Higher mortality after myocardial infarction in patients with severe mental illness: a nationwide cohort study

Abstract Background Severe mental illness (SMI), comprising schizophrenia, bipolar disorder and major depression, is associated with higher myocardial infarction (MI) mortality but lower coronary revascularisation rates. Previous studies have largely focused on schizophrenia, with limited information on bipolar disorder and major depression, long-term mortality or the effects of either sociodemographic factors or year of MI. We investigated the associations between SMI and MI prognosis and how these differed by age at MI, sex and year of MI. Methods We conducted a national retrospective cohort study, including adults with a hospitalised MI in Scotland between 1991 and 2014. We ascertained previous history of schizophrenia, bipolar disorder and major depression from psychiatric and general hospital admission records. We used logistic regression to obtain odds ratios adjusted for sociodemographic factors for 30-day, 1-year and 5-year mortality, comparing people with each SMI to a comparison group without a prior hospital record for any mental health condition. We used Cox regression to analyse coronary revascularisation within 30 days, risk of further MI and further vascular events (MI or stroke). We investigated associations for interaction with age at MI, sex and year of MI. Results Among 235,310 people with MI, 923 (0.4%) had schizophrenia, 642 (0.3%) had bipolar disorder and 6239 (2.7%) had major depression. SMI was associated with higher 30-day, 1-year and 5-year mortality and risk of further MI and stroke. Thirty-day mortality was higher for schizophrenia (OR 1.95, 95% CI 1.64–2.30), bipolar disorder (OR 1.53, 95% CI 1.26–1.86) and major depression (OR 1.31, 95% CI 1.23–1.40). Odds ratios for 1-year and 5-year mortality were larger for all three conditions. Revascularisation rates were lower in schizophrenia (HR 0.57, 95% CI 0.48–0.67), bipolar disorder (HR 0.69, 95% CI 0.56–0.85) and major depression (HR 0.78, 95% CI 0.73–0.83). Mortality and revascularisation disparities persisted from 1991 to 2014, with absolute mortality disparities more apparent for MIs that occurred around 70 years of age, the overall mean age of MI. Women with major depression had a greater reduction in revascularisation than men with major depression. Conclusions There are sustained SMI disparities in MI intervention and prognosis. There is an urgent need to understand and tackle the reasons for these disparities.

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Mammography Among Women With Severe Mental Illness: Exploring Disparities Through a Large Retrospective Cohort Study

Psychiatric Services ◽

10.1176/appi.ps.201600170 ◽

2018 ◽

Vol 69 (1) ◽

pp. 48-54 ◽

Cited By ~ 6

Author(s):

Melanie Thomas ◽

Monique James ◽

Eric Vittinghoff ◽

Jennifer M. Creasman ◽

Dean Schillinger ◽

...

Keyword(s):

Mental Illness ◽

Cohort Study ◽

Severe Mental Illness ◽

Retrospective Cohort Study ◽

Retrospective Cohort

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

The Lancet Psychiatry ◽

10.1016/s2215-0366(17)30097-4 ◽

2017 ◽

Vol 4 (5) ◽

pp. 389-399 ◽

Cited By ~ 39

Author(s):

Jayati Das-Munshi ◽

Chin-Kuo Chang ◽

Rina Dutta ◽

Craig Morgan ◽

James Nazroo ◽

...

Keyword(s):

Mental Illness ◽

Cohort Study ◽

Severe Mental Illness ◽

Excess Mortality

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DISPARITIES IN REVASCULARIZATION FOR ST-ELEVATION MYOCARDIAL INFARCTION PERSIST FOR PATIENTS WITH SEVERE MENTAL ILLNESS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)30657-x ◽

2016 ◽

Vol 67 (13) ◽

pp. 656

Author(s):

Joshua Schulman-Marcus ◽

Parag Goyal ◽

Rajesh Swaminathan ◽

Harsimran Singh ◽

Robert Minutello ◽

...

Keyword(s):

Myocardial Infarction ◽

Mental Illness ◽

Severe Mental Illness ◽

St Elevation Myocardial Infarction ◽

St Elevation

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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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