South London Healthcare Research Articles

Associations between recorded loneliness and adverse mental health outcomes among patients receiving mental healthcare in South London: a retrospective cohort study

PurposeLoneliness disproportionately affects people with mental disorders, but associations with mental health outcomes in groups affected remain less well understood.MethodA cohort of patients receiving mental healthcare on 30th June 2012 was assembled from a large mental health records database covering a south London catchment area. Recorded loneliness within the preceding 2 years was extracted using natural language processing and outcomes were measured between 30th June 2012 until 30th December 2019, except for survival which applied a censoring point of 6th December 2020 according to data available at the time of extraction. The following mental healthcare outcomes: (i) time to first crisis episode; (ii) time to first emergency presentation; (iii) all-cause mortality; (iv) days active to service per year; and (v) face-to-face contacts per year.ResultsLoneliness was recorded in 4,483 (16.7%) patients in the study population and fully adjusted models showed associations with subsequent crisis episode (HR 1.17, 95% CI 1.07–1.29), emergency presentation (HR 1.30, 1.21–1.40), days active per year (IRR 1.04, 1.03–1.05), and face-to-face contacts per year (IRR 1.28, 1.27–1.30). Recorded loneliness in patients with substance misuse problems was particularly strongly associated with adverse outcomes, including risk of emergency presentation (HR 1.68, 1.29–2.18) and mortality (HR 1.29, 1.01–1.65).ConclusionPatients receiving mental healthcare who are recorded as lonely have a higher risk of several adverse outcomes which may require a need for higher service input.

Risk of hospitalised falls and hip fractures in working age adults receiving mental health care

ObjectiveThis retrospective cohort study investigates risks of hospitalised fall or hip fractures in working age adults receiving mental health care in South London. MethodsPatients aged 18 to 64, who received a first mental illness diagnosis between 2008 and 2016 were included. Primary outcome was hospitalised falls, secondary outcome was hip fractures. Age- and gender-standardised incidence rates and incidence rate ratios (IRRs) compared to local general population were calculated. Multivariate Cox proportionate hazard models were used to investigate which mental health diagnoses were most at risk. ResultsIn 50,885 patients incidence rates were 8.3 and 0.8 per 1,000 person-years for falls and hip fractures respectively. Comparing mental health patients to the general population, age-and-gender-adjusted IRR for falls was 3.6 (95% CI: 3.3–4.0) and for hip fractures 7.5 (95% CI: 5.2–10.4). The falls IRR was highest for borderline personality and bipolar disorder and lowest for schizophreniform and anxiety disorder. After adjusting for multiple confounders in the sample of mental health service users, borderline personality disorder yielded a higher and anxiety disorder a lower falls risk. ConclusionWorking age adults using mental health services have almost four times the incidence of hospitalised falls compared to general population. Targeted interventions are warranted.

Associations between loneliness and acute hospitalisation outcomes among patients receiving mental healthcare in South London: a retrospective cohort study

PurposeIt is well known that loneliness can worsen physical and mental health outcomes, but there is a dearth of research on the impact of loneliness in populations receiving mental healthcare. This study aimed to investigate cross-sectional correlates of loneliness among such patients and longitudinal risk for acute general hospitalisations.MethodA retrospective observational study was conducted on the data from patients aged 18 + receiving assessment/care at a large mental healthcare provider in South London. Recorded loneliness status was ascertained among active patients on the index date, 30th Jun 2012. Acute general hospitalisation (emergency/elective) outcomes were obtained until 31st Mar 2018. Length of stay was modelled using Poisson regression models and time-to hospitalisation and time-to mortality were modelled using Cox proportional hazards regression models.ResultsThe data from 26,745 patients were analysed. The prevalence of patients with recorded loneliness was 16.4% at the index date. In the fully adjusted model, patients with recorded loneliness had higher hazards of emergency (HR 1.15, 95% CI 1.09–1.22) and elective (1.05, 1.01–1.12) hospitalisation than patients who were not recorded as lonely, and a longer duration of both emergency (IRR 1.06, 95% CI 1.05–1.07) and elective (1.02, 1.01–1.03) general hospitalisations. There was no association between loneliness and mortality. Correlates of loneliness included having an eating disorder (OR 1.67, 95% CI 1.29–2.25) and serious mental illnesses (OR 1.44, 1.29–1.62).ConclusionLoneliness in patients receiving mental healthcare is associated with higher use of general hospital services. Increased attention to the physical healthcare of this patient group is therefore warranted.

Insights from electronic health record data to improve mental health service delivery during the COVID-19 pandemic

BackgroundRemote consultation technology has been rapidly adopted due to the COVID-19 pandemic. However, some healthcare settings have faced barriers in implementation. We present a study to investigate changes in rates of remote consultation during the pandemic using a large electronic health record (EHR) dataset.MethodsThe Clinical Record Interactive Search tool (CRIS) was used to examine de-identified EHR data of people receiving mental healthcare in South London, UK. Data from around 37,500 patients were analysed for each week from 7th January 2019 and 20th September 2020 using linear regression and locally estimated scatterplot smoothing (LOESS) to investigate changes in the number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals and prescribing of antipsychotics and mood stabilisers. The data are presented in an interactive dashboard: http://rpatel.co.uk/TelepsychiatryDashboard.ResultsThe frequency of in-person contacts was substantially reduced following the onset of the pandemic (β coefficient: -5829.6 contacts, 95% CI -6919.5 to -4739.6, p<0.001), while the frequency of remote contacts increased significantly (β coefficient: 3338.5 contacts, 95% CI 3074.4 to 3602.7, p<0.001). Rates of remote consultation were lower in older adults than in working age adults, children and adolescents. Despite the increase in remote contact, antipsychotic and mood stabiliser prescribing remained at similar levels.ConclusionsThe COVID-19 pandemic has been associated with a marked increase in remote consultation, particularly among younger patients. However, there was no evidence that this has led to changes in prescribing. Further work is needed to support older patients in accessing remote mental healthcare.DisclosureAll authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: RS has received funding from Janssen, GSK and Takeda outside the submitted work. RP has received funding from Janssen, Induction Healthcare and H

The case for improved transdiagnostic detection of first-episode psychosis: Electronic health record cohort study

BackgroundImproving outcomes of a First Episode of Psychosis (FEP) relies on the ability to detect most individuals with emerging psychosis and treat them in specialised Early Intervention (EI) services. Efficacy of current detection strategies is undetermined. MethodsRECORD-compliant clinical, 6-year, retrospective, transdiagnostic, lifespan-inclusive, Electronic Health Record (EHR) cohort study, representing real-world secondary mental healthcare in South London and Maudsley (SLaM) NHS. All individuals accessing SLaM in the period 2007–2017 and receiving any ICD-10 diagnosis other than persistent psychosis were included. Descriptive statistics, Kaplan-Meier curves, logistic regression, epidemiological incidence of psychosis in the general population were used to address pathways to care and detection power of EI services for FEP. ResultsA total of 106,706 individuals underwent the 6-year follow-up: they were mostly single (72.57%) males (50.51%) of white ethnicity (60.01%), aged on average 32.96 years, with an average Health Of the Nation Outcome Scale score of 11.12 and mostly affected with F40–48 Neurotic/stress-related/somatoform disorders (27.46%). Their transdiagnostic risk of developing a FEP cumulated to 0.072 (95%CI 0.067–0.077) at 6 years. Those individuals who developed a FEP (n = 1841) entered healthcare mostly (79.02%) through inpatient mental health services (29.76%), community mental health services (29.54%) or accident and emergency departments (19.50%); at the time of FEP onset, most of them (46.43%) were under the acute care pathway. Individuals contacting accident and emergency departments had an increased risk of FEP (OR 2.301, 95%CI 2.095–2.534, P < 0.001). The proportion of SLaM FEP cases that were eligible and under the care of EI services was 0.456 at any time. The epidemiological proportion of FEP cases in the sociodemographically-matched general population that was detected by EI service was 0.373. ConclusionsMore than half of individuals who develop a FEP remain undetected by current pathways to care and EI services. Improving detection strategies should become a mainstream area in the future generation of early psychosis research.

Community treatment orders and associations with readmission rates and duration of psychiatric hospital admission: a controlled electronic case register study

ObjectivesLimited evidence is available regarding the effect of community treatment orders (CTOs) on mortality and readmission to psychiatric hospital. We compared clinical outcomes between patients placed on CTOs to a...

Transdiagnostic Individualized Clinically Based Risk Calculator for the Detection of Individuals at Risk and the Prediction of Psychosis: Model Refinement Including Nonlinear Effects of Age.

Background: The first rate-limiting step for primary indicated prevention of psychosis is the detection of young people who may be at risk. The ability of specialized clinics to detect individuals at risk for psychosis is limited. A clinically based, individualized, transdiagnostic risk calculator has been developed and externally validated to improve the detection of individuals at risk in secondary mental health care. This calculator employs core sociodemographic and clinical predictors, including age, which is defined in linear terms. Recent evidence has suggested a nonlinear impact of age on the probability of psychosis onset. Aim: To define at a meta-analytical level the function linking age and probability of psychosis onset. To incorporate this function in a refined version of the transdiagnostic risk calculator and to test its prognostic performance, compared to the original specification. Design: Secondary analyses on a previously published meta-analysis and clinical register-based cohort study based on 2008–2015 routine secondary mental health care in South London and Maudsley (SLaM) National Health Service (NHS) Foundation Trust. Participants: All patients receiving a first index diagnosis of non-organic/non-psychotic mental disorder within SLaM NHS Trust in the period 2008–2015. Main outcome measure: Prognostic accuracy (Harrell’s C). Results: A total of 91,199 patients receiving a first index diagnosis of non-organic and non-psychotic mental disorder within SLaM NHS Trust were included in the derivation (33,820) or external validation (54,716) datasets. The mean follow-up was 1,588 days. The meta-analytical estimates showed that a second-degree fractional polynomial model with power (−2, −1: age1 = age−2 and age2 = age−1) was the best-fitting model (P < 0.001). The refined model that included this function showed an excellent prognostic accuracy in the external validation (Harrell’s C = 0.805, 95% CI from 0.790 to 0.819), which was statistically higher than the original model, although of modest magnitude (Harrell’s C change = 0.0136, 95% CIs from 0.006 to 0.021, P < 0.001). Conclusions: The use of a refined version of the clinically based, individualized, transdiagnostic risk calculator, which allows for nonlinearity in the association between age and risk of psychosis onset, may offer a modestly improved prognostic performance. This calculator may be particularly useful in young individuals at risk of developing psychosis who access secondary mental health care.

Accident and Emergency – Doctor over-ruled patient's concern: Anita Border v South London Healthcare NHS Trust (Central London County Court, 20 March 2013 – Judge Moloney QC)

Accident and Emergency – Doctor over-ruled patient's concern: Anita Border v South London Healthcare NHS Trust (Central London County Court, 20 March 2013 – Judge Moloney QC)

South London Healthcare NHS Trust to be dissolved by 1 October 2013

South London Healthcare NHS Trust to be dissolved by 1 October 2013

A retrospective study of cervical screening in women under 25 years (2005–2009)

Since 2003, when the age threshold of cervical screening in England has been raised from 20 to 25, there have been many calls to restore the previous starting age for cervical screening as there are concerns about the delaying of initiating cervical screening may result in an increase in the risk of cervical cancer. We conducted a retrospective study to analyse the safety of changing the starting age of cervical screening programme in England to the age of 25, by reviewing the cervical cytology performed in 426 women under 25 years in Bromley Borough of London, UK, between 2005 and 2009. We conducted a retrospective analysis of 426 women under 25 years, who were referred with cervical smears taken at Bromley PCT's to the colposcopy clinic at Bromley Hospitals, South London Healthcare NHS Trust, over a 4-year period, between 2005 and 2009. The colposcopy findings and histology results were reviewed and analysed. In our review, 44.80 % of smears showed mild dyskaryosis. 23 and 12 % showed moderate dyskaryosis and severe dyskaryosis, respectively. 11.2 % had borderline smear, and 0.2 % revealed glandular changes. On colposcopic examination, only 16.2 % (69) were reported as normal; however, 25.8, 20 % of the women were diagnosed with low and high grade abnormalities, respectively. 12 % (53) of the cases showed HPV-related changes, whereas no suspected malignancy was found. Colposcopic-directed cervical biopsy was obtained in 228 women (~54 %) depending on the colposcopic examination findings. The most histological finding was CIN I which constitutes 48 % (110) of all biopsies. However, 25 % (58) and 9 % (20) revealed CIN II and CIN III, respectively. The glandular changes noticed in only one case (0.44 %). The treatment was planned for 130 women, a significant proportion (30.5 %) of the 426 women who referred for colposcopy. The histological examination of the biopsies showed CIN in 91 % of the cases (115), 74.8 % (86) of them had CIN II (36) or CIN III (50). In addition, the glandular changes found in two cases (1.6 %). More importantly, there was one case diagnosed with micro-invasive cervical cancer (0.79 %) and this comprises 0.23 % of our sample. In view of the size and the heterogeneity of our sample, it is difficult to recommend changing the starting age of the cervical screening programme. However, we strongly recommend to have a low threshold to offering cervical cytology to the women under 25 on clinical basis, particularly, after the recent introduction of HPV triage (outside the scope of this study), which will enable us to avoid the two main disadvantages of the early screening, namely over-diagnosis and over-treatment.

Tender, subcutaneous nodules in an unwell patient

Clinical and Experimental DermatologyVolume 37, Issue 8 p. 934-936 CPD • Clinicopathological case Tender, subcutaneous nodules in an unwell patient T. N. Basu, T. N. Basu Departments of DermatologySearch for more papers by this authorE. E. Craythorne, E. E. Craythorne Departments of DermatologySearch for more papers by this authorJ. R. Salisbury, J. R. Salisbury HistopathologySearch for more papers by this authorR. Marcus, R. Marcus Haematology, King’s College Hospital, London NHS Foundation Trust, London, UKSearch for more papers by this authorA. C. Pembroke, A. C. Pembroke Department of Dermatology, South London Healthcare Trust, Kent, Beckenham, UKSearch for more papers by this authorD. Creamer, D. Creamer HistopathologySearch for more papers by this author T. N. Basu, T. N. Basu Departments of DermatologySearch for more papers by this authorE. E. Craythorne, E. E. Craythorne Departments of DermatologySearch for more papers by this authorJ. R. Salisbury, J. R. Salisbury HistopathologySearch for more papers by this authorR. Marcus, R. Marcus Haematology, King’s College Hospital, London NHS Foundation Trust, London, UKSearch for more papers by this authorA. C. Pembroke, A. C. Pembroke Department of Dermatology, South London Healthcare Trust, Kent, Beckenham, UKSearch for more papers by this authorD. Creamer, D. Creamer HistopathologySearch for more papers by this author First published: 08 June 2012 https://doi.org/10.1111/j.1365-2230.2012.04404.x Dr Daniel Creamer, Dermatology Department, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK E-mail: daniel.creamer@nhs.net Conflict of interest: none declared Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume37, Issue8December 2012Pages 934-936 RelatedInformation

Do patient information leaflets affect patients’ expectation of orthodontic treatment? A randomized controlled trial

To determine the impact that information leaflets have on patient expectations of orthodontic treatment. A prospective, randomized controlled study. The Orthodontic Department at Queen Mary's Sidcup, South London Healthcare NHS Trust. Eighty adolescents, aged 12-14 years,attending their first orthodontic consultation appointment. PARTICIPANTS completed a previously validated questionnaire about their expectations of orthodontic before the consultation.They were then randomly assigned to two groups. The control group (n = 40)received additional written information about fluoride, while the intervention group (n = 40) received additional written information about orthodontic treatment. Both groups then had their orthodontic consultation following which they completed the expectation questionnaire for a second time. The questionnaire consisted of 10 questions.Eight questions used a 10 mm VAS response code. Two questions had categorical response codes. ANCOVA was undertaken using post-consultation scores as the outcome and pre-consultation scores as the covariant. Chi-squared tests were undertaken to assess the categorical variables. All 80 participants recruited to the trial completed the questionnaire on two occasions. No significant differences between the control group and the intervention in their expectations of orthodontic treatment were found, except for one item related to the expectation of a discussion about treatment at the initial appointment (P = 0·04). Information leaflets did not have an immediate impact on patients' expectations of orthodontic treatment. The cost implication of providing information leaflets to patients must be weighed against the limited benefit they provide.