Psychiatric Hospital Admissions Research Articles

Evaluating physical urban features in several mental illnesses using electronic health record data.

ObjectivesUnderstanding the potential impact of physical characteristics of the urban environment on clinical outcomes on several mental illnesses.Materials and MethodsPhysical features of the urban environment were examined as predictors for affective and non-affective several mental illnesses (SMI), the number and length of psychiatric hospital admissions, and the number of short and long-acting injectable antipsychotic prescriptions. In addition, the urban features with the greatest weight in the predicted model were determined. The data included 28 urban features and 6 clinical variables obtained from 30,210 people with SMI receiving care from the South London and Maudsley NHS Foundation Trust (SLaM) using the Clinical Record Interactive Search (CRIS) tool. Five machine learning regression models were evaluated for the highest prediction accuracy followed by the Self-Organising Map (SOM) to represent the results visually.ResultsThe prevalence of SMI, number and duration of psychiatric hospital admission, and antipsychotic prescribing were greater in urban areas. However, machine learning analysis was unable to accurately predict clinical outcomes using urban environmental data.DiscussionThe urban environment is associated with an increased prevalence of SMI. However, urban features alone cannot explain the variation observed in psychotic disorder prevalence or clinical outcomes measured through psychiatric hospitalisation or exposure to antipsychotic treatments.ConclusionUrban areas are associated with a greater prevalence of SMI but clinical outcomes are likely to depend on a combination of urban and individual patient-level factors. Future mental healthcare service planning should focus on providing appropriate resources to people with SMI in urban environments.

Adherence to Antipsychotic Drugs by Medication Possession Ratio for Schizophrenia and Similar Psychotic Disorders in the Republic of Korea: A Retrospective Cohort Study.

ObjectivePharmacotherapy is considered as an essential element in the treatment of psychotic disorders including schizophrenia. Discontinuation of antipsychotic drugs increases medical use and economic burden. Therefore, maintenance of medication is essential to reduce the social burden caused by schizophrenia and schizophrenia similar psychosis (SSP), and hence, it is important to investigate the rate at which pharmacotherapy is maintained. Therefore, this study aimed to examine the current status of drug compliance using national health insurance data.MethodsThis was a retrospective cohort study, which analyzed data from the nationwide insurance claims database. A total of 343,134 patients who were newly diagnosed with schizophrenia and SSP during 2011−2015. The adherence to antipsychotic drugs was assessed by medication possession ratio (MPR) and the risk factors of poor adherence were defined as MPR < 40%.ResultsThe average of the MPRs was 45.8%, and the proportion of patients with less than 40% of MPR was 50.8%. It was found that female patients, the experience of “general hospital outpatient,” “psychiatric hospital admission,” “general hospital admission,” and patients receiving “health insurance” showed high risk of having statistically significant low MPR (< 40%).ConclusionIn this study, the drug adherence of schizophrenia and SSP patients currently under treatment, as estimated by MPR, was very low. However, it was also found that the MPR was high among patients receiving medical aid, with less medical expenses. Thus, it is possible to consider an institutional mechanism in which schizophrenia and SSP patients can be treated with less economic burden.

Associations between antipsychotic use, substance use and relapse risk in patients with schizophrenia: real-world evidence from two national cohorts.

Research on the effectiveness of pharmacotherapies for schizophrenia and comorbid substance use disorder (SUD) is very sparse, and non-existent on the prevention of the development of SUDs in patients with schizophrenia. To compare the real-world effectiveness of antipsychotics in schizophrenia in decreasing risk of developing an initial SUD, and psychiatric hospital admission and SUD-related hospital admission among patients with an SUD. Two independent national cohorts including all persons diagnosed with schizophrenia (N = 45 476) were followed up for 22 (Finland: 1996-2017) and 11 (Sweden: 2006-2016) years. Risk of developing an SUD was calculated with between-individual models, and risks of psychiatric and SUD-related hospital admission were calculated with within-individual models, using Cox regression and adjusted hazard ratios (aHRs) for using versus not using certain antipsychotics. For patients with schizophrenia without an SUD, clozapine use (Finland: aHR 0.20, 95% CI 0.16-0.24, P < 0.001; Sweden: aHR 0.35, 95% CI 0.24-0.50, P < 0.001) was associated with lowest risk of developing an initial SUD in both countries. Antipsychotic polytherapy was associated with second lowest risk (aHR 0.54, 95% CI 0.44-0.66) in Sweden, and third lowest risk (aHR 0.47, 95% CI 0.42-0.53) in Finland. Risk of relapse (psychiatric hospital admission and SUD-related hospital admission) were lowest for clozapine, antipsychotic polytherapy and long-acting injectables in both countries. Results were consistent across both countries. Clozapine and antipsychotic polytherapy are most strongly associated with reduced risk of developing SUDs among patients with schizophrenia, and with lower relapse rates among patients with both diagnoses.

Psychiatric hospitalisation before and after commencing long-acting injectable antipsychotic medication: a mirror-image study.

Treatment adherence is an important predictor of outcomes in schizophrenia, related disorders and bipolar disorder, and may be improved by the use of long acting injectable (LAI) antipsychotic medication. Past research on the efficacy of LAIs is mixed with randomised controlled trials showing similar benefits to oral medication, and naturalistic studies showing advantages to LAIs. Psychiatric hospital bed-nights and admissions were compared before and after commencement of an LAI, using a retrospective cohort study with a mirror-image design. Total bed-nights and hospital admissions for each patient were compared for the same time period before and after commencing the LAI. Subgroup analyses were also conducted. Mean bed-nights decreased from 47.1 pre-LAI to 14.3 post-LAI, and median bed-nights from 24.5 to 0.0. Mean hospital admissions decreased from 1.7 pre-LAI to 0.7 post-LAI, and median admissions from 1.0 to 0.0. In our cohort, LAI treatment was associated with a significant reduction in bed-nights and total admissions to psychiatric hospitals. The findings of the current study are consistent with the results of previous naturalistic studies of LAI treatment for patients with psychotic disorders and bipolar disorder.

Mental health service use among pregnant and early postpartum women

PurposeTo explore the proportion and characteristics of women with a mental disorder who have contact with mental health services during pregnancy and the postnatal period in a maternity service in London.MethodsData from the WEll-being in pregNancy stuDY (WENDY), a prospective cohort study, were used. Women were recruited at their first appointment for antenatal care and assessed for mental disorders using the Structured Clinical Interview DSM-IV Axis I/II Disorders for Research. Clinical, sociodemographic and psychosocial characteristics were collected. Mental health service use data were collected for the period from study entry to 3 months postpartum.ResultsTwo hundred women met diagnostic criteria for a mental disorder. Fifty-five (34%) of these had at least one contact with mental health services. Moderate depression (OR 7.44, CI 2.03–27.28, p < 0.01), severe depression (OR 10.5, CI 2.68–41.12, p < 0.01), past psychiatric hospital admission (OR 3.76, CI 1.05–13.44, p < 0.05), symptoms of anxiety (OR 3.95, CI 1.86–8.37, p < 0.001) and perceived low levels of social support (OR 0.43, CI 0.18–1.01, p = 0.05) were associated with an increased likelihood of contact with mental health services in univariate analyses. However, only moderate (OR 5.92, CI 1.31–26.78, p = 0.02) and severe depression (OR 6.04, CI 1.08–33.72, p = 0.04) remained significant in the multivariate regressions analyses.ConclusionOnly a third of women with a diagnosable mental disorder at their first antenatal appointment had any contact with mental health services during pregnancy or up to 3 months postpartum. Further research is warranted to elicit perinatal women’s views about the potential barriers to accessing professional mental health care.

Exploring the mental healthcare needs of Swiss pre-trial detainees: A pilot investigation of an on-site psychiatric day clinic.

IntroductionResearch has established that justice-involved individuals experience significant mental health problems. However, mental healthcare in correctional settings is often not sufficiently accessible to meet the demand. Hence, to improve the availability of mental healthcare services, especially for pre-trial detainees, the first Swiss on-site psychiatric day clinic (PDC) was established in 2019. The present cross-sectional observational study aimed to evaluate the need of psychiatric care in pre-trial detention and the PDC's potential to improve it.MethodsFile record data were collected from the Office of Corrections and Rehabilitation of the Canton of Zurich. Differences in primary psychiatric care consultations and psychiatric hospital admissions between pre-trial detainees and sentenced prisoners were examined. In addition, a total cohort of pre-trial detainees of the first 18 months of PDC operations was examined to identify differences between three treatment groups: (1) pre-trial detainees exclusively treated in the PDC (n = 41), (2) pre-trial detainees exclusively treated in a psychiatric hospital (n = 58), and (3) pre-trial detainees treated in both the PDC as well as a psychiatric hospital (n = 16).ResultsIn the 5 years before the PDC opened, pre-trial detainees had significantly more primary psychiatric care consultations and were admitted to psychiatric hospitals on significantly more occasions than were sentenced prisoners. In the first 18 months of the PDC, psychiatric hospital admission rates for pre-trial detainees decreased by 18.5% and pretrial detainees exclusively treated in the PDC differed significantly from other treatment groups concerning mental disorder, gender, and alleged index offense. They were more likely to be diagnosed with adjustment disorders and were less likely to be diagnosed with schizophrenia spectrum disorder.ConclusionThe use of mental health care among pre-trial detainees is significantly more frequent than among sentenced prisoners concerning both primary care and inpatient treatment. Since establishment of the novel on-site PDC admissions to psychiatric hospitals were found to decrease. Data indicates that especially male pre-trial detainees with adjustment disorders benefitted from this innovative path forward in correctional healthcare. Further research is needed to improve the PDC's service for female pre-trial detainees.

Discontinuation of antipsychotics in individuals with first-episode schizophrenia and its association to functional outcomes, hospitalization and death: a register-based nationwide follow-up study.

Discontinuation of antipsychotic medication may be linked to high risk of relapse, hospitalization and mortality. This study investigated the use and discontinuation of antipsychotics in individuals with first-episode schizophrenia in relation to cohabitation, living with children, employment, hospital admission and death. Danish registers were used to establish a nationwide cohort of individuals ⩾18 years with schizophrenia included at the time of diagnosis in1995-2013. Exposure was antipsychotic medication calculated using defined daily dose and redeemed prescriptions year 2-5. Outcomes year 5-6 were analysed using binary logistic, negative binomial and Cox proportional hazard regression. Among 21 351, 9.3% took antipsychotics continuously year 2-5, 38.6% took no antipsychotics, 3.4% sustained discontinuation and 48.7% discontinued and resumed treatment. At follow-up year 6, living with children or employment was significantly higher in individuals with sustained discontinuation (OR 1.98, 95% CI 1.53-2.56 and OR 2.60, 95% CI 1.91-3.54), non-sustained discontinuation (OR 1.25, 95% CI 1.05-1.48 and 2.04, 95% CI 1.64-2.53) and no antipsychotics (OR 2.00, 95% CI 1.69-2.38 and 5.64, 95% CI 4.56-6.97) compared to continuous users. Individuals with non-sustained discontinuation had more psychiatric hospital admissions (IRR 1.27, 95% CI 1.10-1.47) and longer admissions (IRR 1.68, 95% CI 1.30-2.16) year 5-6 compared to continuous users. Mortality during year 5-6 did not differ between groups. Most individuals with first-episode schizophrenia discontinued or took no antipsychotics the first years after diagnosis and had better functional outcomes. Non-sustained discontinuers had more, and longer admissions compared to continuous users. However, associations found could be either cause or effect.

Study of bipolar disorder treatments finds lithium linked to better outcomes

Lithium was associated with lower rates of suicide, self‐harm, and psychiatric hospital readmission among individuals with bipolar disorder, according to a cohort study that compared the effects of mood stabilizers and other treatments using both between‐ and within‐individual analyses. For all studied drugs, periods in treatment were associated with reduced psychiatric hospital admission compared with non‐treatment periods. Results were published online April 22, 2022, in the British Journal of Psychiatry.

Examining the health and criminal justice characteristics for young people on compulsory community treatment orders: An Australian birth cohort and data linkage study

BackgroundMost studies on the predictors and effectiveness of community treatment orders (CTOs) are restricted to health-related variables and do not consider forensic contacts as established by criminal justice databases or predictors from birth. We used linked administrative health and criminal justice data for a birth cohort in Queensland, Australia to investigate the characteristics and outcomes of people placed on CTOs. MethodsCTOs were identified from administrative data for hospital admissions and community mental health service contacts for a population cohort of 45,141 individuals born in Queensland in 1990. These data were linked with administrative court records, with individuals followed up to age 23/24 years. Logistic regression analyses were used to examine characteristics associated with CTO placement and Tobit regression analyses to examine factors predicting health and criminal justice outcomes in the following year. ResultsThere were 211 CTO cases by age 23/24 years, for whom it was possible to identify 413 controls on voluntary treatment. Non-affective psychoses [F20-F29] were the strongest predictors of CTO placement (ORadj = 4.07, 2.77–5.99) followed by a court appearance (ORadj = 1.99, 1.28–3.09). CTOs were associated with greater, not lower, subsequent psychiatric hospital admissions, inpatient bed-days and community mental health service contacts, although on sensitivity analyses psychiatric hospital admissions were the same as voluntary controls. CTOs were not associated with more subsequent court appearances despite higher rates of offending before CTO placement. ConclusionsBoth clinical and forensic variables can determine CTO placement and, on adjustment for these covariates, CTOs were not associated with reductions in psychiatric hospital admission, time spent as an inpatient, or subsequent court appearances. The latter finding might mean that CTOs reduce the risk of offending to that of voluntary controls.

Derivation and Validation of the Management and Supervision Tool (MaST) Risk of Crisis (RoC) Algorithm Using Electronic Health Record (EHR) Data

AimsThe Management and Supervision Tool (MaST) helps NHS mental health care professionals identify patients who are most likely to need psychiatric hospital admission or home treatment, due to severe mental illness, through a Risk of Crisis (RoC) algorithm driven by electronic health record (EHR) data analytics. We describe the derivation and validation of the MaST RoC algorithm, and its implementation to support preventative mental healthcare in the NHS.MethodsThe RoC algorithm was developed and evaluated with EHR data from six UK NHS trusts using Ordered Predictor List propensity scores informed by a priori weightings from pre-existing literature, as well as real-world evidence evaluating the associations of clinical risk factors with mental health crisis using NHS EHR data. Mental health crisis was defined as admission to a psychiatric hospital or acceptance to a community crisis service within a 28-day period. Predictor variables included age, gender, accommodation status, employment status, Mental Health Act (MHA) status (under section or Community Treatment Order), and previous mental health service contacts (including hospital admissions and crisis services). Data were analysed using Ordered Predictor List propensity scores. The algorithm was derived using structured EHR data from 2,620 patients in a single NHS trust and externally validated using data from 107,879 patients in five other NHS trusts. Qualitative and quantitative data on feasibility, acceptability and system efficiency impacts of MaST implementation were obtained through staff surveys and local audits.ResultsThe factors associated with greatest propensity for mental health crisis included recent previous crisis, multiple previous crises, higher number of mental health service contacts in recent weeks, MHA section, accommodation status and employment status. The RoC algorithm identified 64% and 80% crises in its top quintile. Sentiment analysis of staff surveys suggested that the use of MaST improved productivity by reducing time taken to access patient information to support caseload management that was previously difficult to obtain through manual review of EHRs. The systems efficiency audit revealed a reduction in duration of crisis and inpatient admissions following MaST implementation.ConclusionThe MaST RoC algorithm supports the identification of people more likely to use crisis services in NHS mental health trusts, is feasible to implement, and improves systems efficiency. EHR-derived algorithms can support real-world clinical practice to improve outcomes in people receiving NHS mental healthcare.

Alternative initiation regimen of paliperidone palmitate long-acting injectable

IntroductionLong-acting injectable antipsychotics (LAIs) hold an important place in the treatment of psychosis. Knowledge of the best way to administer LAIs is important to maximize the efficacy and minimize the side-effectsObjectivesTo assess the effectiveness of flexible doses of palmitate paliperidone long-acting injectable (PPLAI) against standard doses in initiation regimen in the subset of acutely hospitalized patients with schizophrenia and other psychosisMethodsRetrospective, noninterventional study. Group of initiation regimen: A)“Standard-doses” (recommended PPLAI initiation regimen: 150mg-Day-1 and 100mg-Day-8±4days), B)“Low-doses” (any dosage lower than the Standard-dose) C)“High-doses” (150mg-Day-1 and 150mg-Day-8±4days) Effectiveness was measured with the number of psychiatric hospital admission and psychiatric emergency visit 6-months post-discharge. Length of stay of the index hospitalization, adherence to treatment and adverse events was confirmed in the medical record. Concomitant use of biperiden was recorded.Results51 patients were included. We found no statistically differences in study variables between groups (Table-1). Table-1.Standard doses(n=31)Low-doses(n=13)High-doses(n=7)Length of stay mean±sd17.23±13.0913.77±9.0217±10.55No psychiatric hospitalizations 6-month post-discharge, %patients( n)71%(n=22)84.6%(n=11)85.7%(n=6)No psychiatric emergency visits 6-month post-discharge, %patients(n)61.3%(n=19)69.2%(n=9)85.7%(n=6)Prescription of biperiden 6-month post-discharge, %patients(n)13.3%(n=4)0%(n=0)14.3%(n=1)Adherence to treatment 6-month post-discharge, %patients(n)80.6%(n=25)84.61%(n=11)57.1%(n=4)ConclusionsNo differences were found in the effectiveness of flexible-doses in PPLAI initiation regimen. The use of low doses of PPLAI could keep the efficacy of the standard dose with a better side effect profile and treatment adherence. The strength of the conclusion is limited by the design and the number of patients.DisclosureNo significant relationships.

Excess mortality in a cohort of Brazilian patients with a median follow-up of 11 years after the first psychiatric hospital admission

PurposeTo estimate the mortality rates of a cohort of Brazilian patients after their first psychiatric admission and determine the possible risk factors associated with excess mortality.MethodsThe study included a cohort of psychiatric patients hospitalised from Jan 1, 2002 to Dec 31, 2007 in the catchment area of Ribeirão Preto, São Paulo state, Brazil. Data were linked to deaths that occurred between Jan 1, 2002 and Dec 31, 2016 from the SEADE Foundation (state data analysis system of São Paulo). The mortality rate (MR), age-sex-standardised mortality ratio (SMR), life expectancy at birth, and years of life lost (YLL) were computed. The factors associated with mortality were analysed by survival analysis using a Cox proportional hazards regression model.ResultsOf 4019 patients admitted (54.76% male), 803 died (69.74% male) during the follow-up (median = 11.25 years). Mortality rates were approximately three-fold higher than expected (SMR = 2.90, 95% CI 2.71–3.11). The highest mortality rate was noted in men with alcohol-related disorders (SMR = 5.50, 95% CI 4.87–6.19). Male sex (adjusted hazard ratio (aHR) = 1.62, 95% CI 1.37–1.92), higher age (aHR = 21.47, 95% CI 13.48–34.17), and unemployment (aHR = 1.22, 95% CI 1.05–1.43) significantly increased the mortality risk from all causes. The average YLL was 27.64 years with the highest YLL noted in nonalcohol substance-related disorders (39.22 years). The life expectancy at birth in this cohort was 47.27 years. Unnatural causes of death were associated with nonwhite skin colour and substance-related disorders.ConclusionAn excess of mortality and a significant reduction in life expectancy of mentally disordered patients who were first admitted to psychiatric beds was noted, particularly patients admitted for substance-related disorders, which should represent a priority in mental health policies.

Digital media-related precursors to psychiatric hospitalization among youth

Digital media, including smartphones and social media, are central in youths' lives. This study aimed to examine the role of digital media in psychiatric hospital admissions among adolescents. 343 psychiatrically-hospitalized youth (Mage = 15.2; 70.3% White, 13.7% Black, 33.9% Hispanic; 48.7% female) completed self-report measures of potential digital media-related reasons for hospitalization, patterns of digital media use, and clinical symptoms (internalizing, externalizing, suicidal ideation and attempts). Digital media-related reasons for hospitalization were common, with over 40% of the sample endorsing at least one such reason; 24.8% endorsed having their phone taken away as a reason for admission. Younger adolescents and youth with addictive patterns of phone use were more likely to endorse digital media-related reasons for hospitalization, including phone restriction and negative social media experiences. In addition, youth endorsing suicide-related social media engagement (e.g., posting or messaging about suicide) as a precursor to admission reported more severe suicidal ideation and greater likelihood of a recent suicide attempt. Limitations of the study include a reliance on self-report measures and cross-sectional design. Findings highlight the need to identify youth who may be especially vulnerable to digital media experiences that contribute to risk for psychiatric hospitalization.

Factors associated with risk of death by suicide after psychiatric hospitalization by the Unified Health System in Brazil (2002–2015)

ObjectiveTo investigate overall and sex-related characteristics associated with the risk of death by suicide within 365 days of discharge in patients admitted to psychiatric hospitals in the Brazilian Unified Health System (SUS). MethodA non-concurrent prospective cohort of adult patients admitted to psychiatric hospitals in the SUS, from 2002 to 2015. Patients were stratified according to sociodemographic and clinical variables. Adjusted hazard ratios (aHRs) of suicide within 365 days of discharge were estimated using Cox proportional hazard regression models. ResultsThis sample comprised 1,228,784 adult patients admitted to psychiatric hospitals. Of these, 3201 died by suicide within 365 days of discharge. The risk of suicide was positively associated with male sex, age between 18 and 29 years, living in the South region, and living in rural or intermediate municipalities. The highest risk of suicide was among patients with depressive disorders (aHR, 3.87; 95%CI, 3.41–4.38) follow by opioid-related disorders (aHR, 2.71; 95%CI, 2.00–3.67), particularly among female patients. ConclusionPatients with a psychiatric hospital admission should have access to mental health care services immediately after discharge and in the long term. Findings of this study may support suicide prevention policies and have implications for clinical decisions related to patient discharge and follow-up.

Effectiveness of medical treatment for bipolar disorder regarding suicide, self-harm and psychiatric hospital admission: between- and within-individual study on Danish national data.

Mood stabilisers are the main treatment for bipolar disorder. However, it is uncertain which drugs have the best outcomes. To investigate whether rates of suicide, self-harm and psychiatric hospital admission in individuals with bipolar disorder differ between mood stabilisers. A cohort design was applied to people aged ≥15 years who were diagnosed with bipolar disorder and living in Denmark during 1995-2016. Treatment with lithium, valproate, other mood stabilisers and antipsychotics were compared in between- and within-individual analyses, and adjusted for sociodemographic characteristics and previous self-harm. A total of 33 337 individuals with bipolar disorder were included (266 900 person-years). When compared with individuals not receiving treatment, those receiving lithium had a lower rate of suicide (hazard ratio 0.40, 95% CI 0.31-0.51). When comparing treatment and non-treatment periods in the same individuals, lower rates of self-harm were found for lithium (hazard ratio 0.74, 95% CI 0.61-0.91). Lower rates of psychiatric hospital admission were found for all drug categories compared with non-treatment periods in within-individual analyses (P<0.001). The low rates of self-harm and hospital admission for lithium in within-individual analyses were supported by results of between-individual analyses. Lithium was associated with lower rates of suicide, self-harm and psychiatric hospital readmission in all analyses. With respect to suicide, lithium was superior to no treatment. Although confounding by indication cannot be excluded, lithium seems to have better outcomes in the treatment of bipolar disorder than other mood stabilisers.

The Association between Nursing Skill Mix and Patient Outcomes in a Mental Health Setting: Protocol for an Observational Feasibility Study.

International research on nursing skill mix has focused primarily on medical and surgical patient populations. The association between nursing skill mix and clinical outcomes for psychiatric inpatients has not been explored. The aim of this study is to establish the feasibility of extracting and linking nurse and inpatient data from hospital administrative data sources. This is an observational study. Data will be extracted from hospital administrative sources and linked together. Patient information will include duration and number of psychiatric hospital admissions. We will extract information on the educational preparation of nurses working in the participating hospitals to enable us to calculate estimates of the nursing skill mix. The study will be conducted in two psychiatric inpatient services in Australia. Our study will test the feasibility of extracting and linking nursing skill mix and patient data in a mental health setting and will inform the methodological development of an appropriately powered observational study. Australian and New Zealand clinical trial registry: ACTRN12619001337167p.

Associations of short-term exposure to air pollution and increased ambient temperature with psychiatric hospital admissions in older adults in the USA: a case–crossover study

SummaryBackgroundLittle is known about the associations between ambient environmental exposures and the risk of acute episodes of psychiatric disorders. We aimed to estimate the link between short-term exposure to atmospheric pollutants, temperature, and acute psychiatric hospital admissions in adults aged 65 years and older in the USA.MethodsFor this study, we included all people (aged ≥65 years) enrolled in the Medicare programme in the USA who had an emergency or urgent hospital admission for a psychiatric disorder recorded between Jan 31, 2000, and Dec 31, 2016. We applied a case-crossover design to study the associations between short-term exposure to air pollution (fine particulate matter [PM2·5], ozone, and nitrogen dioxide [NO2]), ambient temperature, and the risk of acute hospital admissions for depression, schizophrenia, and bipolar disorder in this population. The percentage change in the risk of hospital admission and annual absolute risk differences were estimated.FindingsFor each 5°C increase in short-term exposure to cold season temperature, the relative risk of acute hospital admission increased by 3·66% (95% CI 3·06–4·26) for depression, by 3·03% (2·04–4·02) for schizophrenia, and by 3·52% (2·38–4·68) for bipolar disorder in the US Medicare population. Increased short-term exposure to PM2·5 and NO2 was also associated with a significant increase in the risk of acute hospital admissions for psychiatric disorders. Each 5 μg/m3 increase in PM2·5 was associated with an increase in hospital admission rates of 0·62% (95% CI 0·23–1·02) for depression, 0·77% (0·11–1·44) for schizophrenia, and 1·19% (0·49–1·90) for bipolar disorder; each 5 parts per billion (ppb) increase in NO2, meanwhile, was linked to an increase in hospital admission rates of 0·35% (95% CI 0·03–0·66) for depression and 0·64% (0·20–1·08) for schizophrenia. No such associations were found with warm season temperature.InterpretationIn the US Medicare population, short-term exposure to elevated concentrations of PM2·5 and NO2 and cold season ambient temperature were significantly associated with an increased risk of hospital admissions for psychiatric disorders. Considering the increasing burden of psychiatric disorders in the US population, these findings suggest that intervening on air pollution and ambient temperature levels through stricter environmental regulations or climate mitigation could help ease the psychiatric health-care burden.

Psychosocial interventions for community-dwelling individuals with schizophrenia: study protocol for a systematic review and meta-analysis

IntroductionDespite the recent global mental health movement of the transition from hospital-centred to integrated community-based services, comprehensive evidence of psychosocial interventions focusing on community-dwelling individuals with schizophrenia is still lacking....

Associations of presenting symptoms and subsequent adverse clinical outcomes in people with unipolar depression: a prospective natural language processing (NLP), transdiagnostic, network analysis of electronic health record (EHR) data

ObjectiveTo investigate the associations of symptoms of mania and depression with clinical outcomes in people with unipolar depression.DesignA natural language processing electronic health record study. We used network analysis to...

Self-harm, somatic disorders and mortality in the 3 years following a hospitalisation in psychiatry in adolescents and young adults

BackgroundThere is limited recent information regarding the risk of self-harm, somatic disorders and premature mortality following discharge from psychiatric hospital in young people.ObjectiveTo measure these risks in young people discharged...