Cause-specific life-years lost in people with mental disorders: a nationwide, register-based cohort study

Erlangsen, Annette; Andersen, Per Kragh; Toender, Anita; Laursen, Thomas Munk; Nordentoft, Merete; Canudas-Romo, Vladimir

doi:10.1016/s2215-0366(17)30429-7

Cited by 129 publications

(128 citation statements)

References 47 publications

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“…Of those, nine (60%) were males, 14 (93%) were White British, 12 (80%) had been transferred to CMHTs and three (20%) to primary healthcare. In line with the current literature that suggests shortened life expectancy in this patient group, mean age ( SD ) at death was 53 (12) years (range 29–67 years) and the mean time ( SD ) from AO service closure to death was 23 (10) months. Cause of death was neoplasm in four (26.7%) patients, heart disease in three (20%) patients, pneumonia in two (13.3%) patients, opioid overdose in two (13.3%) patients, and miscellaneous in four (26.7%) patients (strangulated hernia, surgical complications, sepsis and unknown).…”

supporting

confidence: 89%

“…People with mental disorders have higher mortality and shorter life expectancy compared with the general population. 1,2 In the United Kingdom, in the mid-1990s, assertive outreach (AO) teams began providing assertive community treatment for people with chronic and severe mental disorders who did not engage with more conventional services, resulting in "revolving door" hospitalization, and they became well established over the following two decades. 3 However, the past few years have seen the closure of the majority of AO services in the United Kingdom, 3 which was driven by the current economic climate and the negative findings of the only U.K. randomized controlled trial, 4 which showed that care from AO teams did not reduce hospital admissions or improve clinical or social outcomes.…”

Section: High Mortality Rate In People With Severe Mental Disorders Amentioning

confidence: 99%

“…People with mental disorders have higher mortality and shorter life expectancy compared with the general population …”

mentioning

confidence: 99%

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High mortality rate in people with severe mental disorders after discharge from assertive community treatment

Mustafa

2018

Perspect Psychiatr Care

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supporting

confidence: 89%

Section: High Mortality Rate In People With Severe Mental Disorders Amentioning

confidence: 99%

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High mortality rate in people with severe mental disorders after discharge from assertive community treatment

Mustafa

2018

Perspect Psychiatr Care

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Section: Discussionmentioning

confidence: 99%

“…It is well established that people with mental disorders have a significant disadvantage in terms of mortality; because of their high prevalence, cardiac disease claims a substantial proportion of their shorter life. 20 Nevertheless, there has been no systematic study to address OHCA in psychiatric patients, to the best of our knowledge. The main findings of this study are twofold: (i) fatal arrhythmia (VF and VT) was less commonly noted as the initial rhythm in patients with psychiatric disorders who were successfully resuscitated after OHCA; and (ii) cardiac origin and stroke were less frequently noted as the etiology of cardiac arrest; whereas airway obstruction and pulmonary embolism were more common in psychiatric than in non-psychiatric patients.…”

Section: Discussionmentioning

confidence: 99%

Etiology of out‐of‐hospital cardiac arrest in psychiatric patients: Chart review

Ishida

Miyazaki

Yukawa

et al. 2019

Psychiatry Clin Neurosci

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Aim Although sudden cardiac deaths are more common in psychiatric patients than the general population, data on their causes are very limited. The aim of this study was to investigate initial rhythms and causes of out‐of‐hospital cardiac arrest (OHCA) in patients with psychiatric disorders. Methods We conducted a systematic chart review of patients resuscitated after OHCA and hospitalized in the Tertiary Emergency Medical Center of Tokyo Metropolitan Bokutoh Hospital in Japan between January 2010 and December 2017. The initial rhythms and causes of OHCA were compared between psychiatric patients and non‐psychiatric patients. Parameters of interest were compared using chi‐squared test, Fisher's exact test, or the Mann–Whitney U‐test, as appropriate. Results A total of 49 psychiatric and 600 non‐psychiatric patients were eligible for this study. Fatal but shockable arrhythmias (i.e. ventricular fibrillation and ventricular tachycardia) were less frequently observed as initial rhythms in patients with psychiatric disorders than the others (22.4% vs 49.7%, P < 0.001). Cardiac origin was less common as the cause of OHCA (26.5% vs 58.5%, P < 0.01), while airway obstruction and pulmonary embolism were more frequent in psychiatric versus non‐psychiatric patients (24.5% vs 6.5%, P < 0.01; and 12.2% vs 1.5%, P < 0.01, respectively). The results were similar when psychiatric patients were compared with sex‐ and age‐matched controls selected from the non‐psychiatric patient group. Conclusion Although fatal arrhythmias may be less common, non‐cardiac causes such as pulmonary embolism and airway obstruction need to be treated with high clinical suspicion in an event of sudden cardiac arrest in psychiatric patients.

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Prescription Drug Dispensing and Patient Costs After Implementation of a No Behavioral Health Cost-Sharing Law

Golberstein,

Campbell,

Maclean

et al. 2024

JAMA Health Forum

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ImportanceOn January 1, 2022, New Mexico implemented a No Behavioral Cost-Sharing (NCS) law that eliminated cost-sharing for mental health and substance use disorder (MH/SUD) treatments in plans regulated by the state, potentially reducing a barrier to treatment for MH/SUDs among the commercially insured; however, the outcomes of the law are unknown.ObjectiveTo assess the association of implementation of the NCS with out-of-pocket spending for prescription for drugs primarily used to treat MH/SUDs and monthly volume of dispensed drugs.Design, Settings, and ParticipantsThis retrospective cohort study used a difference-in-differences research design to examine trends in outcomes for New Mexico state employees, a population affected by the NCS, compared with federal employees in New Mexico who were unaffected by NCS. Data were collected on prescription drugs for MH/SUDs dispensed per month between January 2021 and June 2022 for New Mexico patients with a New Mexico state employee health plan and New Mexico patients with a federal employee health plan. Data analysis occurred from December 2022 to January 2024.ExposureEnrollment in a state employee health plan or federal health plan.Main Outcomes and MeasuresThe primary outcomes were mean patient out-of-pocket spending per dispensed MH/SUD prescription and the monthly volume of dispensed MH/SUD prescriptions per 1000 employees. A difference-in-differences estimation approach was used.ResultsThe implementation of the NCS law was associated with a mean (SE) $6.37 ($0.30) reduction (corresponding to an 85.6% decrease) in mean out-of-pocket spending per dispensed MH/SUD medication (95% CI, −$7.00 to −$5.75). The association of implementation of NCS with the volume of prescriptions dispensed was not statistically significant.Conclusions and RelevanceThese findings suggest that the implementation of the New Mexico NCS law was successful in lowering out-of-pocket spending on prescription medications for MH/SUDs, but that there was no association of NCS with the volume of medications dispensed in the first 6 months after implementation. A key challenge is to identify policies that protect from high out-of-pocket spending while also promoting access to needed care.

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Cause-specific life-years lost in people with mental disorders: a nationwide, register-based cohort study

Abstract: The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH).

Cited by 129 publications

References 47 publications

High mortality rate in people with severe mental disorders after discharge from assertive community treatment

High mortality rate in people with severe mental disorders after discharge from assertive community treatment

Etiology of out‐of‐hospital cardiac arrest in psychiatric patients: Chart review

Prescription Drug Dispensing and Patient Costs After Implementation of a No Behavioral Health Cost-Sharing Law

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