, 1076 were in marital relationship, among whom we identified six conjugal pairs, giving the conjugal rate of 0.5%. This rate is 12.5 times higher than the estimated risk of MS for the general population (0.04%). The observed conjugal rate suggests an increased risk of developing MS for MS patients' spouses, this could be due to transmission or, more likely, to the same environmental factors shared in adult life. Multiple Sclerosis 2007; 13: 673-675. http://msj.sagepub.com

Download Full-text

Cardiovascular drug use and mortality in patients with schizophrenia or bipolar disorder: a Danish population-based study

Psychological Medicine ◽

10.1017/s003329171300216x ◽

2013 ◽

Vol 44 (8) ◽

pp. 1625-1637 ◽

Cited By ~ 38

Author(s):

T. M. Laursen ◽

P. B. Mortensen ◽

J. H. MacCabe ◽

D. Cohen ◽

C. Gasse

Keyword(s):

Risk Factors ◽

Bipolar Disorder ◽

Drug Use ◽

General Population ◽

Cerebrovascular Disease ◽

Severity Of Illness ◽

Population Based ◽

Danish Population ◽

Co Morbidity ◽

Rate Ratios

BackgroundCardiovascular (CV) co-morbidity is one of the major modifiable risk factors driving the excess mortality in individuals with schizophrenia or bipolar disorder. Population-based studies in this area are sparse.MethodWe used Danish population registers to calculate incidence rate ratios (IRRs) for CV drug use, and mortality rate ratios comparing subjects with schizophrenia or bipolar disorder with subjects with no prior psychiatric hospitalization.ResultsIRRs for CV prescriptions were significantly decreased in patients with schizophrenia or bipolar disorder compared with the general population. Among persons without previous myocardial infarction (MI) or cerebrovascular disease, persons with schizophrenia or bipolar disorder had an up to 6- and 15-fold increased mortality from all causes or unnatural causes, respectively, compared with the general population, being most pronounced among those without CV treatment (16-fold increase). Among those with previous MI or cerebrovascular disease, excess all-cause and unnatural death was lower (up to 3-fold and 7-fold increased, respectively), but was similar in CV-treated and -untreated persons.ConclusionsThe present study shows an apparent under-prescription of most CV drugs among patients with schizophrenia or bipolar disorder compared with the general population in Denmark. The excess of mortality by unnatural deaths in the untreated group suggests that the association between CV treatment and mortality may be confounded by severity of illness. However, our results also suggest that treatment of CV risk factors is neglected in these patients.

Download Full-text

Use of Treatment Services and Pharmacotherapy for Bipolar Disorder in a General Population-Based Mental Health Survey

Yearbook of Psychiatry and Applied Mental Health ◽

10.1016/s0084-3970(08)70497-3 ◽

2007 ◽

Vol 2007 ◽

pp. 200-201

Author(s):

J.C. Ballenger

Keyword(s):

Mental Health ◽

Bipolar Disorder ◽

General Population ◽

Health Survey ◽

Population Based ◽

Treatment Services ◽

Mental Health Survey

Download Full-text

Differences in cholesterol and metabolic syndrome between bipolar disorder men with and without suicide attempts

Acta Neuropsychiatrica ◽

10.1017/s0924270800032798 ◽

2009 ◽

Vol 21 (S2) ◽

pp. 66-69 ◽

Cited By ~ 5

Author(s):

Bjanka Vuksan-Ćusa ◽

Darko Marčinko ◽

Sanea Nad ◽

Miro Jakovljević

Keyword(s):

Metabolic Syndrome ◽

Bipolar Disorder ◽

General Population ◽

Serum Cholesterol ◽

Suicide Attempts ◽

Statistical Significance ◽

Mental Illnesses ◽

Blood Cholesterol ◽

Relative Risk Ratio ◽

Cholesterol Levels

Abstract:Patient with mental illnesses such as schizophrenia and bipolar disorder have an increased prevalence of metabolic syndrome (MetS) and its components compared to general population. Among psychiatric disorders, bipolar disorder ranks highest in suicidality with a relative risk ratio of completed suicide of about 25 compared to the general population. Regarding the biological hypotheses of suicidality, low blood cholesterol level has been extensively explored, although results are still conflicting. The aim of this study was to investigate whether there were differences in the serum cholesterol levels in hospitalized bipolar disorder men patients with history of suicide attempts (n= 20) and without suicide attempts (n= 20). Additionally, we investigated if there were differences in the prevalence of MetS according to NCEP ATP-III criteria in these two groups of patients. Results of the study indicated significantly lower serum cholesterol levels (P = 0.013) and triglyceride levels (P = 0.047), in the bipolar disorder men with suicide attempts in comparison to bipolar disorder men without suicide attempts. The overall prevalence of MetS was 11/40 (27.5%). On this particular sample it was higher in the non-attempters 8/20 (40.0%) than in attempters 3/20 (15.0%) bipolar men group, but without statistical significance. Lower concentrations of serum cholesterol might be useful biological markers of suicidality in men with bipolar disorder.

Download Full-text

Sources and level of income among individuals with multiple sclerosis compared to the general population: A nationwide population-based study

Multiple Sclerosis Journal ◽

10.1177/1352458515570767 ◽

2015 ◽

Vol 21 (13) ◽

pp. 1730-1741 ◽

Cited By ~ 16

Author(s):

Michael Wiberg ◽

Emilie Friberg ◽

Magnus Stenbeck ◽

Kristina Alexanderson ◽

Anders Norlund ◽

...

Keyword(s):

Multiple Sclerosis ◽

General Population ◽

Sickness Absence ◽

Disability Pension ◽

Reference Group ◽

Work Capacity ◽

Population Based ◽

Social Benefits ◽

Unemployment Compensation ◽

Percentage Difference

Introduction: Multiple sclerosis (MS) is associated with reduced work capacity, but there is limited knowledge about MS patients’ sources of income. Objectives: The purpose of this study was to elucidate MS patients’ earnings and social benefits compared to those of the general population. Methods: From nationwide registers of all residents in Sweden aged 21–64 years in 2010 ( n=5,291,764), those with an MS diagnosis ( n=13,979) were compared to a propensity score matched reference group ( n=69,895). Descriptive statistics and regression models were used to estimate the percentage difference between the MS patients and the matched references regarding the following annual incomes: earnings, disability pension, sickness absence, disability allowance, unemployment compensation and social assistance. Results: Both MS patients and the matched references received most of their income from earnings followed by disability pension and sickness absence. MS patients that were diagnosed in 2010 had 15% lower earnings than the matched references, while MS patients diagnosed before 2005 had 38% lower earnings. Corresponding figures regarding summed social benefits were 33% and 130% higher for MS patients, respectively. Conclusion: The results indicate that MS patients are overrepresented, in relative and absolute terms, regarding health-related benefits and have lower levels of earnings. However, the redistributing welfare systems appear to financially compensate the MS patients considerably.

Download Full-text

The incidence and prevalence of fibromyalgia are higher in multiple sclerosis than the general population: A population-based study

Multiple Sclerosis and Related Disorders ◽

10.1016/j.msard.2012.06.001 ◽

2012 ◽

Vol 1 (4) ◽

pp. 162-167 ◽

Cited By ~ 11

Author(s):

Ruth Ann Marrie ◽

Bo Nancy Yu ◽

Stella Leung ◽

Lawrence Elliott ◽

Sharon Warren ◽

...

Keyword(s):

Multiple Sclerosis ◽

General Population ◽

Population Based ◽

Population Based Study

Download Full-text

Comorbidities in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis versus the General Population

The Journal of Rheumatology ◽

10.3899/jrheum.151151 ◽

2016 ◽

Vol 43 (8) ◽

pp. 1553-1558 ◽

Cited By ~ 15

Author(s):

Martin Englund ◽

Peter A. Merkel ◽

Gunnar Tomasson ◽

Mårten Segelmark ◽

Aladdin J. Mohammad

Keyword(s):

General Population ◽

Statistical Significance ◽

Antineutrophil Cytoplasmic Antibody ◽

Population Based ◽

Endocrine Disorders ◽

Comorbid Conditions ◽

Southern Sweden ◽

Cerebrovascular Accidents ◽

Diagnostic Codes ◽

Rate Ratios

Objective.To evaluate the consultation rates of selected comorbidities in patients with antineutrophil cytoplasmic antibody–associated vasculitis (AAV) compared with the general population in southern Sweden.Methods.We used data from a population-based cohort of patients with AAV diagnosed between 1998 and 2010 in Southern Sweden (701,000 inhabitants). For each patient we identified 4 reference subjects randomly sampled from the general population and matched for year of birth, sex, area of residence, and index year. Using the population-based Skåne Healthcare Register, we identified relevant diagnostic codes, registered between 1998 and 2011, for selected comorbidities assigned after the date of diagnosis of AAV or the index date for the reference subjects. We calculated rate ratios for comorbidities (AAV:reference subjects).Results.There were 186 patients with AAV (95 women, mean age 64.5 yrs) and 744 reference persons included in the analysis. The highest rate ratios (AAV:reference) were obtained for osteoporosis (4.6, 95% CI 3.0–7.0), followed by venous thromboembolism (4.0, 95% CI 1.9–8.3), thyroid diseases (2.1, 95% CI 1.3–3.3), and diabetes mellitus (2.0, 95% CI 1.3–2.9). For ischemic heart disease, the rate ratio of 1.5 (95% CI 1.0–2.3) did not reach statistical significance. No statistically significant differences were found for cerebrovascular accidents.Conclusion.AAV is associated with increased consultation rates of several comorbidities including osteoporosis and thromboembolic and endocrine disorders. Comorbid conditions should be taken into consideration when planning and providing care for patients with AAV.

Download Full-text