Disparities in the management of cardiovascular risk factors in patients with psychiatric disorders: a systematic review and meta-analysis

Ayerbe, Luis; Forgnone, Ivo; Foguet-Boreu, Quintí; Gonzalez, Esteban Alberto; Addo, Juliet; Ayis, Salma

doi:10.1017/s0033291718000302

Cited by 45 publications

(31 citation statements)

References 71 publications

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“…by attending follow-up appointments). 124,126 Other factors explaining why physicians may be reluctant to offer some medical procedures because of the ensuing psychological stress, along with concerns about capacity, informed consent or compliance with postoperative care, or the presence of contra-indications such as substance abuse and smoking. 126 However, contra-indications to specialized interventions, such as smoking or problems with informed consent, are less relevant to the prescription of vascular drugs such as ACE inhibitors, beta-blockers, or statins known to reduce subsequent morbidity and mortality.…”

Section: Looking Beyond Lifestyle: Health Provider and System-level Fmentioning

confidence: 99%

“…124,126 Other factors explaining why physicians may be reluctant to offer some medical procedures because of the ensuing psychological stress, along with concerns about capacity, informed consent or compliance with postoperative care, or the presence of contra-indications such as substance abuse and smoking. 126 However, contra-indications to specialized interventions, such as smoking or problems with informed consent, are less relevant to the prescription of vascular drugs such as ACE inhibitors, beta-blockers, or statins known to reduce subsequent morbidity and mortality. 127 Furthermore, recent data have shown that people with schizophrenia are equally adherent to diabetes medication as the general population, thus further supporting the need for healthcare providers to remain optimistic about prescribing cardiometabolic medications in people with mental illness.…”

Section: Looking Beyond Lifestyle: Health Provider and System-level Fmentioning

confidence: 99%

“…128 Finally, access may be compromised by financial costs, fragmentation of care and stigma. 124,126,129 Although health care should be the one sector where challenging behaviour might be recognized as a symptom of illness, there is evidence that various healthcare providers have stigmatised views on people with mental illness. 124,125 Nonetheless, there are increasing calls for health services to routinely offer health screening and lifestyle interventions to people with psychiatric disorders as they would with a chronic physical condition.…”

Section: Looking Beyond Lifestyle: Health Provider and System-level Fmentioning

confidence: 99%

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The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

Firth

Siddiqi

Koyanagi

et al. 2019

The Lancet Psychiatry

984

1,093

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Executive SummaryThe poor physical health of people with mental illness is a multi-faceted, transdiagnostic, and global problem. Physical health disparities are observed across the entire spectrum of mental illnesses, in low, middle-and high-income countries. This stems from both a heightened risk of physical diseases in people with mental illness, along with their reduced access to adequate healthcare. The high rates of physical comorbidities (and typically-poor clinical management of this) drastically reduces life expectancy, and also increases the personal, social and economic burden of illness across the lifespan.This Commission has brought together an international team of researchers, clinicians, and key stakeholders from various backgrounds and professionally / personally-relevant experience, in order to summarize advances in understanding on this topic, and present clear directions for health promotion, clinical care and future research. The breadth and multifactorial nature of physical health disparities across the range of mental health diagnoses poses an almost limitless number of potential considerations. Therefore, rather than attempting to cover all of the different possible combinations of physical-mental comorbidities individually, the aim of this Commission was to: (i) establish highlypertinent aspects of physical health-related morbidity and mortality which apply transdiagnostically, (ii) highlight the common modifiable factors driving these disparities, (iii) present actions and initiatives for health policy and clinical services to address these issues, and (iv) identify promising areas for future research towards discovering novel solutions. This was addressed across 5 different Parts of the Commission: Parts 1 and 2 determined the scope, priorities and key targets for physical health improvement across multiple mental illnesses. Parts 3, 4 and 5 discussed emerging strategies and produced recommendations for improving physical health outcomes in people with mental illness. Leaders and contributors for each Part are shown in the Appendix (pg.1) . Part 1: 'Its more than premature mortality'Part 1 identified almost 100 systematic reviews/meta-analyses examining the prevalence of physical comorbidities in mental illness. Around 70% of the meta-research focused on cardiometabolic diseases; consistently reporting that mental illnesses were associated with 1.4-to 2-fold increased risk for obesity, diabetes and cardiovascular diseases compared to the general population. Although mostly studied in 'severe mental illness' ('SMI', and particularly psychotic disorders), the prevalence of cardiometabolic diseases was similarly elevated across a broad range of other diagnoses, including substance use disorders (SUDs), and 'common mental disorders' ('CMDs', such as depression and anxiety). Part 2: Key modifiable factors in health behaviours and health servicesPart 2 built on the findings of Part 1 with a hierarchal evidence synthesis of modifiable risk factors for physical diseases in mental illness. The bu...

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Section: Looking Beyond Lifestyle: Health Provider and System-level Fmentioning

confidence: 99%

Section: Looking Beyond Lifestyle: Health Provider and System-level Fmentioning

confidence: 99%

Section: Looking Beyond Lifestyle: Health Provider and System-level Fmentioning

confidence: 99%

See 1 more Smart Citation

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

Firth

Siddiqi

Koyanagi

et al. 2019

The Lancet Psychiatry

984

1,093

View full text Add to dashboard Cite

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“…Additionally, less experienced providers may be uncomfortable with serious mental illness and may avoid intensifying their interaction with a patient by asking probing questions about physical symptoms and performing a physical exam (41). Indeed, there is ample evidence that individuals with schizophrenia are less likely than their peers without any psychiatric illnesses to receive medical procedures and treatments for a range of conditions including cancer screening and treatment (45), use of antihypertensive and lipidlowering drugs (46) and appropriate diabetes care (including A1C and cholesterol testing, eye and feet exams, etc.) (47,48).…”

Section: Discussionmentioning

confidence: 99%

Chronic pain diagnoses and opioid dispensings among individuals with serious mental illness

Owen-Smith

Stewart

Sesay

et al. 2019

Preprint

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Background Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia. Methods Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N=65,750), BD (N=38,117) or schizophrenia or schizoaffective disorder (N=12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses. Results Multivariable models indicated that having a MDD (OR=1.90; 95% CI=1.85–1.95) or BD (OR=1.71; 95% CI=1.66–1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR=0.86; 95% CI=0.82– 0.90). Having a MDD (OR=2.59; 95% CI=2.44–2.75) or BD (OR=2.12; 95% CI=1.97–2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications. Conclusions Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Healthcare providers need to be especially conservative in prescribing opioids – or avoid opioid therapy altogether – for this population. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients.

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“…People with psychosis have increased risk of cardiovascular illness (Foguet-Boreu et al 2016) including in early phases of the illness (Correll et al 2014). But they are less likely than others to receive appropriate health care (Ayerbe et al 2018;De Hert et al 2011;Laursen et al 2014;Mitchell et al 2015). Mental health care and primary care must collaborate to improve monitoring and physical health care for people with psychosis (De Hert et al 2009).…”

Section: Monitoring Cardiovascular Risk Factors and Treatment Of Physmentioning

confidence: 99%

The Physical Health Care Fidelity Scale: Psychometric Properties

Ruud

Høifødt

Hendrick³

et al. 2020

Adm Policy Ment Health

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Mental health programs need an instrument to monitor adherence to evidence-based physical health care for people with serious mental illness. The paper describes the Physical Health Care Fidelity Scale and study interrater reliability, frequency distribution, sensitivity to change and feasibility. Four fidelity assessments were conducted over 18 months at 13 sites randomized to implementation support for evidence-based physical health care. We found good to excellent interrater reliability, adequate sensitivity for change, good feasibility and wide variability in fidelity across sites after 18 months of implementation. Programs were more successful in establishing Policies stating physical health care standards than in implementing these Policies. The Physical Health Care Fidelity Scale measures and guides implementation of evidence-based physical health care reliably.

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Disparities in the management of cardiovascular risk factors in patients with psychiatric disorders: a systematic review and meta-analysis

Abstract: A proactive clinical management, together with further studies, are needed to reduce the CV morbidity and mortality of patients with psychiatric disorders.

Cited by 45 publications

References 71 publications

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

Chronic pain diagnoses and opioid dispensings among individuals with serious mental illness

The Physical Health Care Fidelity Scale: Psychometric Properties

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