Impact Of Severe Mental Illness Research Articles

The impact of severe mental illness (SMI) on the rate of COVID-19 vaccine uptake and hesitancy

IntroductionThe COVID-19 pandemic has disproportionately affected patients with severe mental illness (SMI), a vulnerable population with high morbidity and mortality. A UK-based study found reduced vaccination rates in patients with SMI; they therefore need to be prioritised for prevention and disease management.ObjectivesThe objectives were to determine risk factors for vaccine hesitancy, and how best to manage those in patients with SMI, as well as whether our intervention of calling patients for their vaccines had a positive outcome.MethodsFollowing approval from the Lambeth Directorate of South London and Maudsley (SLaM) NHS Foundation Trust, we investigated COVID-19 vaccination rates inpatients with SMI from a psychosis community service in South London (n=236). Dates of first and second doses were recorded through audit; reasons for refusal of vaccination were noted. Patients were encouraged to take the vaccine. A re-audit was performed after allowing three months. Chi-squared statistical analysis was performed to determine the value of our intervention.ResultsBefore the intervention, 143 patients (60.6%) received at least one vaccine. 24 patients (10.2%) received one dose, and 77 (32.8%) were yet to receive any. There was no statistical significance (p=0.1509) between the number of patients who received a vaccine before and after intervention, with 33.1% of patients still remaining unvaccinated.Image:Image 2:Image 3:ConclusionsThere is limited research on perceptions of receiving vaccines in patients with SMI, despite their cost-effectiveness in disease prevention. Even after intervention, 33.1% of patients remained unvaccinated, compared to 6.6% nationally. A lack of knowledge and recommendations from care teams are reasons for hesitancy. Misinformation, conspiracy theories and propaganda can drive people towards refusal. Patients with SMI typically have disadvantages of healthcare inequality, lower levels of education and access to inaccurate information. Patients and their healthcare team should be knowledgeable about vaccine efficacy and side effects. Studies have shown low uptake in the Black/African/Caribbean ethnic group (49.3%, table 3). Reasons include general mistrust in institutions and access barriers. For minority communities, vaccination sites in community centres or places of worship have proven to be effective, providing familiarity.Patients taking clozapine may have a weaker immune system due to myelosuppression. 24.3% of our patients take this, with many unsure of interactions or side effects. Poorer prognosis means a focussed approach is needed.Vaccine hesitancy is complex and requires targeted, tailor-made strategies, with consideration for patients who may lack capacity. It is evident from our results that calling patients alone may not be effective. A future multi-modal approach may be necessary to address poor vaccine uptake and opens up avenues to further explore vaccine hesitancy.Disclosure of InterestNone Declared

Impact of severe mental illness on healthcare use and health outcomes for people with type 2 diabetes: a longitudinal observational study in England.

BackgroundPeople with severe mental illnesses (SMIs) have reduced life expectancy compared with the general population. Diabetes is a contributor to this disparity, with higher prevalence and poorer outcomes in people with SMI.AimTo determine the impact of SMI on healthcare processes and outcomes for people with type 2 diabetes (T2DM).Design and settingRetrospective, observational, matched, nested, case–control study conducted in England using patient records from the Clinical Practice Research Datalink, linked to Hospital Episode Statistics.MethodA range of healthcare processes (primary care consultations, physical health checks, and metabolic measurements) and outcomes (prevalence and hospitalisation for cardiovascular disease [CVD], and mortality risk) were compared for 2192 people with SMI and T2DM (cases) with 7773 people who had diabetes alone (controls). Sociodemographics, comorbidity, and medication prescription were covariates in regression models.ResultsWhen compared with results for participants with T2DM only, SMI was associated with increased risk of all-cause mortality (hazard ratio [HR] 1.919, 95% confidence interval [CI] = 1.602 to 2.300) and CVD-specific mortality (HR 2.242, 95% CI = 1.547 to 3.250), higher primary care physician consultation rates (incidence rate ratio [IRR] 1.149, 95% CI = 1.111 to 1.188), more-frequent checks of blood pressure (IRR 1.024, 95% CI = 1.003 to 1.046) and cholesterol (IRR 1.038, 95% CI = 1.019 to 1.058), lower prevalence of angina (odds ratio 0.671, 95% CI = 0.450 to 1.001), more emergency admissions for angina (IRR 1.532, 95% CI = 1.069 to 2.195), and fewer elective admissions for ischaemic heart disease (IRR 0.682, 95% CI = 0.508 to 0.915).ConclusionMonitoring of metabolic measurements was comparable for people with T2DM who did, and did not, have SMI. Increased mortality rates observed in people with SMI may be attributable to underdiagnosis of CVD and delays in treatment.

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

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. 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, I2 = 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, I2 = 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, I2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41-2.76, p < 0.001, I2 = 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. 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.

Multidimensional impact of severe mental illness on family members: systematic review

ObjectiveThe impact of severe mental illnesses (SMIs) is not limited to the person with the illness but extends to their family members and the community where the patient comes from....

The impact of severe mental illness on lung cancer mortality of patients with lung cancer in Finland in 1990–2013: a register-based cohort study

BackgroundAlthough the link between severe mental illness (SMI) and elevated cancer mortality is well established, few studies have examined lung cancer survival and SMI in detail. Our study compared cancer-specific mortality in patients with lung cancer with and without a history of SMI and analysed whether mortality differences could be explained by cancer stage at presentation, comorbidity or differences in cancer treatment. MethodsWe identified patients with their first lung cancer diagnosis in 1990–2013 from the Finnish Cancer Registry, their preceding hospital admissions due to SMI from the Hospital Discharge Register and deaths from the Causes of Death statistics. Competing risk analyses were used to estimate hazard ratios (HRs) for the impact of SMI on mortality. ResultsOf the 37,852 lung cancer cases, 12% had a history of SMI. Cancer-specific mortality differences were found between patient groups in some cancer types after controlling for stage at representation and treatment. Men with a history of psychosis had excess mortality risk (HR = 1.24, 1.06–1.45) in squamous cell carcinoma. Similar excess risk was found among women with psychosis in small-cell carcinoma (HR = 1.76, 1.41–2.19) and in squamous cell carcinoma (HR = 1.67, 1.26–2.20) and among women with mood disorders in adenocarcinoma (HR = 1.37, 1.08–1.74). Patient group differences in HRs in five-year mortality did not markedly change from the 1990s. ConclusionsWe found elevated cancer-specific mortality among persons with a history of SMI. Collaboration between patients, mental healthcare professionals and oncological teams is needed to reduce the mortality gap between patients with cancer with and without SMI.

The impact of severe mental illness on mortality of lung cancer in Finland in 1990-2014

The impact of severe mental illness on mortality of lung cancer in Finland in 1990-2014

Impact of severe mental illness on cancer stage at diagnosis and subsequent mortality: A population-based register study

BackgroundExcess mortality in individuals with severe mental illness (SMI) is often explained by physical comorbidity and suboptimal healthcare. Cancer is a prevalent cause of death, and tumour stage at diagnosis is a strong predictor of mortality. We aimed to study cancer incidence, disease stage at diagnosis and subsequent mortality in individuals with SMI compared to individuals without SMI. MethodsThe entire Danish population was followed in 1978–2013 using nationwide registries. Cancer incidence and subsequent mortality stratified by disease stage were compared in individuals with and without SMI. Cox regression was used to estimate incidence rate ratios (IRR) and mortality rate ratios (MRR). Cancer was examined overall and grouped by major aetiological factors. ResultsThe overall cancer incidence rate was lower in males with SMI than in males without SMI; IRR = 0.89 (95% CI: 0.85–0.94), but rates were similar in females with SMI and without SMI; IRR = 1.03 (95% CI: 0.99–1.07). The overall mortality rate was higher in individuals with SMI than those without; MRR = 1.56 (95% CI: 1.48–1.64) for males and MRR = 1.49 (95% CI: 1.43–1.56) for females. Incidence rates and mortality rates showed similar estimates when stratified by tumour stage and aetiology. ConclusionsWe found lower cancer incidence in males with SMI compared to males without SMI and similar incidence in the two groups of women. Higher subsequent mortality was found in both sexes with SMI. The excess mortality was not explained by more advanced stages of cancer; future studies should evaluate the effect of cancer treatment and rehabilitation.

Mental health nurses' support to caregivers of older adults with severe mental illness: a qualitative study.

BackgroundLiterature has shown the serious impact of severe mental illness on the daily life of caregivers. We studied reported caregiver support practices by mental health nurses for use in the development of a nursing intervention. We aimed to explore current caregiver support practices by mental health nurses.MethodsTwenty-one participants completed semi-structured interviews, and 17 participants attended two focus groups. All interviews were audio-taped, transcribed and coded for qualitative analysis.ResultsThe diversity in caregiver support could best be described by three prototypes: the tolerator, the preventer and the concerner, representing three approaches of involvement with caregivers. At one end of the spectrum are mental health nurses (MHN) who are essentially only concerned with the wellbeing of the care recipient and see the caregiver as a potential impediment in reaching the client’s goals. We call these the tolerators. At the other end of the spectrum are the MHNs who see the caregiver and the care recipient as inextricably connected with each other. In these cases the MHN directs her/his intervention towards both the informal caregiver and the care recipient. We call these the concerners. In the middle position are MHNs who realize that caregivers are important agents in the achievement of the client’s goals, and therefore consider preventing them from becoming overburdened as an important goal. We call these the preventers.ConclusionsBased on the extent to which the MHNs believe that the informal caregiver plays a necessary role in the client’s support system, and the degree to which they feel responsible for the caregiver’s wellbeing, three MHN prototypes can be distinguished. These prototypes determine how the nurses’ vision directs their understanding of their role and responsibilities and the content of their behaviour. This implies that a change in behaviour needs to be preceded by a change in vision. Therefore, promoting family support cannot be achieved by one-size-fits-all-programmes.

Carer experience of Community Treatment Orders: implications for rights based/recovery-oriented mental health legislation.

Our aim was to determine the views and experiences of carers of people with severe mental illness in regard to Community Treatment Orders (CTOs). Questionnaires were posted using the mailing lists of two well-established carer support organisations in Victoria. The questionnaires included information about the person with a mental illness, the carer and their experience of care (ECI) and knowledge of recovery (RKI). In total, 278 questionnaires were sent and 63 returned, of which 62 provided valid data. Those who responded were predominantly female (90%) and older (mean age 63 years), and were the carer of a person with a severe and recurrent mental illness. Some 60% had experience of caring for a person on a CTO. Most felt the CTO had been of benefit, and in 89% the person relapsed and needed further treatment when the CTO was stopped. Mental health legislation is shifting to bring a greater focus on rights, individual choice and autonomy in line with recovery-oriented care. This study describes the impact of severe mental illness and decisions in relation to CTOs on carers.

Higher mortality after myocardial infarction in patients with severe mental illness: a nationwide cohort study

The aim of this study was to explore the impact of severe mental illness (SMI) on myocardial infarction survival and determine the influence of risk factor burden, myocardial infarction severity and different treatments. This population-based cohort study, conducted in Sweden during the period 1997-2010, included all patients with a first diagnosis of myocardial infarction in the Swedish nationwide myocardial infarction register SWEDEHEART (n = 209 592). Exposure was defined as a diagnosis of SMI (i.e. bipolar disorder or schizophrenia) in the national patient register prior to infarction. Bias-minimized logistic regression models were identified using directed acyclic graphs and included covariates age, gender, smoking, diabetes, previous cardiovascular disease, myocardial infarction characteristics and treatment. The outcomes were 30-day and 1-year mortality, obtained through linkage with national population registers. Patients with bipolar disorder (n = 442) and schizophrenia (n = 541) were younger (mean age 68 and 63 years, respectively) than those without SMI (n = 208 609; mean age 71 years). The overall 30-day and 1-year mortality rates were 10% and 18%, respectively. Compared with patients without SMI, patients with SMI had higher 30-day [odds ratio (OR) 1.99, 95% confidence interval (CI) 1.55-2.56] and 1-year mortality (OR 2.11, 95% CI 1.74-2.56) in the fully adjusted model. The highest mortality was observed amongst patients with schizophrenia (30-day mortality: OR 2.58, 95% CI 1.88-3.54; 1-year mortality: OR 2.55, 95% CI 1.98-3.29). SMI is associated with a markedly higher mortality after myocardial infarction, also after accounting for contributing factors. It is imperative to identify the reasons for this higher mortality.

Datapoints: Trends in Mortality Among Homeless VA Patients With Severe Mental Illness

B homelessness and severe mental illness are known to increase the likelihood of early mortality. We determined years of potential life lost (YPLL) over an 11-year period among Department of Veterans Affairs (VA) patients using homeless services, assessing for the impact of severe mental illness. Using the VA National Patient Care Database (NPCD), we analyzed allcause mortality for fiscal years (FYs) 2000–2009 among VA patients by severe mental illness status and use of VA homelessness services for each FY. All patients with a severe mental illness diagnosis from each FY were identified by ICD-9 codes. We also used NPCD data to identify a 5% random sample of individuals without a severemental illness diagnosis for each FY. The primary analyses were hazard ratio calculations on all-cause mortality, comparing differences in YPLL adjusted for age and gender by homelessness and severe mental illness status. Regardless of severe mental illness diagnosis, homeless veterans died younger than nonhomeless veterans in all years, with YPLL ranging from 18.9 to 24.3 (Figure 1). For nonhomeless veterans with and without severe mental illness, YPLL ranged from 9.1 to 14.0 years. Homeless veterans with severe mental illness had the greatest YPLL over time. Nonhomeless veterans with severe mental illness died younger than those without a severe mental illness. Using time-series analyses, we found a statistically significant increase in YPLL only for nonhomeless veterans without severe mental illness. Overall, having a severe mental illness diagnosis increased YPLL regardless of housing status. Homelessness was an additional and more severe contributor to YPLL, above and beyond a severe mental illness diagnosis. Thus, in this study, homelessness had the strongest effects on YPLL. However, VA patients who were not homeless and who did not have a severe mental illness diagnosis were also dying younger over time. The VA has made ending homelessness among veterans a priority, with a particular focus on those with severe mental illness. Recent VA efforts to help homeless veterans and integrate services for those with severe mental illness may have offset this trend for these vulnerable populations. Further research is needed to assess the long-term impact of emerging initiatives, such as medical home models for homeless veterans and those with severe mental illness, on reducing the mortality gap.

The Health and the Human Rights-Related Quality of Life of People with Severe Mental Illness in Taiwan

Hui-Ching Wu is an associate professor at the Department of Social Work, National Taiwan University, with a Ph.D. degree in social work practice track from Columbia University School of Social Work (CUSSW). His specialty is mental health and his research interests are in psychiatric rehabilitation, stigma, human rights, involuntary treatment, trauma and criminal psychology. The current working studies are 'Assessing the impact of severe mental illness on adult well siblings a serial model of social support' and 'Developing culturally sensitive psychiatric service intervention in Taiwan: Examining multiple perspectives on attribution, stigma, and treatment utilisation'. Abstract The purpose of this study was to examine human rights as predictors of a satisfactory psychiatric rehabilitation outcome for 207 individuals with severe mental illness in northern and southern Taiwan. One three-part questionnaire was administered to these individuals, which included a set of questions to capture socio-demographic infor- mation, items from the Health and Human Rights of Patients with Severe Mental Illness Scale and items from the Health-Related Quality of Life Scale. T-test, bivariate and sim- ultaneous multiple regression were employed to analyse the collected data. This study found a significantly positive association between the self-awareness of human rights and satisfaction with mental and physical health-related quality of life (QoL). The per- ception of having their rights to interaction with family/friends and work respected sig- nificantly influenced the self-perceived satisfactory QoL of people with severe mental illness. The key to self-awareness and the promotion of rights is to foster a positive culture of healing created through the development of collaborative relationships between people with severe mental illness and health care providers. Further research may be needed to investigate the reason that these patients' rights continue to be deva- lued in Taiwan.

Severe mental illness at ART initiation is associated with worse retention in care among HIV‐infected Ugandan adults

The impact of severe mental illness (SMI) on retention in HIV care remains uncertain. We aimed to measure the association between SMI at antiretroviral therapy (ART) initiation and subsequent retention in care in HIV-infected Ugandan adults. We conducted cohort study of 773 patients who initiated ART between January 2005 and July 2009 at the Butabika HIV clinic in Kampala, Uganda. SMI was defined as any clinically diagnosed organic brain syndrome, affective disorder or psychotic disorder. We used Kaplan-Meier and Cox proportional hazards analysis to evaluate the association between SMI and retention in care. The prevalence of SMI at ART initiation was 23%. Patients with SMI at baseline were similar to those without SMI in terms of age (median [IQR]: 35 [28-40] vs. 35 [30-40], P = 0.03), sex (36% vs. 35% female, P = 0.86) and baseline CD4+ T-cell count (112 [54-175] vs. 120 [48-187] cells/mm3, P = 0.86). At 12 months after ART initiation, Kaplan-Meier estimates of continuous retention in care were 65% (95% confidence interval, CI: 31-39%) among patients without SMI, vs. 47% (95% CI: 39-55%) among those with SMI (P < 0.001). All-cause mortality in the two groups was similar: 1.2% vs. 2.0% (P > 0.05). In multivariable analysis, the only baseline variable independently associated with breakage of continuous care was SMI (HR = 1.58, 95% CI: 1.06─2.33). Severe mental illness at ART initiation is associated with worse retention in HIV care in this urban Ugandan referral hospital. As ART is scaled up across sub-Saharan Africa, greater attention must be paid to the burden of mental illness and its impact on retention in care.

Impact of psychosis on Portuguese caregivers: a cross-cultural exploration of burden, distress, positive aspects and clinical-functional correlates

Further cross-cultural comparisons are needed on caregiving consequences of chronic psychotic disorders. The EPSILON study (European Psychiatric Services: Inputs Linked to Outcome Domains and Needs) involved five European countries, but not Portugal. We aimed to analyse the impact of severe mental illness in a Portuguese sample and to provide support to comparisons with some of the EPSILON results, focusing on the north-European Dutch centre. We studied 108 caregiver-patient dyads by a consecutive sampling of people with schizophrenia-spectrum disorders in psychiatric outpatient services. Relatives' assessments included the Involvement Evaluation Questionnaire, European version (IEQ), the 12-item General Health Questionnaire (GHQ-12); the loss, stigma and positive aspects' subscales of the Experience of Caregiving Inventory, and the Social Network and Family Coping Questionnaires. Patients were assessed regarding symptoms, disability and global functioning. Caregiving rewards and negative consequences co-existed. On the IEQ, 49.1% reported negative consequences and rank order of domain scores was worrying > urging > tension > supervision. More than one-third of caregivers were psychologically distressed according to GHQ screenings. Involvement Evaluation Questionnaire scores were correlated with caregivers' distress, stigma, loss, patient's involvement and other ways of coping, and patients' variables. Some of these failed to be included in a regression model. Many of these Portuguese caregivers were at risk regarding burden and psychological distress. In comparison with other European samples, caregiving arrangements and assessments were typical of Mediterranean countries, as Italy or Spain. All IEQ scores were significantly higher than those in the Netherlands. On account of small numbers, caution is needed in the interpretation of associations.

The Impact of Severe Mental Illness On Parole Decisions

This study examined the extent to which severe mental illness (SMI) affects parole release decisions either directly or indirectly through its association with other factors considered in the parole release decision-making process. A random sample of 407 inmates with parole release decisions in 2007 (200 with SMI and 207 without SMI) was selected from the New Jersey State Parole Board. Data on inmates’ program participation, misconduct, and job assignments while incarcerated along with levels of community support and other pertinent release factors were collected. Differences between the SMI and non-SMI groups as well as the relationships among study variables, SMI, and release decisions were examined. Findings indicate that persons with SMI were released to parole at a rate similar to that of persons without SMI. However, the presence of SMI was associated with disciplinary infractions while incarcerated, which in turn negatively affected parole release decisions. Policy implications are discussed.

Differences in HIV Care Between Patients With and Without Severe Mental Illness

Differences in HIV Care Between Patients With and Without Severe Mental Illness

The Population Impact of Severe Mental Illness on Violent Crime

This study aimed to determine the population impact of patients with severe mental illness on violent crime. Sweden possesses high-quality national registers for all hospital admissions and criminal convictions. All individuals discharged from the hospital with ICD diagnoses of schizophrenia and other psychoses (N=98,082) were linked to the crime register to determine the population-attributable risk of patients with severe mental illness to violent crime. The attributable risk was calculated by gender, three age bands (15-24, 25-39, and 40 years and over), and offense type. Over a 13-year period, there were 45 violent crimes committed per 1,000 inhabitants. Of these, 2.4 were attributable to patients with severe mental illness. This corresponds to a population-attributable risk fraction of 5.2%. This attributable risk fraction was higher in women than men across all age bands. In women ages 25-39, it was 14.0%, and in women over 40, it was 19.0%. The attributable risk fractions were lowest in those ages 15-24 (2.3% for male patients and 2.9% for female patients). The population impact of patients with severe mental illness on violent crime, estimated by calculating the population-attributable risk, varies by gender and age. Overall, the population-attributable risk fraction of patients was 5%, suggesting that patients with severe mental illness commit one in 20 violent crimes.

Violence and Mental Disorders: Data and Public Policy

Violence and Mental Disorders: Data and Public Policy

The Population Impact of Severe Mental Illness on Violent Crime

Objective: This study aimed to determine the population impact of patients with severe mental illness on violent crime. Method: Sweden possesses high-quality national registers for all hospital admissions and criminal convictions. All individuals discharged from the hospital with ICD diagnoses of schizophrenia and other psychoses (N=98,082) were linked to the crime register to determine the population-attributable risk of patients with severe mental illness to violent crime. The attributable risk was calculated by gender, three age bands (15–24, 25–39, and 40 years and over), and offense type. Results: Over a 13-year period, there were 45 violent crimes committed per 1,000 inhabitants. Of these, 2.4 were attributable to patients with severe mental illness. This corresponds to a population-attributable risk fraction of 5.2%. This attributable risk fraction was higher in women than men across all age bands. In women ages 25–39, it was 14.0%, and in women over 40, it was 19.0%. The attributable risk fractions were lowest in those ages 15–24 (2.3% for male patients and 2.9% for female patients). Conclusions: The population impact of patients with severe mental illness on violent crime, estimated by calculating the population-attributable risk, varies by gender and age. Overall, the population-attributable risk fraction of patients was 5%, suggesting that patients with severe mental illness commit one in 20 violent crimes.

Violence and Mental Disorders: Data and Public Policy

Violence and Mental Disorders: Data and Public Policy