Dying Too Soon: Excess Mortality in Severe Mental Illness

Mooij, Liselotte D. de; Kikkert, Martijn; Theunissen, Jan; Beekman, Aartjan; Haan, Lieuwe de; Duurkoop, Pim; Van, Henricus L.; Dekker, Jack

doi:10.3389/fpsyt.2019.00855

Cited by 71 publications

(69 citation statements)

References 70 publications

(116 reference statements)

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“…Life expectancy among people living with SMI is up to 20 years shorter than for the general population and tobacco use is a leading contributor to this early mortality [ 2 , 4 , 5 ]. Clinical practice guidelines for tobacco dependence treatment state that all smokers with psychiatric disorders should be offered treatment [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial

et al. 2021

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Background Rates of smoking among those with serious mental illness (SMI) are two to three times higher than for the general population. Smoking is rarely addressed in mental health settings. Innovative outreach and treatment strategies are needed to address these disparities. The current study is a pilot study of the feasibility and acceptability of a chronic care model of tobacco cessation treatment implemented in outpatient psychiatry clinics. Methods Participants were recruited from two outpatient psychiatric clinics and randomly assigned to intervention (counseling and nicotine replacement for 8 weeks, plus ongoing proactive outreach calls inviting reengagement in treatment) or control (brief education and referral to the state quit line). Assessments were conducted at 8 weeks (end of initial treatment block) and 6 months (end of window for retreatment). Feasibility was assessed by enrollment rate, treatment engagement, and completion of follow-up assessments. Acceptability was assessed both quantitatively and qualitatively. Preliminary efficacy was assessed by 7-day and 30-day abstinence rates, rate of quit attempts, and cigarettes per day. Psychological health was measured to assess for changes related to treatment group or attempts to quit smoking. Results Nineteen participants were randomized to intervention and 19 to control. Recruitment proved feasible, and high rates of treatment engagement (mean of 4.5 sessions completed in initial treatment block, 89.5% uptake of nicotine replacement) and retention (94.7% of follow-up assessments completed) were observed. Treatment acceptability was high. As anticipated, there were no significant differences in abstinence between groups, but results generally favored the intervention group, including bio-verified 7-day abstinence rates of 21.1% in intervention vs. 17.6% in control and self-reported 30-day abstinence rates of 16.1% in intervention vs. 5.1% in control at 8 weeks. Significantly more intervention participants made at least one quit attempt (94.7% vs 52.6%; OR = 16.20, 95% CI: 1.79–147.01). Cigarettes per day decreased significantly more in the intervention group at 8 weeks (b = − 13.19, SE = 4.88, p = .02). Conclusions It was feasible to recruit and retain SMI patients in a smoking cessation trial in the context of outpatient psychiatry. The novel chronic care model treatment was acceptable to patients and showed promise for efficacy. If efficacious, a chronic care model could be effective at reducing smoking among SMI patients. Trial registration ClinicalTrial.gov #: NCT03822416 (registered January 30th 2019).

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Section: Introductionmentioning

confidence: 99%

Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial

et al. 2021

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“…This, in turn, increases mortality, with the life expectancy of schizophrenia patients reduced by up to 15–20 years over the general population. The greater prevalence of physical conditions [ 3 , 4 ] among persons with SMI is most likely the result of lifestyle factors [ 5 ], such as smoking [ 6 ], eating a high-fat, low-fiber diet and exercising less [ 1 ], compared to the general population. To deal with this issue, a number of studies have been conducted with the aim of developing effective healthy living interventions in the areas of smoking cessation [ 7 ], weight management [ 8 , 9 ], exercise [ 10 ] and nutritional education [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of oral health promotion program for persons with severe mental illness: a cluster randomized controlled study

et al. 2020

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Objective To evaluate the effectiveness of a composite oral health promotion program designed to reduce dental plaque among persons with severe mental illness in a psychiatric institution. Methods A cluster randomized controlled study was carried out in chronic psychiatric wards of a general hospital in central Taiwan. Sixty-eight eligible male individuals admitted to 2 wards were randomly assigned to an experimental and a control group. Participants in the experimental group underwent an oral health promotion program that consisted of biweekly group education sessions, and a 12-week individual behavioral modification for oral hygiene course. The participants in the control group received usual care only. Dental plaque (measured by the Plaque Control Index) was examined by a single dentist before and after the experiment. Each participant responded to a questionnaire regarding oral health knowledge, attitude and behavior before and after the experiment. Results Fifty-eight individuals completed the study. Before the experiment, the plaque index was similar between the intervention group (68.9; N = 27) and the control group (69.8; N = 31). After the experiment, the plaque index was significantly better in the intervention group than in the control group (42.6 vs. 61.8; P < 0.001). Participants in the intervention group also demonstrated better oral health knowledge, attitude and behavior than those in the control group after the experiment. Conclusions A composite oral health promotion program using both group education and individual behavioral methods over a 12-week period was effective in both reducing dental plaque and improving the oral health knowledge of persons with severe mental illness in the institution. Trial registration: This study was retrospectively registered in Clinicaltrials.gov, with number NCT04464941, dated 7/7/2020. https://register.clinicaltrials.gov/RD103035018.

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“…Compared to the general population, individuals with mental illness such as schizophrenia, major depression, or bipolar disorder have worse physical health and reduced life expectancy 3‐5 . They die up to 20 years younger than people without mental illness 6 and the mortality gap between people with mental illness and the general population seems to widen further over time 7,8 .…”

Section: Introductionmentioning

confidence: 99%

“…2 Compared to the general population, individuals with mental illness such as schizophrenia, major depression, or bipolar disorder have worse physical health and reduced life expectancy. [3][4][5] They die up to 20 years younger than people without mental illness 6 and the mortality gap between people with mental illness and the general population seems to widen further over time. 7,8 This is not only true for people with so-called severe mental illness but also for people with "common" mental disorders (such as substance use disorders, depression, and anxiety), since their risk for, for example, cardiometabolic diseases is elevated as well.…”

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confidence: 99%

The somatic care situation of people with mental illness

Haussleiter

Emons

Hoffmann

et al. 2020

Health Science Reports

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Background and Aims People with mental illness have worse physical health and reduced life expectancy compared to the general population. Nevertheless, their medical care is often insufficient. The present study aimed to investigate the somatic status of people with mental illness with a focus on somatic diagnoses, metabolic risk factors, regular somatic care, and routine check‐ups. Methods This study used a 14‐item questionnaire to survey the somatic care situation of psychiatric university hospital patients. Main survey topics were psychiatric and somatic diagnoses, metabolic risk factors, regular somatic care, and routine check‐ups. Results Four‐hundred and thirty‐five people with mental illness (48.3% male, mean age 45.4 years) were included. More than three quarters of the participating people with mental illness had access to a general practitioner. People with affective and anxiety disorders reported significantly more contact with medical specialists for somatic diseases, but schizophrenic patients did not receive enough care. Not all people with mental illness and on psychiatric medication received regular somatic care. Somatic diseases increased with number of diagnoses, and the duration of the psychiatric illness was positively correlated with treatment motivation. Conclusion The observed unmet medical needs in this study might reflect the lack of treatment motivation in people with mental illness, but could also represent their obstacles to access care as well as a suboptimal communication between the treating psychiatrist and the referring general practitioner. Increasing awareness of somatic diseases in psychiatric patients and easier access to somatic care have to be implemented in psychiatric clinical routine. The risk of stigmatization in somatic institutions and the lack of self‐care management in people with mental illness are complicating factors.

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Dying Too Soon: Excess Mortality in Severe Mental Illness

Cited by 71 publications

References 70 publications

Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial

Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial

Effectiveness of oral health promotion program for persons with severe mental illness: a cluster randomized controlled study

The somatic care situation of people with mental illness

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