The alarmingly high prevalence of DUD among young patients with severe mental disorders should encourage preventive efforts to reduce illicit drug use in the adolescent population.
This meta-analysis aims to measure disparities in cardiovascular disease (CVD) screening/treatment in people with mental disorders, given the increased CVD incidence and mortality.Methods. PRISMA/MOOSE compliant systematic search, Pubmed/PsycInfo, last search June 31 st , 2020 (protocol https://osf.io/b8rvs/), with random-effect meta-analysis of observational studies comparing CVD screening/treatment in people with vs. without mental disorders. Primary outcome was Odds Ratios (ORs) for CVD screening/treatment. Sensitivity analyses on screening/treatment separately, on specific procedures, as well as country/confounding subgroup analyses, and meta-regressions were run. Publication bias and quality (Newcastle-Ottawa Scale (NOS)) were assessed. Results. Forty-seven studies (n=24,400,452, 1,283,602 with mental disorders), from North America (k=26), Europe (k=16), Asia (k=4), and Australia (k=1) were meta-analyzed. Lower rates of screening/treatment in mental disorders emerged for any CVD (k=47, OR=0.773, 95%CI=0.742-0.804, p<0.001), coronary artery disease (k=34, OR=0.734, 95%CI=0.690-0.781, p<0.001), cerebrovascular disease (k=8, OR=0.810, 95%CI=0.779-0.842, p<0.001), or other mixed CVDs (k=11, OR=0.839, 95%CI=0.761-0.924, p<0.001).Significant disparities emerged for any screening, any intervention, catheterization/revascularization in coronary artery disease, intravenous thrombolysis for stroke, and treatment with any and specific medications for CVD across all mental disorders (except for CVD medications in mood disorders). Disparities were largest for schizophrenia, and differed across countries. Median quality was high (NOS=8), higher quality studies found larger disparities, and publication bias did not affect results. Conclusions.People with mental disorders (schizophrenia in particular) receive less screening and lower quality treatment for CVD. It is of paramount importance to address under-prescribing of CVD medications and under-utilization of diagnostic and therapeutic procedures across all mental disorders.
Individuals with schizophrenia or substance use disorder have a substantially increased mortality compared to the general population. Despite a high and probably increasing prevalence of comorbid substance use disorder in people with schizophrenia, the mortality in the comorbid group has been less studied and with contrasting results. We performed a nationwide open cohort study from 2009 to 2015, including all Norwegians aged 20–79 with schizophrenia and/or substance use disorder registered in any specialized health care setting in Norway, a total of 125,744 individuals. There were 12,318 deaths in the cohort, and total, sex-, age- and cause-specific standardized mortality ratios (SMRs) were calculated, comparing the number of deaths in patients with schizophrenia, schizophrenia only, substance use disorder only or a co-occurring diagnosis of schizophrenia and substance use disorder to the number expected if the patients had the age-, sex- and calendar-year specific death rates of the general population. The SMRs were 4.9 (95% CI 4.7–5.1) for all schizophrenia patients, 4.4 (95% CI 4.2–4.6) in patients with schizophrenia without substance use disorder, 6.6 (95% CI 6.5–6.8) in patients with substance use disorder only, and 7.4 (95% CI 7.0–8.2) in patients with both schizophrenia and substance use disorder. The SMRs were elevated in both genders, in all age groups and for all considered causes of death, and most so in the youngest. Approximately 27% of the excess mortality in all patients with schizophrenia was due to the raised mortality in the subgroup with comorbid SUD. The increased mortality in patients with schizophrenia and/or substance use disorder corresponded to more than 10,000 premature deaths, which constituted 84% of all deaths in the cohort. The persistent mortality gap highlights the importance of securing systematic screening and proper access to somatic health care, and a more effective prevention of premature death from external causes in this group.
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