Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress

O'Connor, Rory C; Worthman, Carol M; Abanga, Marie; Athanassopoulou, Nikoletta; Boyce, Niall; Chan, Lai Fong; Christensen, Helen; Das-Munshi, Jayati; Downs, James; Koenen, Karestan C; Moutier, Christine Yu; Templeton, Peter; Batterham, Philip; Brakspear, Karen; Frank, Richard G; Gilbody, Simon; Gureje, Oye; Henderson, David; John, Ann; Kabagambe, Wilbroad; Khan, Murad; Kessler, David; Kirtley, Olivia J; Kline, Sarah; Kohrt, Brandon; Lincoln, Alisa K; Lund, Crick; Mendenhall, Emily; Miranda, Regina; Mondelli, Valeria; Niederkrotenthaler, Thomas; Osborn, David; Pirkis, Jane; Pisani, Anthony R; Prawira, Benny; Rachidi, Hala; Seedat, Soraya; Siskind, Dan; Vijayakumar, Lakshmi; Yip, Paul S F

doi:10.1016/s2215-0366(23)00058-5

Cited by 39 publications

(27 citation statements)

References 121 publications

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“…Facilitating personalization of digital approaches increases their ability to meet the diverse needs of people in real-world clinical populations [ 10 ]. Incorporating patient preferences in the broad development of tools is essential, but integrating patient preferences into the operation of the digital tool also enables genuine personalization so that the tool is closely matched to the individual requirements and preferences of the user [ 75 ].…”

Section: Resultsmentioning

confidence: 99%

“…The focus of digital mental health research also tends to be on biological and psychological parameters, whereas social mechanisms are equally important [ 10 ].…”

Section: Resultsmentioning

confidence: 99%

“…Increasing access to care for people with severe mental illnesses (SMIs) such as psychosis and bipolar disorder is a priority worldwide for mental health, particularly in low- and middle-income countries (LMICs) [ 8 ]. Although people with SMI experience major health inequalities and have a life expectancy 10 to 25 years shorter than that of the general population [ 9 , 10 ], less research on digital interventions has been conducted in this patient group compared with other conditions [ 11 ]. Assumptions that people with SMI will not be able or willing to engage in technology-augmented assessment and treatment have combined with the known element of digital exclusion due to the intersection of SMI and socioeconomic inequities, resulting in a shortfall of development in this area [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions

Smith,

Hardy,

Vinnikova

et al. 2024

JMIR Ment Health

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Background Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). Objective An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI. Methods The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group. Results Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI. Conclusions The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation.

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Section: Resultsmentioning

confidence: 99%

“…The focus of digital mental health research also tends to be on biological and psychological parameters, whereas social mechanisms are equally important [ 10 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions

Smith,

Hardy,

Vinnikova

et al. 2024

JMIR Ment Health

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“…People with psychiatric disorders are known to be less likely to seek help for health related problems and to attend medical check-ups, and they are also less likely to receive health interventions and prescriptions for non-psychiatric drugs, potentially leading to delays in the detection and treatment of diseases 32334041. A better integration of mental and physical healthcare services, the prioritisation of prevention while strengthening treatment, and the optimisation of intervention synergies across social-ecological levels have been recently proposed as priority action points to prevent premature mortality in people with psychiatric disorders 42…”

Section: Discussionmentioning

confidence: 99%

All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study

Fernández de la Cruz,

Isomura,

Lichtenstein

et al. 2024

BMJ

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Objective To estimate the risk of all cause and cause specific mortality in people with obsessive-compulsive disorder (OCD) compared with matched unaffected people from the general population and with their unaffected siblings. Design Population based matched cohort and sibling cohort study. Setting Register linkage in Sweden. Participants Population based cohort including 61 378 people with OCD and 613 780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34 085 people with OCD and 47 874 unaffected full siblings. Cohorts were followed up for a median time of 8.1 years during the period from 1 January 1973 to 31 December 2020. Main outcome measures All cause and cause specific mortality. Results 4787 people with OCD and 30 619 unaffected people died during the study period (crude mortality rate 8.1 and 5.1 per 1000 person years, respectively). In stratified Cox proportional hazards models adjusted for birth year, sex, county, migrant status (born in Sweden versus abroad), and sociodemographic variables (latest recorded education, civil status, and family income), people with OCD had an increased risk of all cause mortality (hazard ratio 1.82, 95% confidence interval 1.76 to 1.89) and mortality due to natural causes (1.31, 1.27 to 1.37) and unnatural causes (3.30, 3.05 to 3.57). Among the natural causes of death, those due to endocrine, nutritional, and metabolic diseases, mental and behavioural disorders, and diseases of the nervous, circulatory, respiratory, digestive, and genitourinary systems were higher in the OCD cohort. Conversely, the risk of death due to neoplasms was lower in the OCD cohort compared with the unaffected cohort. Among the unnatural causes, suicide showed the highest hazard ratio, followed by accidents. The results were robust to adjustment for psychiatric comorbidities and familial confounding. Conclusions Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD. Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.

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“… 5 10 A recent large umbrella review demonstrated that MHDs increase the risk of poor clinical outcomes for PHCs, including all-cause and disease-specific mortality, particularly for alcohol use disorders, depressive disorders and schizophrenia. 11 Poor mortality-related outcomes are further explained as comorbid PHCs are associated with increased risks for suicidal ideation 12 and suicide attempts 13 in people with MHDs.…”

Section: Introductionmentioning

confidence: 99%

Comorbid physical health burden of serious mental health disorders in 32 European countries

Wienand,

Wijnen,

Heilig

et al. 2024

BMJ Ment Health

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BackgroundMental health disorders (MHDs) are associated with physical health disparities, but underlying excess risk and health burden have not yet been comprehensively assessed.ObjectiveTo assess the burden of comorbid physical health conditions (PHCs) across serious MHDs in Europe.MethodsWe estimated the relative prevalence risk of PHCs associated with alcohol use disorders (AUD), bipolar disorder (BD), depressive disorders (DD) and schizophrenia (SZ) across working-age populations of 32 European countries in 2019 based on a targeted literature review. Excess physical health burden was modelled using population-attributable fractions and country-level prevalence data.FindingsWe screened 10 960 studies, of which 41 were deemed eligible, with a total sample size of over 18 million persons. Relative prevalence of PHCs was reported in 54%, 20%, 15%, 5% and 7% of studies, respectively, for SZ, DD, BD, AUD or mixed. Significant relative risk estimates ranged from 1.44 to 3.66 for BD, from 1.43 to 2.21 for DD, from 0.81 to 1.97 for SZ and 3.31 for AUD. Excess physical health burden ranged between 27% and 67% of the total, corresponding to 84 million (AUD), 67 million (BD), 66 million (DD) and 5 million (SZ) PHC diagnoses in Europe. A 1% reduction in excess risk assuming causal inference could result in two million fewer PHCs across investigated MHDs.ConclusionsThis is the first comprehensive study of the physical health burden of serious MHDs in Europe. The methods allow for updates, refinement and extension to other MHDs or geographical areas.Clinical implicationsThe results indicate potential population health benefits achievable through more integrated mental and physical healthcare and prevention approaches.

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Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress

Cited by 39 publications

References 121 publications

Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions

Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions

All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study

Comorbid physical health burden of serious mental health disorders in 32 European countries

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