Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders

Wahlbeck, Kristian; Westman, Jeanette; Nordentoft, Merete; Gissler, Mika; Laursen, Thomas Munk

doi:10.1192/bjp.bp.110.085100

Cited by 483 publications

(376 citation statements)

References 29 publications

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“…A substantial proportion of all smokers have a history of depression, and among people with depression, smoking prevalence is about twice as high as in the general population [1][2][3], leading to increased morbidity and premature mortality [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up

et al. 2016

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Background Smoking is more prevalent among people with depression. Depression may make cessation more difficult and cessation may affect depression symptoms. Purpose The aims of this study were to assess the associations between (1) baseline depression and 1-year smoking abstinence and (2) abstinence and change in depression. Methods Observational study using data collected routinely in a smoking cessation clinic in the Czech Republic from 2008 to 2014. Aim 1: N = 3775 patients; 14.3% reported mild and 15.4% moderate/severe baseline depression levels measured using Beck's Depression Inventory (BDI-II). Logistic regressions assessed if depression level predicted 1-year biochemically verified abstinence while adjusting for patient and treatment characteristics. Aim 2: N = 835 patients abstinent at 1 year; change in depression was analysed using Chi-square statistics, t test and mixed method analyses of variance. Results Rate of abstinence was lower for patients with mild (32.5%, OR = 0.68; 95% CI: 0.54 to 0.87, p = 0.002) and moderate/severe depression (25.8%; OR = 0.57, 95% CI: 0.45 to 0.74, p < 0.001) compared with patients without depression (40.5%).Across abstinent patients, the majority with baseline depression reported lower depression levels at follow-up. Overall mean (SD) BDI-II scores improved from 9.2 (8.6) to 5.3 (6.1); t(834) = 14.6, p < 0.001. There were significant main effects of time (F(1832) = 880.8, p < 0.001, partial η 2 = 0.51) and baseline depression level (F(2832) = 666.4, p < 0.001, partial η 2 = 0.62) on follow-up depression and a significant depression * time interaction (F(2832) = 296.5, p < 0.001, partial η 2 = 0.42). Conclusions In this effective smoking cessation clinic, depression at the start of treatment predicted reduced smoking abstinence 1 year later. Patients abstinent from smoking experienced considerable improvement in depression.

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Section: Introductionmentioning

confidence: 99%

Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up

et al. 2016

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“…Mental disorder is an established risk factor for increased mortality [1,2]. People with mental disorders die prematurely for a variety of reasons, including poor physical health [3][4][5], adverse physiological consequences of long term psychotropic medication, unhealthy lifestyle [5], as well as increased death rates as a result of suicide, accidents and homicide [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Life expectancy at birth and all-cause mortality among people with personality disorder

Fok

Hayes

Chang

et al. 2012

Journal of Psychosomatic Research

195

148

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Publisher's copyright statement: NOTICE: this is the author's version of a work that was accepted for publication in the Journal of Psychosomatic Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be re ected in this document. Changes may have been made to this work since it was submitted for publication. Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. ABSTRACT ObjectiveIt is well established that serious mental illness is associated with raised mortality, yet few studies have looked at the life expectancy of people with personality disorder (PD). This study aims to examine the life expectancy and relative mortality in people with PD within secondary mental health care. MethodsWe set out to examine this using a large psychiatric case register in southeast London, UK.Mortality was obtained through national mortality tracing procedures. In a cohort of patients with a primary diagnosis of PD (n=1836), standardized mortality ratios (SMRs) and life expectancies at birth were calculated, using general population mortality statistics as the comparator. ResultsLife expectancy at birth was 63.3 years for women and 59.1 years for men with PD -18.7 years and 17.7 years shorter than females and males respectively in the general population in England and Wales. The SMR was 4.2 (95% CI: 3.03 -5.64) overall; 5.0 (95% CI: 3.15 -7.45) for females and 3.5 (95% CI: 2.17 -5.47) for males. The highest SMRs were found in the younger age groups for both genders. ConclusionPeople with PD using mental health services have a substantially reduced life expectancy, highlighting the significant public health burden of the disorder.

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“…Long-term patients treated in community also demonstrated more favourable outcomes than patients treated in hospitals (James et al, 2006). There is also evidence suggesting that deinstitutionalization might have led to a decreasing gap in life expectancy between psychiatric patients and the general population (Wahlbeck et al, 2011).…”

Section: Discussionmentioning

confidence: 95%

Long-term hospitalizations for schizophrenia in the Czech Republic 1998–2012

Winkler

Mladá

Krupchanka

et al. 2016

Schizophrenia Research

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Deinstitutionalization has not been pursued in the post-communist Europe until recently. The population of psychiatric patients institutionalized in the regional mental hospitals is, however, largely understudied. The aim of this study is to assess discharges of long-term inpatients with schizophrenia from Czech psychiatric hospitals and to analyse re-hospitalizations within this group. The nationwide register of all-cause inpatient hospitalizations was merged with the nationwide register of all-cause deaths on an individual level basis. Descriptive statistics, survival analysis and logistic regression were performed. 3,601 patients with schizophrenia previously hospitalized for more than a year were discharged from Czech mental hospitals between 1998 and 2012. This included 260 patients hospitalized for more than 20 years. Nearly one fifth (n=707) of the long-term patients died during the hospitalization; and discharges of 19.36 % (n=697) were only administrative in their nature. Out of 2,197 truly discharged patients, 14.88 % (n=327) were re-hospitalized within two weeks after the discharge. The highest odds of rehospitalization were associated with being discharged against medical advice (OR 5.27, p<0.001). These data are important for the ongoing mental health care reforms in the Czech Republic and other countries in the Central and Eastern Europe.

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Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders

Cited by 483 publications

References 29 publications

Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up

Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up

Life expectancy at birth and all-cause mortality among people with personality disorder

Long-term hospitalizations for schizophrenia in the Czech Republic 1998–2012

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