Excess mortality and risk factors for mortality among patients with severe mental disorders receiving home care case management

Wen-Yin Chen,Sheng-Jean Huang,Chin-Kuo Chang,Chun-Hung Pan,Sheng-Shiang Su,Tien-Wei Yang,Chian-Jue Kuo

doi:10.1080/08039488.2020.1799431

Abstract

Aim Home care case management (CM) is the main intervention for patients with severe mental disorders (SMDs) requiring outreach care. This study investigated the long-term mortality outcome and associated risk factors in patients who received home care CM. Methods This nationwide study enrolled patients who received home care CM (n = 10,255) between 1 January 1999 and 31 December 2010. Each patient was followed up from the baseline (when patients underwent home case CM for the first time during the study period) to the censor (i.e. mortality or the end of the study). We calculated the standardized mortality ratio (SMR) and presented by age and diagnosis. Multivariate regression was performed to assess independent risk factors for mortality. Results Among 10,255 patients who received home care CM, 1409 died during the study period; the overall SMR was 3.13. Specifically, patients with organic mental disorder had the highest SMR (4.98), followed by those with schizophrenia (3.89), major depression (2.98), and bipolar disorder (1.97). In the multivariate analysis, patients with organic mental disorder or dementia had the highest risk, whereas the mortality risk in patients with schizophrenia was comparable to that in patients with bipolar disorder or major depression. Deceased patients had a significantly higher proportion of acute or chronic physical illnesses, including cancer, chronic hepatic disease, pneumonia, diabetes mellitus, cardiovascular disease, and asthma. Conclusion This study presented the gap of mortality in patients with SMDs receiving home care CM in Taiwan. We highlight the need for effective strategies to improve medical care for this specified population.

Highlights

The burden of mental disorders has increased in recent years and is currently the major cause of lost disabilityadjusted life years globally [1]
Another limitation is that additional studies such as a randomized clinical trial are required to investigate whether the home care case management intervention can reduce mortality
Home care case management (CM) is part of the community therapy in Taiwan [15], which is similar to the intensive CM (ICM) model, but the caseload of home care CM is higher than that of ICM

Summary

Introduction

The burden of mental disorders has increased in recent years and is currently the major cause of lost disabilityadjusted life years globally [1]. Patients with severe mental disorders (SMDs) often present with prolonged illness with episodic exacerbations if they do not receive optimal treatment, and these patients have a high risk of premature mortality [2]. High mortality in patients with SMDs is a global public health challenge, among those not receiving regular treatment [4, 5]. Underlying risk factors, such as economic disadvantage, negative health habits, and difficulty accessing and adhering to medical treatment, usually contribute to high mortality in patients with chronic mental illness [6]. The gap of life expectancy between patients with SMDs and the general population is usually presented as the standardized mortality ratio (SMR), which can be considered as an index for local mental health services.

Methods

Results

Conclusion