Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis

Abstract

Background Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. Methods and findings PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies ( n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21–2.80, p = 0.005, I 2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36–0.83, p < 0.001, I 2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28–1.47, p < 0.001, I 2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41–2.76, p < 0.001, I 2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. Conclusions In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.

Identification and management of cardiometabolic risk in subjects with schizophrenia spectrum disorders: A Delphi expert consensus study

“…As the EPA guidance recommend, the psychiatrist and the general practitioner should play an active role in the assessment and management of cardiovascular risk factors, as an integral part of the care of their psychiatric patients [4]. Difficulties experienced by people with severe mental disorders in accessing general medical services contribute to reduced life expectancy (Lawrence & Kisely, 2010) [57,40]. Several studies demonstrated underutilization of health care services, especially specialized care services, by psychiatric patients [40][41][42], particularly by patients with schizophrenia.…”

“…Difficulties experienced by people with severe mental disorders in accessing general medical services contribute to reduced life expectancy (Lawrence & Kisely, 2010) [57,40]. Several studies demonstrated underutilization of health care services, especially specialized care services, by psychiatric patients [40][41][42], particularly by patients with schizophrenia. To ensure standards of care and to avoid further stigmatization of these patients [43], psychiatrists should facilitate patients' access to primary and specialized somatic health care services and collaborate with primary care physicians, endocrinologists, and cardiologists to ensure accurate follow-up of patients' health care.…”

Discovery of Association Rules Patterns and Prevalence of Comorbidities in Adult Patients Hospitalized with Mental and Behavioral Disorders

“…Moreover, suffering from both mental and physical disorders has complex and bidirectional characteristics. When a mental disorder is accompanied by a mental or physical problem, it has been reported that the patient suffered from exacerbated symptom burden, functional disability, reduced quality of life, higher cost, and more medical service use [6][7][8][9][10]. Prevalence of comorbidities is high among those with mood disorders including depression and anxiety disorders [5].…”

“…It is difficult to estimate the proportion of people who had a mental disorder with a comorbidity, and even if it is reported, the criteria used for symptom classification vary by country [6,11,12]. Registration of medical comorbidity is an important research domain, which is related to survival [13], and various studies have been attempted.…”

“…Studies have been conducted to identify some mental disorders (e.g., schizophrenia, depressive disorder, and bipolar disorder) and a comorbidity [6], but only limited studies examined the physical and mental comorbidities, including more inclusive mental disorders. In particular, it is necessary to analyze the pattern between the accompanying diseases and check hidden meanings beyond descriptive analyses.…”