Closing the mortality gap for severe mental illness: Are we going in the right direction?

SummaryIn this editorial, we discuss a UK-based cohort study examining the mortality gap for people with schizophrenia and bipolar disorder from 2000 to 2014. There have been concerted efforts to improve physical and mental healthcare for this population in recent decades. Have these initiatives reduced mortality and ‘closed the gap’?

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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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Severe mental illness and mortality and coronary revascularisation following a myocardial infarction: a retrospective cohort study

BMC Medicine ◽

10.1186/s12916-021-01937-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Kelly Fleetwood ◽

Sarah H. Wild ◽

Daniel J. Smith ◽

Stewart W. Mercer ◽

Kirsty Licence ◽

...

Keyword(s):

Myocardial Infarction ◽

Bipolar Disorder ◽

Mental Illness ◽

Cohort Study ◽

Major Depression ◽

Severe Mental Illness ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Sociodemographic Factors ◽

Coronary Revascularisation

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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Prejudice, ethnic discrimination, and double jeopardy in migrants

Oxford Textbook of Migrant Psychiatry ◽

10.1093/med/9780198833741.003.0004 ◽

2021 ◽

pp. 39-44

Author(s):

Cameron Watson ◽

Edgardo Juan Tolentino ◽

Dinesh Bhugra

Keyword(s):

Mental Illness ◽

Negative Attitude ◽

Mental Healthcare ◽

Ethnic Discrimination ◽

Clinical Settings ◽

Human Beings ◽

Double Jeopardy ◽

Potential Factors ◽

Prejudice And Discrimination ◽

The Right

Prejudice is a universal phenomenon and all human beings carry at least one prejudice in them, whether this is against individuals with mental illness or migrants. Often potential factors can also cause prejudice. In many clinical settings, migrants with mental illness can face double jeopardy, leading to facing further discriminations at a number of levels. Individuals with mental illness in many countries do not have the right to vote, marry, make a will or inherit property, or the right to employment. Migrants in many countries do not have full rights as citizens. Double or triple jeopardy means that migrants with mental healthcare needs often fail to get their needs met at a number of levels. Prejudice and discrimination are learned behaviours, whereas stigma is often a negative attitude. Racism is a form of discrimination, but it takes the form of xenoracism if the migrant is white, although shared whiteness does not exclude the possibility of racism.

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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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Telemental Health in Africa

10.1093/med/9780190622725.003.0003 ◽

2017 ◽

Author(s):

Sinclair Wynchank ◽

Dora Wynchank

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Mental Healthcare ◽

Cross Cultural ◽

Healthcare Personnel ◽

Telemental Health ◽

African Countries ◽

Broadcast Media ◽

Equipment Costs

Although telemental health (TMH) in Africa shares much with TMH in well-resourced nations, significant differences exist. These mainly result from relatively small funds available for all forms of healthcare, inadequate infrastructure, lack of mental healthcare personnel, and cross-cultural difficulties. The majority of individuals with severe mental illness receive no treatment in most African countries. This lack has been alleviated in part by some “North–South” and “South–South” TMH programs, in addition to other locally initiated programs. African TMH has emphasized provision of a wide variety of TMH—education, managing psychotrauma in regions of violent upheavals, and the provision of other TMH services. Novel African telecommunications techniques and means of providing TMH, for example using broadcast media and diasporic mental healthcare personnel, are outlined. So, future African TMH will surely grow because of decreasing equipment costs, but principally because of proven effectiveness and the power of such interventions.

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Integrating Mental Health Perspectives into the Legal Discourse on Reproductive Justice in India

Journal of National Law University Delhi ◽

10.1177/2277401719870643 ◽

2019 ◽

Vol 6 (1) ◽

pp. 21-38

Author(s):

Malavika Parthasarathy

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mentally Ill ◽

Mental Healthcare ◽

Legal Discourse ◽

Reproductive Justice ◽

Bodily Integrity ◽

Persons With Disabilities ◽

Mentally Ill Persons ◽

The Right

The reproductive justice framework envisions a world where all women, including those situated at the intersection of multiple structures of oppression such as class, caste, sexual orientation, disability and mental health, are able to exercise their right to decisional and reproductive autonomy. S. 3(4)(a) of the Medical Termination of Pregnancy Act, 1971, provides that an abortion cannot be performed on a mentally ill woman without the consent of her guardian. I analyse the Indian Supreme Court’s decision in Suchita Srivastava v. Chandigarh Administration [(2009) 9 SCC 1] in light of contemporary legal developments in the field of disability law and mental health law. The first argument that I make in this paper is that the Rights of Persons with Disabilities Act, 2016, covers persons with mental illness, with the rights in the Act applicable to those with mental illness as well. The second argument rests on the Mental Healthcare Act, 2017, which recognizes the right to privacy and dignity of mentally ill persons, including their capacity to make decisions affecting healthcare. I argue that the judgment, while path-breaking in its recognition of the reproductive rights of disabled women, is inimical to the rights of mentally ill women, perpetuating dangerous stereotypes about their ability to exercise choices, and dehumanizing them. It is imperative for the reproductive justice framework to inform legal discourse and judicial decision-making, to fully acknowledge the right to self-determination and bodily integrity of mentally ill persons.

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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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Prediction of transition from common adolescent bipolar experiences to bipolar disorder: 10-year study

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.065763 ◽

2010 ◽

Vol 196 (2) ◽

pp. 102-108 ◽

Cited By ~ 66

Author(s):

Marijn J. A. Tijssen ◽

Jim van Os ◽

Hans-Ulrich Wittchen ◽

Roselind Lieb ◽

Katja Beesdo ◽

...

Keyword(s):

Bipolar Disorder ◽

Cohort Study ◽

Clinical Outcomes ◽

Mental Healthcare ◽

Dependent Manner ◽

Manic Symptoms ◽

The Poor ◽

Affective Symptoms ◽

Dsm Iv ◽

Dose Dependent

BackgroundAlthough (hypo)manic symptoms are common in adolescence, transition to adult bipolar disorder is infrequent.AimsTo examine whether the risk of transition to bipolar disorder is conditional on the extent of persistence of subthreshold affective phenotypes.MethodIn a 10-year prospective community cohort study of 3021 adolescents and young adults, the association between persistence of affective symptoms over 3 years and the 10-year clinical outcomes of incident DSM–IV (hypo)manic episodes and incident use of mental healthcare was assessed.ResultsTransition to clinical outcome was associated with persistence of symptoms in a dose-dependent manner. Around 30–40% of clinical outcomes could be traced to prior persistence of affective symptoms.ConclusionsIn a substantial proportion of individuals, onset of clinical bipolar disorder may be seen as the poor outcome of a developmentally common and usually transitory non-clinical bipolar phenotype.

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