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

Siddiqi, Najma; Doran, Timothy; Prady, Stephanie L.; Taylor, Johanna

doi:10.1192/bjp.bp.117.203026

Cited by 9 publications

(9 citation statements)

References 10 publications

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“…Recent evidence indicates that this 'mortality gap' is widening for people with schizophrenia and bipolar disorder. 17,18 Suicide accounts for around 15% of the increased mortality, but the majority of premature deaths are due to physical disorders, including non-communicable diseases, such as diabetes. Rates of such disorders are increased in people with SMI, typically being two to three times higher.…”

Section: Chapter 1 Backgroundmentioning

confidence: 99%

Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study

Lister

Han

Bellass

et al. 2021

Health Serv Deliv Res

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Background People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.

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Section: Chapter 1 Backgroundmentioning

confidence: 99%

Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study

Lister

Han

Bellass

et al. 2021

Health Serv Deliv Res

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“…Patients with severe mental disorders die on average 20 years prior to the general population ( 7 ). In patients with severe mental disorders, cardiovascular diseases, and other physical diseases contribute significantly to the reduced life expectancy, even if more than other “unnatural” causes, such as accidents or suicide ( 8 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial on the Efficacy of a Psychosocial Behavioral Intervention to Improve the Lifestyle of Patients With Severe Mental Disorders: Study Protocol

et al. 2018

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Patients with severe mental disorders die on average 20 years prior to the general population. This mortality gap is mainly due to the higher prevalence of physical diseases and the adoption of unhealthy lifestyle behaviors.The LIFESTYLE trial aims to evaluate the efficacy of a new psychosocial group intervention (including psychoeducational, motivational, and problem-solving techniques) focused on healthy lifestyle behavior compared to a brief educational group intervention in a community sample of patients with severe mental disorders. The trial is a national-funded, multicentric, randomized controlled trial with blinded outcome assessments, which is carried out in six outpatient units of the Universities of Campania “Luigi Vanvitelli” in Naples, Bari, Genova, L'Aquila, Pisa, and Rome—Tor Vergata. All patients are assessed at the following time points: baseline (T0); 2 months post-randomization (T1); 4 months post-randomization (T2); 6 months post-randomization (T3); 12 months post-randomization (T4); and 24 months post-randomization (T5). T1 and T2 assessments include only anthropometric tests. The BMI, a reliable and feasible anthropometric parameter, has been selected as primary outcome. In particular, the mean value of BMI at 6 months from baseline (T3) will be evaluated through a Generalized Estimated Equation model. The work hypothesis is that the LIFESTYLE psychosocial group intervention will be more effective than the brief educational group intervention in reducing the BMI. We expect a mean difference between the two groups of at least one point (and standard deviation of two points) at BMI. Secondary outcomes are: the improvement in dietary patterns, in smoking habits, in sleeping habits, physical activity, personal and social functioning, severity of physical comorbidities, and adherence to medications. The expected sample size consists of 420 patients (70 patients for each of the six participating centers), and they are allocated with a 1:1 ratio randomization, stratified according to center, age, gender, and educational level. Heavy smoking, sedentary behavior, and unhealthy diet pattern are very frequent and are associated with a reduced life expectancy and higher levels of physical comorbidities in people with severe mental disorders. New interventions are needed and we hope that the LIFESTYLE protocol will help to fill this gap.Trial registration number: 2015C7374S.

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“…Severe mental illnesses are defined as mental health conditions that impair a person’s ability to function in their daily life, typically conditions that can present with psychosis, such as schizophrenia and bipolar disorder [ 3 ]. People who have an SMI diagnosis die, on average, 15–20 years earlier than people who do not [ 4 ]. One issue that contributes substantially to this inequality is the high prevalence of long-term conditions among people with SMI, and the poor clinical outcomes that people with coexisting SMI and long term conditions experience in comparison to those without SMI [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease and severe mental illness: a scoping review

et al. 2023

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Background People who have severe mental illness experience higher rates of long-term conditions and die on average 15–20 years earlier than people who do not have severe mental illness, a phenomenon known as the mortality gap. Long-term conditions, such as diabetes, impact health outcomes for people who have severe mental illness, however there is limited recognition of the relationship between chronic kidney disease and severe mental illness. Therefore, the aim of this scoping review was to explore the available evidence on the relationship between chronic kidney disease and severe mental illness. Methods Electronic databases, including MEDLINE, Embase, CINAHL, and PsycINFO were searched. The database searches were limited to articles published between January 2000–January 2022, due to significant progress that has been made in the detection, diagnosis and treatment of both SMI and CKD. Articles were eligible for inclusion if they explored the relationship between SMI and CKD (Stages 1–5) in terms of prevalence, risk factors, clinical outcomes, and access to treatment and services. Severe mental illness was defined as conditions that can present with psychosis, including schizophrenia, schizoaffective disorder, bipolar disorder, and other psychotic disorders. Thirty articles were included in the review. Results The included studies illustrated that there is an increased risk of chronic kidney disease amongst people who have severe mental illness, compared to those who do not. However, people who have severe mental illness and chronic kidney disease are less likely to receive specialist nephrology care, are less likely to be evaluated for a transplant, and have higher rates of mortality. Conclusion In conclusion, there is a dearth of literature in this area, but the available literature suggests there are significant health inequalities in kidney care amongst people who have severe mental illness. Further research is needed to understand the factors that contribute to this relationship, and to develop strategies to improve both clinical outcomes and access to kidney care. Graphical abstract

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

Cited by 9 publications

References 10 publications

Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study

Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study

A Randomized Controlled Trial on the Efficacy of a Psychosocial Behavioral Intervention to Improve the Lifestyle of Patients With Severe Mental Disorders: Study Protocol

Chronic kidney disease and severe mental illness: a scoping review

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