Long-term mortality of persons with severe mental illness and diabetes: a population-based cohort study in Denmark

Ribe, Anette Riisgaard; Laursen, Thomas Munk; Sandbæk, Annelli; Charles, Morten; Nordentoft, Merete; Vestergaard, Mogens

doi:10.1017/s0033291714000634

Cited by 60 publications

(44 citation statements)

References 45 publications

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“…1, 22,23 In a Danish study involving 4.7 million participants, the overall mortality ratios for those with SMI and diabetes mellitus (1,083 individuals) were 4.14 (95% CI 3.81-4.51) for men and 3.13 (95% CI 2.88-3.40) for women. 24 The cumulative risks of death following the diagnosis of diabetes melli tus were substantial for people with SMI; 15.0% (95% CI 12.4-17.6%) of those aged <50 years died within 7 years of diagnosis, with the risk rising to 30.7% (95% CI 27.8-33.4%) for those aged 50-69 years and to 63.8% (95% CI 58.9-68.2%) for those aged ≥70 years. Of deaths from physical causes, 33.4% were attributed to diabetes mellitus and 14% of deaths from physical causes were attributed to the interaction between diabetes mellitus and SMI.…”

Section: Epidemiologymentioning

confidence: 99%

Diabetes mellitus and severe mental illness: mechanisms and clinical implications

2014

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The prevalence of diabetes mellitus is twofold to threefold higher in people with severe mental illness (SMI) than in the general population, with diabetes mellitus affecting ∼12% of people receiving antipsychotics. The consequences of diabetes mellitus are more severe and frequent in people with SMI than in those without these conditions, with increased rates of microvascular and macrovascular complications, acute metabolic dysregulation and deaths related to diabetes mellitus. Multiple complex mechanisms underlie the association between diabetes mellitus and SMI; these mechanisms include genetic, environmental and disease-specific factors, and treatment-specific factors. Although antipsychotics are the mainstay of treatment in SMI, a causative link, albeit of uncertain magnitude, seems to exist between antipsychotics and diabetes mellitus. The principles of managing diabetes mellitus in people with SMI are similar to those for the general population and should follow currently established treatment algorithms. Lifestyle interventions are needed to reduce incident diabetes mellitus. In addition, improved uptake of opportunities to screen for this disease will reduce the high prevalence of undiagnosed diabetes mellitus. Currently, people with SMI receive poorer treatment for diabetes mellitus than the general population. Thus, health-care professionals in primary care, diabetes mellitus services and mental health teams have a responsibility to ensure that patients with SMI are not disadvantaged.

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Section: Epidemiologymentioning

confidence: 99%

Diabetes mellitus and severe mental illness: mechanisms and clinical implications

2014

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“…This mortality rate is largely linked to physical health inequalities which can be ameliorated through modifiable risk factors such as diet and exercise (Ribe et al . ). A healthy lifestyle is particularly relevant for those receiving antipsychotic medication which, when combined with large amounts of sedentary behaviour, can significantly increase cardio‐metabolic risk (Vancampfort et al .…”

Section: Introductionmentioning

confidence: 97%

Promoting exercise behaviour in a secure mental health setting: Healthcare assistant perspectives

Kinnafick¹,

Papathomas²,

Regoczi³

2018

Int J Mental Health Nurs

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Individuals with severe mental illness engage in significantly less amounts of physical activity than the general population. A secure mental health setting can exacerbate barriers to exercise, and facilitate physical inactivity and sedentary behaviour. Healthcare assistants are intimately involved in the daily lives of patients and, therefore, should be considered integral to exercise promotion in secure mental health settings. Our aim was to explore healthcare assistants' perceptions of exercise and their attitudes to exercise promotion for adult patients in a secure mental health hospital. Qualitative semi-structured interviews were conducted with 11 healthcare assistants from a large UK-based secure mental health hospital. Topics included healthcare assistants' personal experiences of exercise within a secure facility, their perceptions of exercise as an effective treatment tool for mental health, and their perceived roles and responsibilities for exercise promotion. Thematic analysis was used to analyse the data. Three main themes were identified: (i) exercise is multi-beneficial to patients, (ii) perceived barriers to effective exercise promotion, and (iii) strategies for effectives exercise promotion. Healthcare assistants considered exercise to hold patient benefits. However, core organizational and individual barriers limited healthcare assistants' exercise promotion efforts. An informal approach to exercise promotion was deemed most effective to some, whereas others committed to more formal strategies including compulsory sessions. With education and organizational support, we propose healthcare assistants are well placed to identify individual needs for exercise promotion. Their consultation could lead to more efficacious, person-sensitive interventions.

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“…People with severe mental illness (SMI) experience a premature mortality of around 15–20 years, largely due to inequalities in physical health (Ribe et al 2014). For instance, people with SMI have a significantly higher risk of obesity, hyperglycaemia and metabolic syndrome, all of which contribute towards the development of cardiovascular diseases (Gardner-Sood et al 2015).…”

Section: Introductionmentioning

confidence: 99%

Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis

et al. 2016

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Exercise can improve clinical outcomes in people with severe mental illness (SMI). However, this population typically engages in low levels of physical activity with poor adherence to exercise interventions. Understanding the motivating factors and barriers towards exercise for people with SMI would help to maximize exercise participation. A search of major electronic databases was conducted from inception until May 2016. Quantitative studies providing proportional data on the motivating factors and/or barriers towards exercise among patients with SMI were eligible. Random-effects meta-analyses were undertaken to calculate proportional data and 95% confidence intervals (CI) for motivating factors and barriers toward exercise. From 1468 studies, 12 independent studies of 6431 psychiatric patients were eligible for inclusion. Meta-analyses showed that 91% of people with SMI endorsed ‘improving health’ as a reason for exercise (N = 6, n = 790, 95% CI 80–94). Among specific aspects of health and well-being, the most common motivations were ‘losing weight’ (83% of patients), ‘improving mood’ (81%) and ‘reducing stress’ (78%). However, low mood and stress were also identified as the most prevalent barriers towards exercise (61% of patients), followed by ‘lack of support’ (50%). Many of the desirable outcomes of exercise for people with SMI, such as mood improvement, stress reduction and increased energy, are inversely related to the barriers of depression, stress and fatigue which frequently restrict their participation in exercise. Providing patients with professional support to identify and achieve their exercise goals may enable them to overcome psychological barriers, and maintain motivation towards regular physical activity.

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Long-term mortality of persons with severe mental illness and diabetes: a population-based cohort study in Denmark

Abstract: Long-term mortality is high for persons with SMI and diabetes. This calls for effective intervention from a coordinated and collaborating healthcare system.

Cited by 60 publications

References 45 publications

Diabetes mellitus and severe mental illness: mechanisms and clinical implications

Diabetes mellitus and severe mental illness: mechanisms and clinical implications

Promoting exercise behaviour in a secure mental health setting: Healthcare assistant perspectives

Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis

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