Health inequalities

The association between mental illness and poor physical health has been known for decades (Philips, 1934). This is not a trivial relationship between mental ill health and minor physical problems but an association with such poor physical health that it results in premature death. For example, a study in the USA showed that the life expectancy of those with schizophrenia or other serious mental illness was 9 years shorter than for the general population (Dembling et al, 1999). Similarly, those with learning disabilities have an increased risk of early death, and this increase is greater in those with severe disability.

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Improving physical health in people with severe mental illness

Practice Nursing ◽

10.12968/pnur.2020.31.11.456 ◽

2020 ◽

Vol 31 (11) ◽

pp. 456-460

Author(s):

Sheila Hardy

Keyword(s):

Mental Illness ◽

Health Disparities ◽

General Population ◽

Physical Health ◽

Severe Mental Illness ◽

Physical Condition ◽

Early Death ◽

Practice Nurses

People with severe mental illness have a higher mortality than the general population. Sheila Hardy explains how nurses can address the health disparities that people with severe mental illness face People with severe mental illness have a higher mortality than the general population, with the main cause of early death being from a physical condition. Practice nurses are well placed to address the health disparities that people with severe mental illness face. This article describes the reasonable adjustments that can be made to increase engagement with patients.

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Total and Cause-Specific Mortality by Moderately and Markedly Increased Ferritin Concentrations: General Population Study and Metaanalysis

Clinical Chemistry ◽

10.1373/clinchem.2014.229013 ◽

2014 ◽

Vol 60 (11) ◽

pp. 1419-1428 ◽

Cited By ~ 27

Author(s):

Christina Ellervik ◽

Jacob Louis Marott ◽

Anne Tybjærg-Hansen ◽

Peter Schnohr ◽

Børge G Nordestgaard

Keyword(s):

General Population ◽

Total Mortality ◽

Early Death ◽

Premature Death ◽

Population Based ◽

General Population Study ◽

Ferritin Concentration ◽

Heart Study ◽

Increased Risk ◽

Specific Mortality

Abstract BACKGROUND Previous population-based studies of plasma ferritin concentration have not revealed a relationship with total mortality. We tested the possible association of increased ferritin concentrations with increased risk of total and cause-specific mortality in the general population. METHODS We examined total and cause-specific mortality according to baseline plasma ferritin concentrations in a Danish population–based study (the Copenhagen City Heart Study) of 8988 individuals, 6364 of whom died (median follow-up 23 years). We also included a metaanalysis of total mortality comprising population-based studies according to ferritin quartiles or tertiles. RESULTS Multifactorially adjusted hazard ratios (HRs) for total mortality for individuals with ferritin ≥200 vs <200 μg/L were 1.1 (95% CI 1.1–1.2; P = 0.0008) overall, 1.1 (1.0–1.2; P = 0.02) in men, and 1.2 (1.0–1.3; P = 0.03) in women. Stepwise increasing concentrations of ferritin were associated with a stepwise increased risk of premature death overall (log rank, P = 2 × 10−22), with median survival of 55 years at ferritin concentrations ≥600 μg/L, 72 years at 400–599 μg/L, 76 years at 200–399 μg/L, and 79 years at ferritin <200 μg/L. The corresponding HR for total overall mortality for ferritin ≥600 vs <200 μg/L was 1.5 (1.2–1.8; P = 0.00008). Corresponding adjusted HRs for ferritin ≥600 vs <200 μg/L were 1.6 (1.1–2.3; P = 0.01) for cancer mortality, 2.9 (1.7–5.0; P = 0.0001) for endocrinological mortality, and 1.5 (1.1–2.0; P = 0.01) for cardiovascular mortality. The metaanalysis random effects odds ratio for total mortality for ferritin upper vs reference quartile or tertile was 1.0 (0.9–1.1; P = 0.3) (P heterogeneity = 0.5). CONCLUSIONS Moderately to markedly increased ferritin concentrations represent a biological biomarker predictive of early death in a dose-dependent linear manner in the general population.

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Social Dimensions of Mental Illness among Rural Elderly Populations

The International Journal of Aging and Human Development ◽

10.2190/revp-59g8-3u2u-q2b0 ◽

1988 ◽

Vol 26 (3) ◽

pp. 169-190 ◽

Cited By ~ 6

Author(s):

Jon Hendricks ◽

Howard B. Turner

Keyword(s):

Mental Health ◽

Mental Illness ◽

Physical Health ◽

Elderly People ◽

The Elderly ◽

Rural Elderly ◽

Policy Implications ◽

Elderly Persons ◽

Increased Risk ◽

Elderly Populations

Despite growing concern with rural elderly populations, little attention has focused on their mental health, ways it may correlate with physical health, or how rural mental health patterns compare to urban. Popular wisdom contends that elderly people in general, and rural elderly persons in particular, are at increased risk for mental illness. This article examines these questions. A review of available literature suggests that elderly people may be at only slightly greater risk of mental illness than the population at large, though there are some indications that rates of depression may be somewhat higher among the elderly population. Much of this same literature implies that objective environmental conditions play a significant role in the incidence of depression. Analysis of data gathered in a statewide random poll ( N = 743) indicates that while physical health tends to be poorer among rural populations, when health is held constant there is actually an inverse relationship between age and depression. Therefore, rural elderly persons are no more likely to be depressed than their urban counterparts despite harsher living conditions. Both conceptual and policy implications are discussed.

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Older people with learning disabilities

10.1093/med/9780199644957.003.0050 ◽

2013 ◽

Cited By ~ 1

Author(s):

Maria Luisa Hanney

Keyword(s):

Mental Illness ◽

Learning Disabilities ◽

Down Syndrome ◽

General Population ◽

Elderly People ◽

Peer Group ◽

Social Challenges ◽

Early Onset Dementia ◽

Complex Population ◽

Dementia Of Alzheimer’S Type

Elderly people with Learning Disabilities are a heterogeneous clinically complex population with unique medical and social challenges. Little is known of the epidemiology of mental ill health in this group. Emerging evidence indicates that they suffer higher rates of mental illness than the general population and than their younger peer group. Point prevalence of mental ill health in elderly people with Learning Disabilities has been reported about 69% compared with 48% in the younger peer group. This higher rate of psychiatric diagnosis in the older group is mainly due to a higher rate of dementia of about 21 %. People with Down syndrome appear to have lower rates of mental ill health apart from depression and early onset dementia of Alzheimer’s type. People with Learning Disability due to other causes are also at higher risk of developing dementia at an earlier age than the general population

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Spanish Consensus on Physical Health in Patients with Bipolar Disorder

European Psychiatry ◽

10.1016/s0924-9338(09)70826-0 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

J. Saiz-Ruiz ◽

J. Bobes ◽

E. Vieta ◽

J. Mostaza

Keyword(s):

Bipolar Disorder ◽

General Population ◽

Physical Health ◽

Psychosocial Functioning ◽

General Medicine ◽

Diagnostic Procedures ◽

Mortality Rates ◽

Morbidity And Mortality ◽

Increased Risk ◽

Co Morbidity

Background and objective:Bipolar disorder is a serious mental illness which may affect between 2% and 5% of the population. These patients present much higher morbidity and mortality rates than the general population. In addition to a higher mortality rate from suicide, they also have a higher prevalence of other physical disorders.The purpose of this consensus is to establish recommendations for diagnostic procedures and clinical interventions in order to control the risk factors which have repercussions on the physical health of the patients.Methods:After carrying out a systematic review of medical co-morbidity and mortality rates in bipolar disorder, two multidisciplinary consensus meetings were held in which 31 psychiatrists and 11 experts from other medical specialities participated.Working groups were formed for each speciality for the purposes of adapting the guidelines applied in the general population to these patients.Results:The bibliographical review revealed an increased risk of hypertension, obesity, smoking, pulmonary diseases, migraine and HIV infection. There is evidence of higher mortality rates from cardiovascular and respiratory diseases and infections, as well as from suicide. The expert group reached consensus on a series of basic measures for detecting medical co-morbidity. The resulting recommendations will be validated by Spanish Psychiatry and General Medicine Associations.Conclusion:The physical health of patients with bipolar disorder could be improved. It is hoped that the publication of this consensus will have an impact in terms of better psychosocial functioning, quality of life and life expectancy for these patients in Spain.

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Physical activity as an intervention in severe mental illness

BJPsych Advances ◽

10.1192/bja.2021.33 ◽

2021 ◽

pp. 1-10

Author(s):

Aaron A. Kandola ◽

David P. J. Osborn

Keyword(s):

Mental Health ◽

Physical Activity ◽

Mental Illness ◽

Physical Health ◽

Severe Mental Illness ◽

Routine Practice ◽

Physical And Mental Health ◽

Increased Risk ◽

Physical Health Problems ◽

Health Complications

SUMMARY Physical activity is a modifiable risk factor for several physical and mental health conditions. It is well established that people with severe mental illness have increased risk of physical health complications, particularly cardiovascular disease. They are also more likely to be physically inactive, contributing to the elevated cardiovascular and metabolic risks, which are further compounded by antipsychotic medication use. Interventions involving physical activity are a relatively low risk and accessible way of reducing physical health problems and weight in people with severe mental illness. They also have wider benefits for mental health symptoms and quality of life. However, many barriers still exist to the widespread implementation of physical activity interventions in the treatment of severe mental illness. A more concerted effort is needed to facilitate their translation into routine practice and to increase adherence to activity interventions.

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Association between circulating insulin-like growth factor 1 and risk of all-cause and cause-specific mortality

Acta Endocrinologica ◽

10.1530/eje-21-0573 ◽

2021 ◽

Author(s):

Yu Xie ◽

Changzhi Huang ◽

Xingchen Zhu ◽

Jiayu Wang ◽

Xikang Fan ◽

...

Keyword(s):

Growth Factor ◽

General Population ◽

Early Death ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Response Analysis ◽

Insulin Like Growth Factor ◽

Increased Risk ◽

Specific Mortality ◽

Cvd Mortality

Abstract Background: Insulin-like growth factor 1 (IGF-1) is an important growth factor modulating development, homeostasis, and aging. However, whether and how circulating IGF-1 concentrations influence early death risk in the general population remains largely unknown. Methods: We included 380,997 participants who had serum IGF-1 measurement and no history of cancer, cardiovascular disease (CVD) or diabetes at baseline from UK Biobank, a prospective cohort study initiated in 2006-2010. Restricted cubic splines and Cox proportional hazards regression models were used to assess the association between baseline IGF-1 concentrations and all-cause and cause-specific mortality. Results: Over a median follow-up of 8.8 years, 10,753 of the participants died, including 6110 from cancer and 1949 from CVD. Dose-response analysis showed a U-shaped relationship between IGF-1 levels and mortality. Compared to the fifth decile of IGF-1, the lowest decile was associated with 39% (95% CI: 29%-50%), 20% (95% CI: 8%-34%), and 39% (95% CI: 14%-68%) higher risk of all-cause, cancer, and CVD mortality, respectively, while the highest decile was associated with 17% (95% CI: 7%-28%) and 38% (95% CI: 11%-71%) higher risk of all-cause and CVD mortality, respectively. The results remained stable in detailed stratified and sensitivity analyses. Conclusions: Our findings indicate that both low and high concentrations of serum IGF-1 are associated with increased risk of mortality in the general population. Our study provides a basis for future interrogation of underlying mechanisms of IGF-1 in early death occurrence and possible implications for mitigating the risk.

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Early mortality and mental illness: ‘Fatal’ Discrimination

Bengal Journal of Psychiatry ◽

10.51332/bjp.2015.v20.i1.44 ◽

2015 ◽

pp. 14-19

Author(s):

Anindya Das ◽

Mohan Rao ◽

Mercian Daniel

Keyword(s):

Mental Illness ◽

General Population ◽

Health Systems ◽

Premature Death ◽

Early Mortality ◽

Mental Illnesses ◽

Social Structures ◽

People With Mental Illness ◽

And Behavior

Worldwide research has provided evidence of premature death in people with mental illness (as compared to the general population). Moreover, in recent decades, the mortality gap between the preceding two groups has not shown any decline even in countries with the most accessible/responsive health systems. This essay considers mortality to be influenced by a multiplicity of factors, many of which, in addition, influence the rate of occurrence and recovery from mental illnesses. The essay examines these factors and analyses them through the lens of structural discrimination (defined as institutional and social structures that perpetuate norms, practices and behavior that deny opportunities/rights to others, often members of a minority). The implications for India in this regard are also reflected upon.

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Attitudes toward psychiatry and psychiatric patients in medical students: Can real-world experiences reduce stigma?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.531 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s218-s218 ◽

Cited By ~ 1

Author(s):

M. Pascucci ◽

E. Stella ◽

M. La Montagna ◽

A. De Angelis ◽

P. Parente ◽

...

Keyword(s):

Mental Illness ◽

Medical Students ◽

Psychiatric Patient ◽

Real World ◽

Psychiatric Patients ◽

Statistical Significance ◽

Premature Death ◽

Psychiatric Ward ◽

Increased Risk ◽

Competing Interest

IntroductionStigma towards psychiatry and mental illness significantly worsens the quality of life of psychiatric patients. Negative prejudices in medical students make it difficult for future doctors to send patients to mental health services and promote an increased risk of premature death.AimsOur aim is to assess stigma towards mental illness and psychiatry in medical students, and to study the influence of real-world experiences, such as having visited a psychiatric ward, having personally met a psychiatric patient or having friends and/or family members who suffer from a mental illness.MethodsOne hundred and thirteen Italian medical students completed the following tests:– Attitudes Towards Psychiatry (ATP-30);– Community Attitudes Towards Mental Ill (CAMI);– Perceived Discrimination Devaluation Scale (PDD);– Baron-Cohen's Empathy Quotient (EQ).ResultsHaving visited a psychiatric ward correlates with a better attitude towards psychiatry (P = 0.008), rather than towards the mentally ill. Having personally known someone with mental disorders correlates with less stigmatizing scores in CAMI: total score (P = 0.002), authoritarianism (P < 0.001), benevolence (P = 0.047) and social restriction (P = 0.001). Similar results emerged in those who have close relationships with a psychiatric patient. There is no statistical significance as to empathy.ConclusionsThe students who have visited a psychiatric ward have a less stigmatizing vision of psychiatry, while having personally known psychiatric patients favors a less stigmatizing attitude towards them. Those who have not had this experience, have a more hostile and intolerant vision of mental illness, and consider psychiatric patients as inferior subjects that require coercive attitudes and that would be better to avoid because socially dangerous.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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