AbstractObjectivesThe main objective of this study was to compare neutrophil-lymphocyte ratio, a marker of systemic inflammation, between patients diagnosed with ICD-10 psychiatric disorders and control participants.DesignA cross-sectional methodology was employed to retrospectively analyse electronic health records and records derived from a national health survey.SettingA secondary mental health care service consisting of four boroughs in South London.ParticipantsA diverse sample of 13,888 psychiatric patients extracted from South London and Maudsley electronic health records database and 3,920 control participants extracted from National Health and Nutrition Survey (2015-2016) were included in the study.Primary and secondary outcome measuresPrimary: NLR levels in patients with mental health diagnoses, NLR between patients with different mental health diagnoses. Secondary: Relationship of NLR to length of hospitalisation and to mortality.ResultsNLR was elevated compared to controls in patients with diagnoses including dementia, alcohol dependence, schizophrenia, bipolar affective disorder, depression, non-phobic anxiety disorders, and mild mental retardation (p < 0.05). NLR also correlated with age, antipsychotic use and hypnotic use. NLR was found to be higher in individuals of “White” ethnicity and lower in individuals of “Black” ethnicity. Elevated NLR was associated with increased mortality (β = 0.103, p = 2.9e-08) but not with hospital admissions or face-to-face contacts.ConclusionsElevated NLR may reflect a transdiagnostic pathological process occurring in a subpopulation of psychiatric patients. NLR may be useful to identify and stratify patients who could benefit from adjunctive anti-inflammatory treatment.Article SummaryStrengths and limitations of this studyLargest study to date of cross-diagnostic neutrophil-lymphocyte measurements in a psychiatric population.Sample is representative of diverse adult psychiatric patients in South London.Systematic differences between patients and controls reduce the validity of these comparisons.This study was retrospective and thus, confounding measures such as body mass index, smoking status and diet were unavailable.
A Qualitative Exploration of Workarounds Related to the Implementation of National Electronic Health Records in Early Adopter Mental Health Hospitals
