Abstract
Serious mental illness (SMI, including schizophrenia, schizoaffective disorder, and bipolar disorder) is associated with worse general health. However, admissions to general hospitals have received little investigation. We sought to delineate frequencies of and causes for non-psychiatric hospital admissions in SMI and compare with the general population in the same area. Records of 18 380 individuals with SMI aged ⩾20 years in southeast London were linked to hospitalisation data. Age- and gender-standardised admission ratios (SARs) were calculated by primary discharge diagnoses in the 10th edition of the World Health Organization International Classification of Diseases (ICD-10) codes, referencing geographic catchment data. Commonest discharge diagnosis categories in the SMI cohort were urinary conditions, digestive conditions, unclassified symptoms, neoplasms, and respiratory conditions. SARs were raised for most major categories, except neoplasms for a significantly lower risk. Hospitalisation risks were specifically higher for poisoning and external causes, injury, endocrine/metabolic conditions, haematological, neurological, dermatological, infectious and non-specific ('Z-code') causes. The five commonest specific ICD-10 diagnoses at discharge were 'chronic renal failure' (N18), a non-specific code (Z04), 'dental caries' (K02), 'other disorders of the urinary system' (N39), and 'pain in throat and chest' (R07), all of which were higher than expected (SARs ranging 1.57-6.66). A range of reasons for non-psychiatric hospitalisation in SMI is apparent, with self-harm, self-neglect and/or reduced healthcare access, and medically unexplained symptoms as potential underlying explanations.
Highlights
There is a growing awareness of the adverse physical health experienced by people living with serious mental illness (SMI, which includes schizophrenia, schizoaffective disorder, and bipolar disorder)
The number of comorbid health conditions was associated with higher odds of using speciality mental health service, while not associated with utilisation of services provided by general health care providers (Lee, 2016)
Diagnoses recorded in Clinical Record Interactive Search (CRIS) are based on the 10th edition of the World Health Organization International Classification of Diseases (ICD-10) and were extracted both from those recorded in structured dropdown menus within the source electronic health record or extracted from free text fields using bespoke software (Perera et al 2016)
Summary
There is a growing awareness of the adverse physical health experienced by people living with serious mental illness (SMI, which includes schizophrenia, schizoaffective disorder, and bipolar disorder). People with schizophrenia were significantly more likely to have one physical-health comorbidity (OR 1.21, 95% CI 1.16–1.27), two physical-health comorbidities (OR 1.37, 95% CI 1.29–1.44), and three or more physical-health comorbidities (OR 1.19, 95% CI 1.12–1.27) (Smith et al 2013a, b). A range of reasons for non-psychiatric hospitalisation in SMI is apparent, with self-harm, self-neglect and/or reduced healthcare access, and medically unexplained symptoms as potential underlying explanations
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