Premature Mortality In People Research Articles

Gaps and challenges: WHO treatment recommendations for tobacco cessation and management of substance use disorders in people with severe mental illness

BackgroundPeople with severe mental disorders (SMD) experience premature mortality mostly from preventable physical causes. The World Health Organization (WHO) have recently produced guidelines on the management of physical health conditions in SMD. This paper presents the evidence which led to the recommendations for tobacco cessation and management of substance use disorders in SMD.MethodsScoping reviews informed 2 PICO (Population Intervention, Comparator, Outcome) questions relating to tobacco cessation and management of substance use disorders in SMD. Systematic searches led to the identification of systematic reviews with relevant evidence to address these questions. Retrieved evidence was assessed using GRADE methodology, informing the development of guidelines.ResultsOne thousand four hundred thirty-four records were identified through systematic searches for SMD and tobacco cessation, of which 4 reviews were included in GRADE tables and 18 reviews in narrative synthesis. For SMD and substance use disorders, 4268 records were identified, of which 4 studies from reviews were included in GRADE tables and 16 studies in narrative synthesis.People with SMD who use tobacco should be offered combined pharmacological (Varenicline, Bupropion or Nicotine Replacement Therapy) and non-pharmacological interventions such as tailored directive and supportive behavioural interventions. For people with SMD and substance use disorders (drug and/or alcohol), interventions should be considered in accordance with WHO mhGAP guidelines. Prescribers should note potential drug-drug interactions. Recommendation were conditional and based on low/very low certainty of evidence with a scarcity of evidence from low- and middle-income settings.ConclusionsThese guidelines mark an important step towards addressing premature mortality in people with SMD. The dearth of high-quality evidence and evidence from LMIC settings must inform the future research agenda.Guidelines: https://www.who.int/mental_health/evidence/guidelines_physical_health_and_severe_mental_disorders/enhttps://www.who.int/publications-detail/mhgap-intervention-guide%2D%2D-version-2.0

The relationship between hopelessness and risk factors for early mortality in people with a lived experience of a serious mental illness

ABSTRACT The purpose of this study was to explore the relationships between self-reported hopelessness and risk factors for premature mortality in people with serious mental illness (SMI). Data were extracted from the 2014 Health Center Patient Survey (N = 5,592). Having a diagnosis of SMI was significantly associated with self-reported hopelessness. Hypertension or high blood pressure, congestive heart failure, and chronic obstructive pulmonary disorder were significantly associated with self-reported hopelessness. Higher levels of hopelessness were found to be significantly associated with increased alcohol consumption. Hopelessness may be an important dimension of health in people with SMI.

Association of physical health multimorbidity with mortality in people with schizophrenia spectrum disorders: Using a novel semantic search system that captures physical diseases in electronic patient records

ObjectiveSingle physical comorbidities have been associated with the premature mortality in people with schizophrenia-spectrum disorders (SSD). We investigated the association of physical multimorbidity (≥two physical health conditions) with mortality in people with SSD. MethodsA retrospective cohort study between 2013 and 2017. All people with a diagnosis of SSD (ICD-10: F20–F29), who had contact with secondary mental healthcare within South London during 2011–2012 were included. A novel semantic search system captured conditions from electronic mental health records, and all-cause mortality were retrieved. Hazard ratios (HRs) and population attributable fractions (PAFs) were calculated for associations between physical multimorbidity and all-cause mortality. ResultsAmong the 9775 people with SSD (mean (SD) age, 45.9 (15.4); males, 59.3%), 6262 (64%) had physical multimorbidity, and 880 (9%) died during the 5-year follow-up. The top three physical multimorbidity combinations with highest mortality were cardiovascular-respiratory (HR: 2.23; 95% CI, 1.49–3.32), respiratory-skin (HR: 2.06; 95% CI, 1.31–3.24), and respiratory-digestive (HR: 1.88; 95% CI, 1.14–3.11), when adjusted for age, gender, and all other physical disease systems. Combinations of physical diseases with highest PAFs were cardiovascular-respiratory (PAF: 35.7%), neurologic-respiratory (PAF: 32.7%), as well as respiratory-skin (PAF: 29.8%). ConclusionsApproximately 2/3 of patients with SSD had physical multimorbidity and the risk of mortality in these patients was further increased compared to those with none or single physical conditions. These findings suggest that in order to reduce the physical health burden and subsequent mortality in people with SSD, proactive coordinated prevention and management efforts are required and should extend beyond the current focus on single physical comorbidities.

Cohort profile: Mental Health Living Longer: a population-wide data linkage to understand and reduce premature mortality in mental health service users in New South Wales, Australia

PurposeHealth systems must move from recognition to action if we are to address premature mortality in people with mental illness. Population data registers are an essential tool for planning and...

A brief tobacco dependence intervention for people living with HIV in Nepal: results of a quasi-experimental study

AbstractIntroductionThere is evidence of increased morbidity, decreased quality of life, and premature mortality in people living with HIV (PLHIV) who smoke tobacco compared to PLHIV who do not smoke tobacco. Evidence-based screening for tobacco dependence, pharmacological treatment, and treatment monitoring and education into relapse prevention are not readily available in low- and middle-income countries (LMIC). We evaluated the effects of a brief tobacco dependence intervention in improving knowledge on the health effects of smoking and intention to quit smoking in PLHIV in Nepal, a low-income country in south Asia.MethodsUsing a quasi-experimental design, we assigned 59 smokers to participate in the intervention and 67 in the control group. The 1.5 h smoking cessation intervention emphasized harms of smoking, reasons for smoking and quitting, causes of relapse in previous quit attempts, and quitting strategies. We collected data at baseline and immediately post-intervention.ResultsFindings indicate that a brief smoking cessation intervention produced a significant increase in smoking-related knowledge and intention to quit among PLHIV. The positive effects of our intervention remained significant after adjusting for potential confounders.ConclusionsOur brief tobacco dependence intervention was effective in improving knowledge on the health effects of smoking and intention to quit among PLHIV. Further studies are required to evaluate the effectiveness of our intervention in increasing smoking cessation among PLHIV in LMIC.

Risk factors for suicidal tendency in adult patients with epilepsy in China

ObjectiveThe major cause of premature mortality in people with epilepsy (PWE) is suicide. Actual data on the risk of suicidal tendency in adult PWE in China are scarce. In our study, associations between possible risk factors and suicidal tendency in adult PWE in China were investigated. MethodsPeople with epilepsy (n = 251) were recruited, and their demographic and clinical characteristics were evaluated. Suicide risk was examined using the suicidality module (SM) of the Mini International Neuropsychiatric Interview (MINI) Plus Chinese Version 5.0.0. ResultsSuicidal tendency was present in 36 (14.3%) of the 251 PWE. On the basis of the results of univariate analyses, family relationship (P < 0.001), age at epilepsy onset (P = 0.037), seizure-free period (P = 0.041), seizures/month (P = 0.015), depressive disorders (P < 0.001), and number of antiepileptic drugs (AEDs) (P = 0.017) were associated with suicidal tendency. Multivariate analysis revealed that moderate or poor family relationships (odds ratio (OR): 6.468, 95% confidence interval (CI): 2.418–17.300) and depressive disorders (OR: 3.548, 95% CI: 1.575–7.995) were associated with high odds of suicidal tendency. ConclusionSuicidal tendency is common among adult PWE. This study reveals that family relationships and depressive disorders are independent risk factors for suicidal tendency among adult PWE. Therefore, while maintaining treatment of epilepsy, more attention should be directed to the social support and mental state of PWE to prevent suicide.

From impact factors to real impact: translating evidence on lifestyle interventions into routine mental health care.

The scandal of premature mortality in people with serious mental illness is well established. Despite an increase in studies evaluating the efficacy of lifestyle interventions, translating this evidence into routine clinical care and policies is challenging, in part due to limited effectiveness or implementation research. We highlight the challenge of implementation that is increasingly recognized in clinical practice, advocate for adopting implementation science to study the implementation and systematic update of effective interventions in practice and policy, and provide directions for future research.

The early detection of atherosclerosis in type 1 diabetes: why, how and what to do about it.

The major cause of morbidity and often premature mortality in people with type I diabetes (T1D) is cardiovascular disease owing to accelerated atherosclerosis. We review publications relating to the rationale behind, and clinical tests for, detecting and treating early atherosclerosis in people with T1D. Currently available tools for atherosclerosis assessment include risk equations using vascular risk factors, arterial intima-media thickness, the ankle-brachial index, coronary artery calcification and angiography, and for more advanced lesions, intravascular ultrasound and optical coherence tomography. Evolving research tools include risk equations incorporating novel clinical, biochemical and molecular tests; vascular MRI and molecular imaging. As yet there is little information available to quantify early atherosclerosis. With better means to control the vascular risk factors, such as hypertension, dyslipidaemia and glycaemic control, and emerging therapies to control novel risk factors, further epidemiologic and clinical trials are merited to facilitate the translation into clinical practice of robust means to detect, monitor and treat early atherosclerosis in those with T1D.

Premature Mortality among People with Severe Mental Illness – New Evidence from Linked Primary Care Data

IntroductionStudies assessing premature mortality in people with severe mental illness (SMI) are often based in one setting, hospital (secondary care inpatients and/or outpatients) or community (primary care). This may lead to ascertainment bias.&#x0D; Objectives and ApproachThis study aimed to estimate standardised mortality ratios (SMRs) for all-cause and cause-specific mortality in people with SMI drawn from linked primary and secondary care populations compared to the general population. Standardised mortality ratios (SMRs) were calculated using the indirect method for a United Kingdom population of almost four million between 2004-2013.&#x0D; ResultsThe all-cause SMR was higher in the cohort identified from secondary care hospital admissions (SMR: 2.9; 95% CI: 2.8-3.0) than from primary care (SMR: 2.2; 95% CI: 2.1-2.3) when compared to the general population. The SMR for the combined cohort was 2.6 (95% CI: 2.5-2.6). Solely hospital admission based studies may somewhat over-estimate premature mortality in those with SMI. However, there is no doubt this remains a major health inequality. Cause specific SMRs in the combined cohort were particularly elevated in those with SMI relative to the general population for ill-defined and unknown causes, suicide, and substance abuse, as well as a number of other causes.&#x0D; Conclusion/ImplicationsThe ability to combine cohorts electronically from primary and secondary care is more representative of the whole population. Comprehensive characterisation of mortality is important to inform policy and practice and to discriminate settings to allow for proportionate interventions to address this health injustice.

Decreasing the risk of sudden unexpected death in epilepsy: structured communication of risk factors for premature mortality in people with epilepsy.

Good practice guidelines highlight the importance of making people with epilepsy aware of the risk of premature mortality in epilepsy particularly due to sudden unexpected death in epilepsy (SUDEP). The SUDEP and Seizure Safety Checklist ('Checklist') is a structured risk communication tool used in UK clinics. It is not known if sharing structured information on risk factors allows individuals to reduce SUDEP and premature mortality risks. The aim of this study was to ascertain if the introduction of the Checklist in epilepsy clinics led to individual risk reduction. The Checklist was administered to 130 consecutive people with epilepsy attending a specialized epilepsy neurology clinic and 129 attending an epilepsy intellectual disability (ID) clinic within a 4-month period. At baseline, no attendees at the neurology clinic had received formal risk advice, whereas all those attending the ID clinic had received formal risk advice on multiple occasions for 6 years. The Checklist was readministered 1 year later to each group and scores were compared with baseline and between groups. Of 12 risk factors considered, there was an overall reduction in mean risk score for the general (P = 0.0049) but not for the ID (P = 0.322) population. Subanalysis of the 25% of people at most risk in both populations showed that both sets had a significant reduction in risk scores (P < 0.001). Structured discussion results in behavioural change that reduces individual risk factors. This impact seems to be higher in those who are at current higher risk. It is important that clinicians share risk information with individuals as a matter of public health and health promotion.

Premature mortality among people with severe mental illness — New evidence from linked primary care data

Studies assessing premature mortality in people with severe mental illness (SMI) are usually based in one setting, hospital (secondary care inpatients and/or outpatients) or community (primary care). This may lead to ascertainment bias. This study aimed to estimate standardised mortality ratios (SMRs) for all-cause and cause-specific mortality in people with SMI drawn from linked primary and secondary care populations compared to the general population. SMRs were calculated using the indirect method for a United Kingdom population of almost four million between 2004 and 2013. The all-cause SMR was higher in the cohort identified from secondary care hospital admissions (SMR: 2.9; 95% CI: 2.8–3.0) than from primary care (SMR: 2.2; 95% CI: 2.1–2.3) when compared to the general population. The SMR for the combined cohort was 2.6 (95% CI: 2.5–2.6). Cause specific SMRs in the combined cohort were particularly elevated in those with SMI relative to the general population for ill-defined and unknown causes, suicide, substance abuse, Parkinson's disease, accidents, dementia, infections and respiratory disorders (particularly pneumonia), and Alzheimer's disease. Solely hospital admission based studies, which have dominated the literature hitherto, somewhat over-estimate premature mortality in those with SMI. People with SMI are more likely to die by ill-defined and unknown causes, suicide and other less common and often under-reported causes. Comprehensive characterisation of mortality is important to inform policy and practice and to discriminate settings to allow for proportionate interventions to address this health injustice.

Sedentary Behavior in People Living With HIV: A Systematic Review and Meta-Analysis.

Sedentary behavior is independently associated with an increased risk of poor mental health, developing cardiovascular disease (CVD) and premature mortality. Despite the knowledge that CVD is one of the leading causes of non-AIDS related premature mortality in people living with HIV (PLWH), relatively little attention has been attributed to sedentary behavior in this population. The aims of this meta-analysis were to (a) establish the pooled mean time spent sedentary, (b) investigate predictors of sedentary levels, and (c) explore differences with age- and gender-matched healthy controls. Two independent authors searched major databases until August 2016. A random effects meta-analysis was performed. Across 6 unique cross-sectional studies, including 9 sedentary levels, there were 523 (292 men) PLWH (age range = 37 to 58 years). PLWH spent 533 min/day (95% CI = 466 to 599) engaging in sedentary behavior. There was a trend (P = .07) for higher levels of sedentary behavior in self-report measures (551 min, 95% CI = 543 to 560, N = 4) than in objective sedentary behavior time (505 min, 95% CI = 498 to 512, N = 3). The time PLWH spend engaging in sedentary behavior is among the highest levels reported in the literature. Given that sedentary behavior is an independent predictor of CVD, future lifestyle interventions specifically targeting the prevention of sedentary behavior in PLWH are warranted.

Physical Activity Levels and Psychosis: A Mediation Analysis of Factors Influencing Physical Activity Target Achievement Among 204 186 People Across 46 Low- and Middle-Income Countries.

Physical activity (PA) can help reduce cardiovascular disease and premature mortality in people with psychosis. However, there is a paucity of representative data on PA in people with psychosis, especially from low- and middle-income countries (LMICs). Moreover, data on subclinical psychosis and PA is absent. This study explored whether complying with PA recommendations of 150 minutes of moderate-vigorous PA per week is related to: (1) psychotic symptoms without a psychosis diagnosis (subclinical psychosis); and (2) clinical psychosis (psychosis diagnosis). A total of 204 186 participants aged 18-64 years from 46 LMICs recruited via the World Health Survey were subdivided into those with (1) no psychosis diagnosis and no psychotic symptoms in the past 12 months (controls); (2) subclinical psychosis; and (3) psychosis diagnosis. People with a psychosis diagnosis had significantly higher odds for low PA in the overall sample (OR = 1.36; 95% CI = 1.04-1.78; P = .024) and among males (OR = 2.29; 95% CI = 1.57-3.34; P < .0001) but not females (OR = 0.93; 95% CI = 0.67-1.30; P = .6712). No difference was found among those with subclinical psychosis vs controls. Mediation analyses demonstrated that mobility difficulties explained the largest amount of low PA among males (18.5%) followed by self-care difficulties (16.3%), depression (16.1%), cognition (11.8%), pain and discomfort (11.4%), interpersonal activities (8.6%), sleep and energy (7.2%), and vision (3.0%). The results from the largest dataset on PA and psychosis and first in LMICs, found that psychosis diagnosis (especially among males) but not subclinical psychosis, is associated with physical inactivity. Population level interventions seeking to increase PA among people with psychosis may help improve health outcomes.

Bridging the gap: What have we done and what more can we do to reduce the burden of avoidable death in people with psychotic illness?

Despite overwhelming evidence demonstrating a persisting gap in life expectancy between those with psychotic illness and the general population, there has been no widespread implementation of interventions to improve the physical wellbeing of people with psychotic illness. This article explores opportunities to 'Bridge the Gap' in life expectancy. We describe an Australian evidence-based intervention that has substantially improved the physical health of young people recently commenced on antipsychotic medication. Further epidemiological research, accompanied by cultural change within mental health services, is an essential precursor to the implementation of effective and sustainable lifestyle interventions. There are other relatively neglected areas of physical wellbeing for people with psychotic illness, such as screening and diagnosis of malignancies, which need more research and clinical attention. While there has been progress with intervention development and evaluation, translation of evidence-based short-term intervention studies into feasible and sustainable system-wide changes within routine mental health service settings remains a challenge. Developing an implementation framework to support such change is an urgent priority so as to bridge the persisting premature mortality in people living with psychotic illness.

Suicide in schizophrenia: an observational study of coroner records in Toronto.

Suicide is an important cause of premature mortality in people suffering from schizophrenia. This study aimed to identify demographic, personal, and suicide-specific features that distinguish suicide in people with schizophrenia from those with another severe mental illness (bipolar disorder) and those with neither illness. We conducted a coroner's chart review for 2,886 suicide victims in Toronto from 1998 to 2010. Diagnoses were made based on coroner interviews with available informants including family members, acquaintances, the deceased's physician(s) and/or review of medical records. Of the total, 258 formed what we defined as the schizophrenia group (204 schizophrenia, 34 unspecified psychotic illness, and 20 schizoaffective disorder). Of the remainder, 169 had bipolar disorder, and 2,459 had neither illness. One-way analysis of variance (ANOVA) tests and χ² tests were conducted to examine differences between the groups. The group with schizophrenia was the youngest (mean age for schizophrenia, 41.0 years; bipolar disorder, 43.3 years; and neither, 47.7 years; P < .001), most likely to have never been married (schizophrenia, 75.6%; bipolar disorder, 57.4%; and neither, 52.9%; P < .001), most likely to be living in temporary/assisted housing or jail (schizophrenia, 9.3%; bipolar disorder, 5.4%; and neither, 3.2%; P < .001), and least likely to have experienced a recent stressor (schizophrenia, 26.7%; bipolar disorder, 37.9%; and neither, 54.1%; P < .001). The schizophrenia group was the most likely to use a violent cause of death, specifically by fall from a height or by jumping in front of a vehicle (schizophrenia, 81.4%; bipolar disorder, 58.0%; and neither, 73.1%; P < .001). There are important demographic and suicide-related differences between suicide victims with and without schizophrenia. Notably, suicide in schizophrenia overall appears to be more illness driven and occurs by more violent means than in the bipolar disorder group or those with neither illness.

Assessing GP use of varenicline therapy for smoking cessation

Smoking cessation is an important public health policy in reducing premature mortality in people with risk factors or comorbidities. Varenicline is the most effective therapy for sustained cessation, but it is not used as widely as nicotine replacement therapy.

Seizure-Induced Myocardial Stunning: A Possible Cardiac Link to Sudden Unexpected Death In Epilepsy (SUDEP)

Transient left ventricular dysfunction complicating neurological conditions has been well described. Although most commonly linked to subarachnoid hemorrhage, ‘‘neurogenic stunned myocardium’’ has also been reported to complicate metastatic brain tumors, subdural hematoma, hydrocephalus and ischemic strokes. We report a case of transient cardiomyopathy complicating generalized tonic-clonic seizures.

Policy actions to achieve integrated community-based mental health services.

Globally, the majority of people with mental health problems do not receive evidence-based interventions that can transform their lives. We describe six mental health policy actions adopted at the World Innovation Summit for Health in 2013. For each policy action, we offer real-world examples of mental health innovations that governments and health care providers can implement to move toward universal health coverage for mental health. The six policy actions are empowering people with mental health problems and their families, building a diverse mental health workforce, developing collaborative and multidisciplinary mental health teams, using technology to increase access to mental health care, identifying and treating mental health problems early, and reducing premature mortality in people with mental health problems. Challenges to implementing these policy actions include the lack of recognition of mental health as a global health priority and the resulting lack of investment in mental health, the difficulties of integrating mental health into primary care health services because of a scarcity of human and financial resources, and the lack of evidence on the effectiveness and costs of taking innovations to a national scale.

NIMH Fosters ‘Practice-Ready’ Solutions to Integrating Primary, MH Care

Research at the interface of mental health and primary care should focus on generating knowledge that decision makers need and incorporating practice-based evidence.

Narrowing the health inequality gap by annual health checks for patients with intellectual disability

Premature mortality in people with intellectual disability (ID; also referred to as learning disability) is significant and to some extent, avoidable. In the 2013 report Confidential Inquiry into Premature Deaths of People with Learning Disabilities people with ID tended to die from causes potentially amenable to change by improvement of quality of health care: ‘All aspects of care provision, planning, coordination and documentation were significantly less good… than for comparators.’ 1 A recent article in the BJGP addresses acute care in this group of vulnerable patients.2 This article addresses how primary care teams may improve maintenance care to reduce the health inequality gap that these patients may experience. Over the past decade, GP practices have taken on increasing responsibilities for the care of people with ID. Two principal reasons are the closure of long-stay ID institutions and relocation of their patients to the community. Many patients are now settled in residential care homes and others in supervised tenancies. Also, with recent medical technological advances more people with intellectual disabilities are living longer. This means the total prevalence for ID in the general population, including those with mild ID is 2.5%, but the prevalence for those likely to have been identified on GP practice registers (those with moderate, severe and profound ID) is now 0.45%. Should this mean a change in the role of the specialist nursing and psychiatric services? Closer working relationships and collaboration could improve communications and reduce duplication of clinical monitoring. By definition people with ID have impaired social functioning and limited cognitive ability that …