Excess Mortality and Risk Factors for Mortality Among Patients with Severe Mental Disorders Receiving Home Care Case Management

Abstract

Background: Home care case management (CM) is the main intervention for patients with severe mental disorders (SMDs) requiring outreach care. The present study investigated the long-term mortality outcome and associated risk factors in patients who received home care CM. Methods: In this nationwide study, we enrolled patients who received home care CM (n=10255) between January 1, 1999, and December 31, 2010; data of these patients were derived from a Taiwan health insurance database. We calculated the standardized mortality ratio (SMR) as the ratio of observed deaths in the study cohort to expected deaths in the general population and presented by diagnosis. Multivariate regression was performed to assess independent risk factors for mortality. Results: Among 10255 patients who received home care CM, 1409 died during the study period; the overall SMR was 3.13. Specifically, patients with organic mental disorder had the highest SMR (4.98), followed by those with schizophrenia (3.89), major depression (2.98), and bipolar disorder (1.97). After adjustment for confounding factors in the multivariate analysis, patients with organic mental disorder or dementia had the highest risk of mortality, whereas the mortality risk in patients with schizophrenia was comparable to that in patients with bipolar disorder or major depression. Deceased patients had a significantly higher proportion of acute or chronic physical illnesses, including cancer, chronic hepatic disease, and pneumonia. Conclusion: This study presented the gap of mortality in patients with SMDs receiving home care CM in Taiwan. We highlight the need for more effective strategies to improve medical care for this specified population.

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

“…An initial search retrieved 8,345 abstracts; removal of duplicates resulted in 6,390 abstracts for review. Of these, a total of 135 studies 5‐10,38‐166 were included, after excluding 463 articles upon full text assessment (see Figure 1, Table 1 and supplementary information). We ultimately included 4,536,447 individuals with schizophrenia who were compared with 1,115,600,059 control subjects from the general population.…”

A Large Sample Epidemiological Survey of Severe Mental Disorders: Current Status and Prospects

“…Moreover, patients in non-urban areas often go out for work, making it di cult for community rehabilitation workers and medical staff to manage them in a uni ed manner. Therefore, the government should strengthen the work quality of non-urban psychiatrists and improve the follow-up work in the community, targeted training of medical staff and family care management [ 21] to enhance the management rate of registered patients.…”

Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy

“…Although this disorder is more prevalent than schizophrenia, less data are available showing a higher risk of developing cancer 23 and a higher SMR with respect to the general population. [24][25][26] With respect to this, in a 5-year-period study carried out in New Zealand among 8762 people with breast and 4022 with colorectal cancer, those affected by schizophrenia, schizoaffective, or bipolar disorders received diagnosis at a later stage and that contributed, after adjusting for several factors, a two and half times higher mortality for breast cancer and three times for colon cancer than people without SMI. 27 A number of international studies on mortality in SMI are based on hospital-based registry, with the limit that data related to lifestyle and other variables evident in community-based studies cannot be examined.…”

“…Cancer‐related morbidity and premature mortality seem to plague patients with bipolar‐spectrum disorders not less than it does those with schizophrenia. Although this disorder is more prevalent than schizophrenia, less data are available showing a higher risk of developing cancer 23 and a higher SMR with respect to the general population 24–26 . With respect to this, in a 5‐year‐period study carried out in New Zealand among 8762 people with breast and 4022 with colorectal cancer, those affected by schizophrenia, schizoaffective, or bipolar disorders received diagnosis at a later stage and that contributed, after adjusting for several factors, a two and half times higher mortality for breast cancer and three times for colon cancer than people without SMI 27 …”