Severe Mental Illness Patients Research Articles

A Comparative Cross-sectional Study to Assess Knowledge Regarding Human Rights of Mentally Ill between Patient with Severe Mental Illness and People Without Mental Illness

Abstract Background: Human rights violation of mental illness (MI) in society by people without MI (PWMI) has been a common occurrence. The present study aims to compare the knowledge regarding the human rights of the mentally ill between asymptomatic patients with severe MI (SMI) and PWMI. Materials and Methods: A cross-sectional comparative design was adopted to study the knowledge regarding the human rights of MI among selected asymptomatic patients with SMI and people with PWMI (n = 122). Purposive sampling technique was used to collect the data through face-to-face interview using a structured questionnaire. Descriptive and inferential statistics were used to analyze the data. Results: In the present study, findings revealed that mentally ill patients are still struggling for their rights to be accepted as a part of society. MI patients are being discriminated against by the community because of their MI without getting equal treatment even after their recovery is accepted by both SMI and PWMI. SMI patients did not find the community a safe place contrary to PWMI. PWMI was aware of the rights and policies against harassment of mentally ill other than SMI patients. Conclusion: The study finds that the mentally ill patients are discriminated on various aspects and are not fully aware of their rights which conclude that community needs to be educated regarding the human rights of mentally ill to protect and promote the rights of PWMI.

Caregiver burden, attachment and cognitive emotion among the family caregivers of severe mental illness patients

BackgroundSerious mental illness (SMI) is a debilitating medical condition that causes stress and challenges for the family caregivers (FCs) of affected patients, increasing their caregiver burden (CB). This situation can activate attachment styles (AS) and trigger negative emotions, further contributing to CB. Given that AS and cognitive-emotional regulation (CER) can affect the CB of FCs of patients with SMI, the aim of this study was to evaluate the relationship between CB with AS, and CER among the FCs.MethodsThis cross-sectional descriptive-correlational study was carried out in May–November 2022. Participants were 278 FCs of patients with SMI consecutively recruited from Roozbeh leading psychiatric hospital, Tehran, Iran. Data were collected using a patients’ demographic and clinical characteristics questionnaire, an FCs’ demographic characteristics questionnaire, the Attachment Style Questionnaire, the Cognitive Emotion Regulation Questionnaire, and the Burden Scale for Family Caregivers, and were analyzed using the SPSS software (v. 16.0).ResultsCB had significant inverse relationship with secure AS (r = − 0.262) and significant positive relationship with fearful AS (r = 0.194) and dismissive AS (r = 0.242) (P < 0.01). Moreover, CB had significant inverse relationship with adaptive CER strategies and significant positive relationship with maladaptive CER strategies (P < 0.001). Regression analysis also showed that CB had significant relationship with secure AS and catastrophizing, rumination, self-blame, and positive refocusing CER strategies (P < 0.05).ConclusionThis study concludes that AS and CER can impact CB. There is a negative relationship between secure AS and CB, as well as between adaptive CER strategies and CB. Conversely, there is a positive relationship between avoidant AS and increased CB, as well as between maladaptive CER strategies and CB. It is recommended to adopt strategies that promote the use of secure AS and adaptive CER among the FCs of patients with SMI.

Recovery From Severe Mental Illnesses: The Influence of Personal and Psychosocial Factors in Community Settings.

Severe mental illnesses (SMIs) represent a significant public health challenge with substantial personal, economic and societal burdens. Despite treatment advances, recovery outcomes for SMI patients remain variable. This study aimed to investigate the influence of personal and psychosocial factors on recovery among SMI patients in community health settings. This cross-sectional study was conducted in 23 community health service centres in Nanjing, China. We recruited 924 participants diagnosed with SMIs, using a random sampling method. The relationships between individual, psychosocial factors and patients' recovery status were analysed by multiple linear regression. The mediation effect of medication adherence was further tested by the Sobel test with bootstrapping. The mean score of the Morningside Rehabilitation Status Scale (MRSS) of 924 patients with SMIs was 49.82 ± 41.52. The main influencing personal factors of recovery status were age, marital status, education, average annual income and duration of illness. Patients who were accepted by their families tended to have better recovery outcomes, while stigma and social impairment may hinder recovery. Medication adherence played a mediating role between psychosocial factors and recovery status. This study highlights the crucial role of psychosocial factors in the treatment and recovery of SMI patients. Furthermore, medication adherence emerged as a mediating factor. Implementing targeted interventions and policies addressing identified psychosocial barriers can offer promising avenues for improving recovery outcomes for SMI patients in community settings.

Unraveling the role of the renin-angiotensin system in severe mental illnesses: An insight into psychopathology and cognitive deficits

Severe mental illnesses (SMI), especially schizophrenia and bipolar disorder (BD), are associated with significant distress to patients, reduced life expectancy and a higher cost of care. There is growing evidence that SMI may increase the risk of dementia in later life, posing an additional challenge in the management of these patients. SMI present a complex and highly heterogeneous pathophysiology, which has hampered the understanding of its underlying pathological mechanisms and limited the success of the available therapies. Despite the advances in therapeutic approaches in psychiatry over the past decades, treatment resistance is still a common problem in clinical practice, highlighting the urgent need for novel therapeutic targets for SMI. The discovery that renin-angiotensin system (RAS) components are expressed in the central nervous system opened new possibilities for investigating a potential role for this system in the neurobiology of SMI. The safety and efficacy of AT1 receptor blockers and angiotensin-converting enzyme inhibitors in cardiovascular and metabolic diseases, common medical comorbidities among SMI patients and well-known risk factors for dementia, suggest the potential scalability of these strategies for the management of SMI outcomes including the risk of subsequent dementia. This review aimed to discuss the available evidence from animal models and human studies of the potential involvement of RAS in the pathophysiology of SMI. We also provided a reflection on drawbacks and perspectives that can foster the development of new related therapeutic strategies.

Effectiveness of COVID-19 Vaccines in People with Severe Mental Illness: A Systematic Review and Meta-Analysis.

Prior to the introduction of COVID-19 vaccines, patients with severe mental illness (SMI) were at greater risk of COVID-19-related outcomes than the general population. It is not yet clear whether COVID-19 vaccines have reduced the risk gap. We systematically searched nine international databases and three Chinese databases to identify relevant studies from December 2020 to December 2023 to compare the risk of COVID-19-related outcomes for SMI patients to those without SMI after vaccination. Random effects meta-analysis was performed to estimate the pooled odds ratio (OR) with 95% confidence intervals (CI). Subgroup analysis, sensitivity analysis, and publication bias analysis were conducted with R software 4.3.0. A total of 11 observational studies were included. Compared with controls, SMI patients were associated with a slightly increased risk of infection (pooled OR = 1.10, 95% CI, 1.03-1.17, I2 = 43.4%), while showing a 2-fold higher risk of hospitalization (pooled OR = 2.66, 95% CI, 1.13-6.22, I2 = 99.6%), even after both groups have received COVID-19 vaccines. Limited evidence suggests a higher mortality risk among SMI patients compared to controls post vaccination, but the findings did not reach statistical significance. SMI patients remain at increased risk compared to their peers in COVID-19-related outcomes even after vaccination. Vaccination appears an effective approach to prevent severe COVID-19 illness in SMI patients, and actions should be taken by healthcare providers to improve vaccination coverage in these vulnerable groups.

Fasting insulinemia as biomarker of illness relapse in patients with severe mental illness?

Severe Mental Illness (SMI) is often associated with metabolic alteration and/or metabolic syndrome, which may determine an increased mortality due to a further increased cardiovascular risk. The relationship with metabolic syndrome is often bidirectional, resulting in a pathoplastic effect of these dysmetabolisms. Among the several hormones involved, insulin appears to play a key role, albeit not entirely clear. The aim of our real-world cross-sectional observational study is to investigate a set of metabolic biomarkers of illness relapse/recurrence/onset in a cohort of 310 adult SMI inpatients consecutively admitted to the Psychiatry Clinic of the Azienda Ospedaliero Universitaria of Marche, in Ancona (Italy), between February 2021 and February 2024. According to the stepwise multivariate regression model, a higher number of acute episodes per year was positively predicted by the age of illness onset, the lifetime number of suicidal attempts and fasting insulinemia and negatively by the participant’s age. A second stepwise multivariate regression model using only the metabolic characteristics as independent variables, found that a higher number of acute episodes per year was predicted positively by the fasting insulinemia and red blood cells and negatively by the abdominal circumference. Overall, our findings could provide practical implications for the treatment and management of SMI patients, emphasizing the importance of monitoring and managing metabolic factors, particularly insulinemia, metabolic syndrome and insulin resistance. Finally, insulinemia could potentially act as metabolic biomarker of illness relapse, though more larger and longitudinal studies should be carried out to confirm these results.

TAPS-tool reveals severe under detection of substance use problems in patients with severe mental illness.

Substance use disorders (SUD) and associated problems are highly prevalent but often undetected in patients with Severe Mental Illness (SMI). This study investigates the prevalence, under-detection, and variables associated with a high risk of SUD in a Dutch sample of adult outpatient SMI patients (N = 83). Substance use (The Tobacco, Alcohol, Prescription medication, and other Substance use -TAPS-tool), quality of life (Manchester Short Assessment of Quality of Life-MANSA), general functioning (Health of the Nation Outcome Scale-HoNOS), DSM-5 classifications and patient characteristics (age, education, marital status) were assessed. Detection of SUD was determined by calculating % agreement of DSM-5 classification to TAPS outcome. A logistic regression analysis was performed to determine the association of patient characteristics, quality of life and general functioning to an increased risk of SUD as determined by the TAPS. Concerning prevalence, 89% of the patients used tobacco, above guideline-recommended daily limits of alcohol, illicit drugs or prescription medications for nonmedical purposes. Almost all smokers, half of the alcohol users and three-quarter of the patients that use marihuana or stimulant drugs had a high risk of SUD. All patients with high risk of SUD associated with alcohol, drugs or medications also had SUD associated with tobacco use. Concerning under detection less than half of the patients with a high risk of SUD according the TAPS had a SUD in their DSM-5 classification. Gender, partner, age and satisfaction about the relationship with family had a significant association with a high risk of SUD. Screening for addiction in an SMI sample with the TAPS-tool revealed a high prevalence of substance use and a high risk of SUD. TAPS outcomes compared to the clinically obtained DSM-5 classification revealed a high degree of under-detection of substance use problems. Smoking seems to pose a specific additional risk of addiction and deserves more attention in treatment to achieve greater health care benefits.

Supported employment coaches’ difficulties and facilitators with clients diagnosed with personality versus other disorders: A qualitative study

AimPeople with severe mental illnesses (SMI) face different occupational challenges than those diagnosed with personality disorders (PD). Supported employment (SE) has been validated for SMI patients but its effectiveness for individuals with PD remains unclear, and the reasons for this potential difference have not been explored. This study aimed to identify differences in SE practice for clients with SMI and those with PD. MethodsSix SE job coaches were interviewed about their experiences. A thematic analysis was run. ResultsMore difficulties and facilitators were mentioned regarding clients with PD than regarding clients with other SMI. For both, patients’ symptoms were reported to negatively affect their (re)integration into the job market. However, in contrast to that of clients with SMI, the relation between symptoms and SE success for clients with PD involved difficult behaviors and their negative impact on the therapeutic relationship. ConclusionIn summary, SE practice seems to be undermined by PD and could benefit from adaptations, such as specific training for SE teams to help them in managing clients with this disorder.

Difficult-to-Engage Patients with Severe Mental Illness in Rural Community Settings: Results of the Greek Hybrid Assertive Community Treatment Model of Mental Healthcare.

Background: Modified Assertive Community Treatment (ACT) in rural settings may be effective in the care of patients with severe mental illness (SMI) that are difficult to engage in community care. The objective of the present study was to explore the impact of the care by a hybrid ACT team on SMI patients' hospitalizations, length of hospital stay, symptomatology and functioning in a rural community treatment setting in Greece. Methods: The hybrid ACT team is an expansion of the services of the well-established generic Mobile Mental Health Unit in a rural area of Northwest Greece, and delivers home-based care for patients with SMI. This was a 3-year prospective, mirror image, pre-post observational study. Patients' symptomatology, functioning and general outcome were measured with the use of the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF), and the Health of the Nation Outcome Scale (HοNOS). Results: The mean age of the 23 enrolled patients was 52.4 years and the mean age of disease onset was 23.5 years, with a mean number of hospitalizations 10.74. Over the 16-month follow-up patients' hospitalizations, both voluntary and involuntary, had been significantly reduced by almost 80%. Length of hospital stay had been significantly reduced by 87%, whereas patients' functioning and symptomatology had been significantly improved, by 17% and 14.5%, respectively. Conclusions: The model of hybrid ACT in rural areas in Greece may be effective in the treatment of difficult-to-engage patients with SMI and may improve patients' outcomes.

Vulnerability to risky sexual behavior among patients with severe mental illness in Uganda

BackgroundThe relationship between severe mental illness and risky sexual behaviors, defined as acts associated with a higher risk level is notably significant in sub-Saharan Africa. In Uganda, mental disorders have been substantially correlated with unsafe sexual practices, contributing to the global burden of risky sexual behaviors. The consequential outcomes, such as sexually transmitted diseases, has resulted into a significant challenge in managing severe mental illness and potentially increased risky sexual behaviour. There is an urgent need to identify and understand factors specific to Uganda that amplify the vulnerability of severe mental illness patients to risky sexual behaviors. This study aimed to understand the vulnerability factors to risky sexual behaviour in severe mental illness in central and south-western Uganda, seeking to inform the development of tailored and effective intervention strategies to address this critical issue.MethodsThis was a qualitative descriptive study that was carried out at Butabika and Masaka hospitals in Uganda, involving a varied group of 32 individuals, comprising 12 persons with diagnosed Severe Mental Illness (Schizophrenia, Bipolar Affective Disorder, or Recurrent Major Depressive Disorder) and to risky sexual behaviors, 8 caregivers (who had patients with severe mental illness and to risky sexual behaviors) and 12 mental health specialists, (who had treated these participants). Purposive sampling was done by intentionally selecting participants based on specific attributes relevant to the research question and the objective of the study which was to explore the factors contributing vulnerability to risky sexual behaviour in severe mental illness in central and south-western Uganda. The interviews were conducted, centered on personal experiences and influences on risky sexual behaviors for the persons with severe mental illness, targeting insights into the nuanced interplay of severe mental illness and sexual behavior. For caregivers and mental health specialists, the interviews were conducted to gain a comprehensive understanding of the unique challenges, perspectives, and experiences they encounter in providing support and treatment respectively. The interviews were tape-recorded and transcribed verbatim. Framework analysis of transcribed interviews, using NVivo11 software that helped to systematically organize and code data within the predetermined and emergent thematic framework, we were able to identify patterns and themes to address the research question and objective.ResultsThe study findings underscored a pervasive pattern of engaging in risky sexual behavior among individuals coping with severe mental illness, a growing concern traditionally associated with sexually transmitted infections like HIV and AIDS, unwanted pregnancies, and sexual encounters with strangers. This problem was largely attributed to factors such as compromised judgment due to underlying morbidity, abnormally high libido, poverty, desperation, and inadequate social support. Additionally, sexual deprivation, often a result of stigma, discrimination, and prolonged periods of hospitalization, was found to contribute to irresponsible and risky sexual acts. Respondents also highlighted certain practices and structural weaknesses within hospital environments, such as stripping patients naked when going to seclusion rooms and inadequate patient monitoring.ConclusionsThe findings underscore the need for targeted interventions addressing both individual and structural factors to alleviate the risks associated with sexual behavior among individuals with severe mental illness.

General practitioners’ experiences of providing somatic care for patients with severe mental illness: a qualitative study

BackgroundPatients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties.MethodsWe conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group.ResultsGPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations.ConclusionThe GPs’ interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.

Clinical Outcome in Persons with Severe Mental Disorders Attending a Mental Health Day Center during the COVID-19 Pandemic.

Studies assessing the psychological impact of the COVID-19 pandemic on populations highlight the emergence of mental health difficulties, especially if a mental health disorder is already present. Patients with severe mental illnesses (SMIs) may be even more vulnerable to the psychosocial effects of the pandemic. However, little is known regarding the possible impact of the pandemic on SMI patients supported by community-based mental health day centers. A two-year prospective study comprising 29 individuals with SMI was conducted by the Skitali Mental Health Day Center in Ioannina, Northwest Greece. The described group of examined patients consisted mainly of psychotic patients (65.5%). Patients were assessed using the Health of Nations Outcome Scale and the Global Assessment of Functioning scale, and scores prior to and after the onset of the pandemic were compared. The results indicated that participants did not present any significant decline in their overall clinical status during the COVID-19 pandemic and the national lockdown measures. This finding is relevant because previous research has shown that the pandemic may negatively impact adherence to treatment and service attendance and that the symptomatology of patients with SMIs may further deteriorate. It is suggested that the operation of mental health day centers during collective stressful events should be preserved, but further research is needed to evaluate their role in maintaining continuity of care during such events.

AĞIR RUH HASTALIĞI OLAN HASTALARDA COVİD-19 AŞILAMA ORANLARI

The pandemic is thought to affect patients with severe mental illness (SMI). There are no data on COVID-19 vaccination in patients with SMI in Turkey. The aim of our study is to determine the vaccination rates and demographic and clinical characteristics that may be associated with vaccination in SMI patients followed in a community mental health center (TRSM). Data including demographic and clinical characteristics of 307 patients followed in TRSM were obtained. The mean age of the patients was 44.17±11.23. There were 199 (64.8%) men, 205 (66.8%) single, 247 (80.5%) unemployed, 288 (95%) living with their families. 242 (78.8%) were diagnosed with schizophrenia spectrum disorder and 65 (21.2%) were diagnosed with bipolar disorder. 78 (28.9%) of them had a suicide attempt in the past. 118 (38.4%) had chronic co-morbidities. Fifty (16.3%) of the patients had past Covid-19 infection. 257 (83.7%) 1 dose, 246 (80.1%) 2 doses, 173 (56.4%) 3 doses, 61 (19.9%) 4 doses and 9 (2.9%) 5 doses 150 (48.9%) patients were vaccinated. fully vaccinated, 50 (16.3%) unvaccinated and 107 (34.9%) partially vaccinated. In the current study, vaccination rates against covid 19 were lower in SMI patients than in the general population. There was no difference between full or partial/unvaccinated groups in terms of demographic or clinical characteristics except marital status in SMI patients. Organizational changes are needed to increase vaccination rates in SMI patients.

Oxytocin as a transdiagnostic biomarker of well-being in severe mental illness during the Covid-19 pandemic

Individuals with severe mental illness (SMI) have been found to suffer a greater decline in psychological well-being compared to the general population in times of stress. The present study aimed to examine clinical and endocrine resilience factors of psychological well-being in SMI patients during the Covid-19 pandemic. Methods: After Covid-19 crisis outburst in Israel 112 participants, 69 outpatients, and 43 inpatients and day treatment patients were recruited. Outpatients signed an online informed consent and filled in questionnaires regarding their level of mental health symptoms (OQ-45), fear of Covid-19 (FCV), and psychological well-being (PWB). Inpatients answered the same questionnaires and in addition, went through a positive social interaction paradigm while providing three saliva samples to measure their s-IgA and oxytocin (OT) levels. Results: A strong negative correlation was found in the whole sample between reported mental health symptoms, fear of Covid-19, and well-being. Hierarchical regression did not find additional contribution of the fear of the pandemic in predicting well-being beyond the impact of symptomatology. For inpatients (N = 39) only, hierarchical regression found that oxytocin, but not s-IgA could explain 5% of the variance of well-being (R2 = 0.05) in individuals with SMI regardless of their mental health symptoms (R2 = 0.46) and their marital status (R2 = 0.21). Conclusions: OT is suggested as a possible independent biological resilience factor of well-being in times of major stress among SMI patients. It is still unknown whether OT is a mediator that contributes to well-being or a biological marker that indicates the degree of beneficial social interactions.

Analysis of factors associated with family disease burden and correlation with social support among family caregivers of patients with severe mental illnesses.

Caregivers are responsible for the home care of family members with severe mental illnesses (SMIs) and their lives are often subject to changes that can create stress and burden. The purpose of this study was to explore the current state of family disease burden and its correlation with social support among family caregivers of SMIs patients. Using a random sampling method, a total of 1,108 family caregivers of SMIs patients in community health service centers were selected. A general information questionnaire of family caregivers and patients, the Family Disease Burden Scale, and the Social Support Rating Scale were used. The score of the Family Disease Burden Scale of 1108 family caregivers was 16.57 ± 10.65. Family disease burden was negatively correlated with social support (p < .05). The main influencing factors of family disease burden were average annual family income, duration of illness, distance to medical care, risk of unpredictable behavior, social support, caregiver-patient relationship, gender, and comorbid chronic conditions (p < .05). Family caregivers of SMIs patients have a relatively low level of caregiver-perceived social support. Interventions to enhance perceived social support could help maintain the health of family caregivers and improve the quality of family care.

How to quit cannabis when you have a mental illness: study from the perspective of patients who have successfully quit.

Research regarding quitting cannabis use often excludes patients with severe mental illness (SMI). We investigated facilitating and impeding factors in SMI patients and their advice to others, using semi-structured interviews with 12 SMI-patients, who were daily cannabis users for ≥12 months and had fully stopped using for ≥6 months. Seeking distraction, social contacts in personal environment, avoiding temptation and support from professionals were facilitating factors in stopping. Impeding factors were withdrawal symptoms, user environment, experiencing stress and user's routine. Advice to other patients included to just do it, seek support from others, quit 'cold turkey' and acknowledge that cannabis use is a problem. Advice to mental health professionals is to discuss cannabis use from the start of treatment. It is important to inform patients that cannabis use has negative consequences and limits the effects of treatment. Do not judge cannabis use or force the patient to stop.

Development of the PREMIUM computerized adaptive testing for measuring the access and care coordination for patients with severe mental illness

Severe mental illness (SMI) patients often have complex health needs, which makes it difficult to access and coordinate their care. This study aimed to develop a computerized adaptive testing (CAT) tool, PREMIUM CAT-ACC, to measure SMI patients' experience with access and care coordination. This multicenter and cross-sectional study included 496 adult in- and out-patients with SMI (i.e., schizophrenia, bipolar disorder, or major depressive disorder). Psychometric analysis of the 13-item bank showed adequate properties, with preliminary evidence of external validity and no substantial differential item functioning for sex, age, care setting, and diagnosis, making it suitable for CAT administration. A post-hoc CAT simulation demonstrated that the tool was efficient and accurate, with an average of seven items, compared to the full item bank administration. Its use by clinicians can contribute to optimizing patient care pathways and transitioning towards more person-centered healthcare.

Clinical characteristics and outcomes of people with severe mental disorders hospitalized due to COVID-19: A nationwide population-based study

ObjetiveHospitalized COVID-19 patients with severe mental illness (SMI) have worse outcomes than counterparts without SMI. Barriers in access to acute care medical procedures among SMI patients may partially explain this phenomenon. Here, we examined differences in critical care admission and in-hospital mortality between hospitalized COVID-19 patients with and without SMI. MethodsThis population-based study used Spain's nationwide electronic health records. Based on International Classification Diseases, Tenth Revision, ICD-10-CM codes, we identified all patients aged ≥15 years hospitalized due to COVID-19 between July 1st-December 31st, 2020, and compared patients with and without SMI in terms of (i) critical care admission and (ii) in-hospital mortality – overall and stratified by age. We used logistic regression models including sex, age, and comorbidity burden as measured by Charlson Comorbidity Index Score as covariates. ResultsOf 118,691 hospital admissions due to COVID-19 of people aged ≥15 years, 1512 (1.3%) included a diagnosis of SMI. Compared to non-SMI patients, SMI patients had higher in-hospital mortality (OR,95%CI: 1.63,1.42–1.88) and were less frequently admitted to critical care (OR,95%CI: 0.70,0.58–0.85). Admission to critical care in SMI patients was lower than for non-SMI counterparts only among individuals aged ≥60 years. The magnitude of the difference in in-hospital mortality between SMI and non-SMI patients decreased as age increased. ConclusionsIndividuals with SMI had reduced critical care admission and increased in-hospital mortality compared non-SMI counterparts, suggesting that differences in delivery of acute care medical procedures may partially explain higher risk of negative outcomes among COVID-19 patients with SMI.

A Rose by Any Other Name: Gender-Affirming Care and Severe Mental Illness

The transgender population has higher rates of psychiatric disorders and stigma within medical settings. Literature suggests that gender-affirming care is the standard when working with such patients. There are limited studies regarding treating these patients with severe mental illness (SMI). This article explores how to treat SMI that impacts patients' reality to the point where their assigned sex cannot be acknowledged. The case presented is that of a transgender woman, where clarification of her natal sex was crucial to treatment. The patient denied her natal sex, endorsing a history of miscarriage. Studies on treatment of transgender SMI patients are limited. Gender-affirming treatment is the standard of care for these patients. Training how to ask pertinent questions and communicate effectively is necessary to prevent misdiagnosis, unnecessary treatment, and agitation. [ Psychiatr Ann. 2023;53(5):221–223.]

Examining Place-Based Neighborhood Factors in a Multisite Peer-Led Healthy Lifestyle Effectiveness Trial for People with Serious Mental Illness.

People with severe mental illness (SMI) experience significantly higher obesity-related comorbidities and premature mortality rates than healthy populations. The physical and social characteristics of neighborhoods where people with SMI reside can play an important role in promoting or hindering healthy eating and physical activity. However, this is seldom considered when designing and testing health behavior interventions for these populations. This study used baseline data from an obesity control trial for low-income, minority people with SMI to demonstrate the utility of assessing neighborhood- and city-level place-based factors within the context of lifestyle interventions. GIS was used to create a zip-code-level social and built environment geodatabase in New York City and Philadelphia, where the trial occurred. Chi-square and t-tests were used to assess differences in the spatial distribution of health-related built and social environment characteristics between and within cities and diet and physical activity outcomes. All types of neighborhood characteristics showed significant environmental differences between and within cities. Several neighborhood characteristics were associated with participants' baseline healthy eating and physical activity behaviors, emphasizing that place-based factors may moderate lifestyle interventions for SMI patients. Future behavioral interventions targeting place-dependent behaviors should be powered and designed to assess potential moderation by place-based factors.