The trends of mental disorders mortality in China over a 33-year period.

OBJECTIVES: We investigated the variations in the trends of mental disorders mortality by age, period, and cohort, over a 33-year period from 1987 to 2020, to reveal the relationship between age, period, cohort, and mental disorders mortality, as well as providing guidance for resource allocation to prevent mental disorders-related deaths in vulnerable target populations. METHODS: The data of mental disorders mortality 1987-2020 were from five administrative organizations, which collected from the National Health Commission in China with national monitoring by sex and age, covering 31 provinces in China. The International Classification of Diseases (ICD), its 9th Revision (ICD-9) and its 10th Revision were used to code the mental diseases. From 1987-2002, ICD-9 was used, and ICD-10 was used from 2003 to 2020. The age standardized mortality rates (ASMRs) were calculated using the World Standard Population as the reference. We used joinpoint models to assess the trends of mental disorders mortality in China for the period 1987-2020. And the age-period-cohort models were employed to estimate the age-period-cohort effect on mental disorders mortality. RESULTS: The age-standardized overall mental disorders mortality rate (ASMR) showed a downward trend from 1987 to 2020. Further, the ASMR of individuals in urban was higher than that in rural from 1987 to 2001, but, post-2002, this urban-rural disparity in ASMR showed a less clear pattern, with urban areas occasionally surpassing rural areas and vice versa. ASMR is less prevalent among females compared to males overall. The contribution of age effects to mental disorders mortality gradually increases with advancing age, the period effects of mental disorders mortality gradually decrease over time. The cohort effect's contribution to mental disorders mortality decreases in the newly born population, while in the older birth cohorts, the cohort effect's contribution to the mortality rate of mental disorders increases. CONCLUSIONS: The ASMR exhibits a decreasing trend from 1987 to 2020, and these change trend showed urban-rural and sex differences. The primary factors contributing to this overall decline are period effects and cohort effects. Our results provide valuable information for shaping mental health policies, designing targeted interventions, and preparing for future changes in disease mortality rates. The focus on different demographic factors allows for a nuanced and tailored approach to mental health promotion and intervention strategies.

Perinatal mental health and pregnancy-associated mortality: opportunities for change.

Perinatal mental health conditions have been associated with adverse pregnancy outcomes, including maternal death. This quality improvement project analyzed pregnancy-associated death among veterans with mental health conditions in order to identify opportunities to improve healthcare and reduce maternal deaths. Pregnancy-associated deaths among veterans using Veterans Health Administration (VHA) maternity care benefits between fiscal year 2011 and 2020 were identified from national VHA databases. Deaths among individuals with active mental health conditions underwent individual chart review using a standardized abstraction template adapted from the Centers for Disease Control and Prevention (CDC). Thirty-two pregnancy-associated deaths were identified among 39,720 paid deliveries with 81% (n = 26) occurring among individuals with an active perinatal mental health condition. In the perinatal mental health cohort, most deaths (n = 16, 62%) occurred in the late postpartum period and 42% (n = 11) were due to suicide, homicide, or overdose. Opportunities to improve care included addressing (1) racial disparities, (2) mental health effects of perinatal loss, (3) late postpartum vulnerability, (4) lack of psychotropic medication continuity, (5) mental health conditions in intimate partners, (6) child custody loss, (7) lack of patient education or stigmatizing patient education, and (8) missed opportunities for addressing reproductive health concerns in mental health contexts. Pregnancy-associated deaths related to active perinatal mental health conditions can be reduced. Mental healthcare clinicians, clinical teams, and healthcare systems have opportunities to improve care for individuals with perinatal mental health conditions.

The association between area-level factors and mortality in severe mental illnesses: A systematic review.

BACKGROUND: Premature mortality is a well-documented adverse outcome for people living with severe mental illnesses (SMI). Emerging evidence suggests that area-level factors play a role that are experienced disproportionately by this population. This review assesses the potential association between area-level factors and mortality in people with SMI. METHOD: We searched Medline, EMBASE, PsychINFO, Social Policy and Practice, Web of Science and OpenGrey databases. Literature searches were conducted in May 2020 and updated in June 2023. Reference lists were hand-searched and authors of included studies contacted to identify additional studies and minimise publication biases. Narrative synthesis was used to appraise the included studies. The review protocol was registered on PROSPERO (CRD42019155447). RESULTS: Our searches identified 7 studies (8 papers), which were included in the review, and indicated evidence of an association between deprivation and mortality. One study suggested an association between mortality in SMI and urbanicity in low to middle income settings which was not observed in studies from high income settings. One study suggested a protective association of area-level ethnic density with mortality within urbanised settings. CONCLUSION: Consistent associations were reported between residence in areas of higher deprivation and increased risk of mortality in SMI. Two studies suggested an association between area-level ethnic density and urbanicity and mortality in SMI. Most studies were conducted across high income countries and therefore future research could benefit from similar investigations being conducted in low- and middle-income countries. These methods would inform health and social policies, including interventions to reduce premature mortality in SMI.

What About Us? Experiences of Relatives Regarding Physician-Assisted Death for Patients Suffering from Mental Illness: A Qualitative Study.

Physician-assisted death (PAD) for patients suffering from mental illness is legally permitted in the Netherlands. Although patients' relatives are not entrusted with a legal role, former research revealed that physicians take into account the patient's social context and their well-being, in deciding whether or not to grant the request. However, these studies focussed on relatives' experiences in the context of PAD concerning patients with somatic illness. To date, nothing is known on their experiences in the context of PAD concerning the mentally ill. We studied the experiences of relatives with regard to a PAD request by patients suffering from mental illness. The data for this study were collected through 12 interviews with relatives of patients who have or had a PAD request because of a mental illness. We show that relatives are ambivalent regarding the patient's request for PAD and the following trajectory. Their ambivalence is characterised by their understanding of the wish to die and at the same time hoping that the patient would make another choice. Respondents' experiences regarding the process of the PAD request varied, from positive ('intimate') to negative ('extremely hard'). Some indicated that they wished to be more involved as they believe the road towards PAD should be a joint trajectory. To leave them out during such an important event is not only painful, but also harmful to the relative as it could potentially complicate their grieving process. Professional support during or after the PAD process was wanted by some, but not by all.

Increased short-term mortality among patients presenting with altered mental status to the emergency department: A cohort study.

OBJECTIVES: To evaluate the short-term mortality of adult patients presenting to the emergency department (ED) with altered mental status (AMS) as compared to other common chief complaints. METHODS: Observational cohort study of adult patients (age ≥ 40) who presented to an academic ED over a 1-year period with five pre-specified complaints at ED triage: AMS, generalized weakness, chest pain, abdominal pain, and headache. Primary outcomes included 7 and 30-day mortality. Hazard ratios (HR) were calculated with 95% confidence intervals (CI) using Cox proportional hazards models adjusted for age, acuity level, and comorbidities. RESULTS: A total of 9850 ED visits were included for analysis from which 101 (1.0%) and 295 (3.0%) died within 7 and 30 days, respectively. Among 683 AMS visits, the 7-day mortality rate was 3.2%. Mortality was lower for all other chief complaints, including generalized weakness (17/1170, 1.5%), abdominal pain (32/3609, 0.9%), chest pain (26/3548, 0.7%), and headache (4/840, 0.5%). After adjusting for key confounders, patients presenting with AMS had a significantly higher risk of death within 7 days of ED arrival than patients presenting with chest pain (HR 3.72, 95% CI 2.05 to 6.76, p < .001). Similarly, we found that patients presenting with AMS had a significantly higher risk of dying within 30 days compared to patients with chest pain (HR 3.65, 95% CI 2.49 to 5.37, p < .001), and headache (HR 2.09, 95% CI 1.09 to 4.01, p = .026). Differences were not statistically significant for comparisons with abdominal pain and generalized weakness, but confidence intervals were wide. CONCLUSION: Patients presenting with AMS have worse short-term prognosis than patients presenting to the ED with chest pain or headache. AMS may indicate an underlying brain dysfunction (delirium), which is associated with adverse outcomes and increased mortality.

Mortalidade em transtornos mentais no estudo UK Biobank / Mortality in mental disorders in the UK Biobank study

Introdução - Vasta literatura tem associado transtornos mentais a uma mortalidade aumentada. Porém, poucos estudos sobre o tema identificaram transtornos mentais através de questionários validados. Além disso, pouco se sabe sobre a contribuição de fatores de risco modificáveis para explicar o excesso de mortalidade associado a transtornos mentais. Objetivo - Utilizar dados do UK Biobank, um grande estudo prospectivo que recrutou meio milhão de participantes de meia idade e idosos entre 2006 e 2010, para investigar: (I) a mortalidade relativa e as causas de morte associadas a uma ampla gama de transtornos mentais; (II) padrões de combinações de transtornos mentais e a mortalidade relativa associada a essas combinações; e (III) a contribuição de fatores de risco modificáveis para explicar o excesso de mortalidade associado à depressão. Transtornos mentais foram identificados por variados métodos, incluindo um Questionário de Saúde Mental completado por cerca de 160.000 participantes, diagnósticos registrados durante internações hospitalares obtidos via linkage e diagnósticos autorrelatados. Métodos - Foram obtidas estimativas de mortalidade relativa por todas as causas associadas a diferentes transtornos mentais e suas combinações com modelos de regressão de Cox ajustados por idade (ou idade e sexo). Padrões de combinações de transtornos mentais foram explorados através de mineração de regras de associação. Um método baseado em modelos de regressão de Cox foi utilizado para estimar a porcentagem do excesso de mortalidade associada à depressão explicada por fatores de risco modificáveis. Resultados - A maioria dos transtornos mentais e combinações de transtornos mentais se associaram com maior mortalidade, independentemente do método de identificação. Cerca de 70% da mortalidade em excesso associada à depressão pôde ser explicada por fatores de risco modificáveis. Conclusões - Em uma grande amostra de indivíduos de meia idade e idosos no Reino Unido, transtornos mentais e suas combinações estiveram consistentemente associados a uma maior mortalidade. Em depressão, essa associação parece ser explicada em grande parte pela presença de fatores de risco modificáveis.

Introduction - Extensive literature has associated mental disorders with increased mortality. However, few studies on this topic have identified mental disorders through validated questionnaires. In addition, little is known about the contribution of modifiable risk factors to explain the excess mortality associated with mental disorders. Objective - To use data from the UK Biobank, a large prospective study which recruited half a million middle-aged and elderly participants between 2006 and 2010, to investigate: (I) the relative mortality and causes of death associated with a wide range of mental disorders; (II) patterns of combinations of mental disorders and the relative mortality associated with these combinations; and (III) the contribution of modifiable risk factors to explain the excess mortality associated with depression. Mental disorders were identified by various methods, including a Mental Health Questionnaire completed by approximately 160,000 participants, diagnoses from hospital inpatient records obtained via linkage, and self-reported diagnoses. Methods - The relative all-cause mortality associated with different mental disorders and their combinations was estimated using Cox regression models adjusted for age (or age and sex). Association rule mining was used to explore patterns of combinations of mental disorders. A method based on Cox regression models was used to estimate the percentage of excess mortality associated with depression explained by modifiable risk factors. Results The majority of mental disorders and combinations of mental disorders were associated with higher mortality, regardless of the identification method. Approximately 70% of the excess mortality associated with depression could be explained by modifiable risk factors. Conclusions - In a large sample of middle-aged and elderly individuals in the UK, mental disorders and their combinations were consistently associated with higher mortality. In depression, this association seems to be largely explained by the presence of modifiable risk factors.

Factors associated with psychiatric disorders and treatment seeking behaviour among older adults in India.

Since untreated or undertreated late-life mental disorders is associated with grave consequences including poor quality of life and increased mortality rates, this study investigates the associated factors of psychiatric disorders and its treatment seeking among older adults in India. Data for this study were derived from the Longitudinal Ageing Study in India (LASI) conducted during 2017-2018. The effective sample size was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were used to present the preliminary results. Chi-square test was used to find the significance level for bivariate association. Additionally, the Heckprobit selection model was employed to fulfil the objectives. It was revealed that about 2.8% of older adults had psychiatric disorder and of those who were suffering from psychiatric disorder, 41.3% (out of 2.8%) sought medical treatment. It was found that older adults who ever worked but currently not working, who had low level of life satisfaction, had poor self-rated health, had difficulty in activities of daily living (ADL) and instrumental ADL and had symptoms of psychological distress had higher probability of suffering from psychiatric disorder in reference to their counterparts. Older adults from oldest-old age group, who were females, from poorest wealth quintile, from Scheduled Tribe and from eastern region had lower probability of seeking treatment for psychiatric disorder in reference to their counterparts. The findings of the present study urge that greater attention be devoted at detecting and preventing late-life psychiatric disorder particularly among those who are at greater risk vis., male gender, working status as "ever worked but currently not working", having low life satisfaction, poor SRH, ADL and IADL difficulties, higher psychological distress, belonging to higher wealth quintile and rural place of residence.

Analysis of COVID-19 Infection and Mortality Among Patients With Psychiatric Disorders, 2020.

Importance: People with major psychiatric disorders are more likely to have comorbidities associated with worse outcomes of COVID-19. This fact alone could determine greater vulnerability of people with major psychiatric disorders to COVID-19. Objective: To assess the odds of testing positive for and mortality from COVID-19 among and between patients with schizophrenia, mood disorders, anxiety disorders and a reference group in a large national database. Design, Setting, and Participants: This cross-sectional study used an electronic health record data set aggregated from many national sources in the United States and licensed from Optum with current and historical data on patients tested for COVID-19 in 2020. Three psychiatric cohorts (patients with schizophrenia, mood disorders, or anxiety disorders) were compared with a reference group with no major psychiatric conditions. Statistical analysis was performed from March to April 2021. Exposure: The exposures observed include lab-confirmed positivity for COVID-19 and mortality. Main Outcomes and Measures: The odds of testing positive for COVID-19 in 2020 and the odds of death from COVID-19 were measured. Results: The population studied included 2 535 098 unique persons, 3350 with schizophrenia, 26 610 with mood disorders, and 18 550 with anxiety disorders. The mean (SD) age was 44 (23) years; 233 519 were non-Hispanic African American, 1 583 440 were non-Hispanic Caucasian; and 1 580 703 (62%) were female. The schizophrenia cohort (positivity rate: 9.86%; adjusted OR, 0.90 [95% CI, 0.84-0.97]) and the mood disorder cohort (positivity rate: 9.86%; adjusted OR, 0.93 [95% CI, 0.87-0.99]) had a significantly lower rate of positivity than the anxiety disorder cohort (positivity rate: 11.17%; adjusted OR, 1.05 [95% CI, 0.98-1.12) which was closer to the reference group (11.91%). After fully adjusting for demographic factors and comorbid conditions, patients with schizophrenia were nearly 4 times more likely to die from the disease than the reference group (OR, 3.74; 95% CI, 2.66-5.24). The mood disorders COVID-19 cohort had a 2.76 times greater odds of mortality than the reference group (OR, 2.76; 95% CI, 2.00-3.81), and the anxiety disorders cohort had a 2.39 times greater odds of mortality than the reference group (OR, 2.39; 95% CI, 1.68-3.27). Conclusions and Relevance: By examining a large database while controlling for multiple confounding factors such as age, race and ethnicity, and comorbid medical conditions, the present study found that patients with schizophrenia had much increased odds of mortality by COVID-19.

Altered mental status predicts length of stay but not death in a community-based cohort of hospitalized COVID-19 patients.

INTRODUCTION: Altered Mental Status (AMS) is a common neurological complication in patients hospitalized with the diagnosis of COVID-19 (Umapathi et al., 2020; Liotta et al., 2020). Studies show that AMS is associated with death and prolonged hospital stay. In addition to respiratory insufficiency, COVID-19 causes multi-organ failure and multiple metabolic derangements, which can cause AMS, and the multi-system involvement could account for the prolonged hospital stay and increased mortality. In this study, we built on our previous publication (Chachkhiani et al., 2020) using a new, larger cohort to investigate whether we could reproduce our previous findings while addressing some of the prior study's limitations. Most notably, we sought to determine whether AMS still predicted prolonged hospital stay and increased mortality after controlling for systemic complications such as sepsis, liver failure, kidney failure, and electrolyte abnormalities. OBJECTIVES: The primary purpose was to document the frequency of AMS in patients with COVID-19 at the time of presentation to the emergency room. Secondary aims were to determine: 1) if AMS at presentation was associated with worse outcomes as measured by prolonged hospitalization and death; and 2) if AMS remained a predictor of worse outcome after adjusting for concomitant organ failure and metabolic derangements. RESULTS: Out of 367 patients, 95 (26%) had AMS as a main or one of the presenting symptoms. Our sample has a higher representation of African Americans (53%) than the US average and a high frequency of comorbidities, such as obesity (average BMI 29.1), hypertension (53%), and diabetes (30%). Similar to our previous report, AMS was the most frequent neurological chief complaint. At their admission, out of 95 patients with AMS, 83 (88%) had organ failure or one of the systemic problems that could have caused AMS. However, a similar proportion (86%) of patients without AMS had one or more of these same problems. Age, race, and ethnicity were the main demographic predictors. African Americans had shorter hospital stay [HR1.3(1.0,1.7),p = 0.02] than Caucasians. Hispanics also had shorter hospital stay than non-Hispanics [HR1.6(1.2,2.1), p = 0.001]. Hypoxia, liver failure, hypernatremia, and kidney failure were also predictors of prolonged hospital stay. In the multivariate model, hypoxia, liver failure, and acute kidney injury were the remaining predictors of longer hospital stay, as well as people with AMS at baseline [HR0.7(0.6,0.9), p < 0.02] after adjusting for the demographic characteristics and clinical predictors. AMS at baseline predicted death, but not after adjusting for demographics and clinical variables in the multivariate model. Hypoxia and hyperglycemia at baseline were the strongest predictors of death. CONCLUSION: Altered mental status is an independent predictor of prolonged hospital stay, but not death. Further studies are needed to evaluate the causes of AMS in patients with COVID-19.

Mortality in association with antipsychotic medication use and clinical outcomes among geriatric psychiatry outpatients with COVID-19.

OBJECTIVES: Older adults are particularly vulnerable to the negative consequences of antipsychotic exposure and are disproportionally affected by higher mortality from coronavirus disease 2019 (COVID-19). Our goal was to determine whether concurrent antipsychotic medication use was associated with increased COVID-19 mortality in older patients with preexisting behavioral health problems. We also report on findings from post-COVID follow-ups. DESIGN: Retrospective observational study. PARTICIPANTS: Outpatients at a geriatric psychiatric clinic in New York City. MEASUREMENTS: Demographic and clinical data including medication, diagnosis and Clinical Global Impression Severity (CGI-S) scales on outpatients who had COVID-19 between February 28th and October 1st 2020 were extracted from the electronic health records (EHR) from the hospital. RESULTS: A total of 56 patients were diagnosed with COVID-19 (mean age 76 years; median age 75 years) and 13 (23.2%) died. We found an increased mortality risk for patients who were prescribed at least one antipsychotic medication at the time of COVID-19 infection (Fisher's exact test P = 0.009, OR = 11.1, 95% confidence interval: 1.4-96.0). This result remains significant after adjusting for age, gender, housing context and dementia (Logistic regression P = 0.035, Beta = 2.4). Furthermore, we found that most patients who survived COVID-19 (88.4%) recovered to pre-COVID baseline in terms of psychiatric symptoms. Comparison of pre- and post-COVID assessments of CGI-S for 33 patients who recovered from COVID-19 were not significantly different. CONCLUSION: We observed a higher COVID-19 mortality associated with concurrent antipsychotics use in older patients receiving behavioral health services. The majority of patients in our geriatric clinic who recovered from COVID-19 appeared to return to their pre-COVID psychiatric function. More precise estimates of the risk associated with antipsychotic treatment in older patients with COVID-19 and other underlying factors will come from larger datasets and meta-analyses.

Association of Mental Health Disorders and Aortic Dissection.

INTRODUCTION: Mental health disorders (MHD), including substance abuse, have been associated with aortic dissection (AD). Aneurysmal degeneration in the residual untreated aorta after both open and endovascular treatment is not uncommon in AD. Thus, diligent long-term follow-up is necessary and MHD may play a role in treatment plan and surveillance. The impact of MHD on management, outcomes and follow-up after AD treatment is unknown and here we sought to evaluate these associations. METHODS: A retrospective review was performed on all patients diagnosed with Stanford Type A and B dissections from 2008 to 2018 at a tertiary referral center. MHD was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Patient demographics, procedural characteristics, and outcomes were analyzed. RESULTS: A total of 649 non-traumatic aortic dissections were identified in the study timeframe. The cohort consisted of 51% Type A (n = 334) dissection and 49% Type B (n = 315) dissection. Mental health disorders were present in 49.3% of the cohort. Notably, the timing of MHD diagnosis relative to development of AD is unknown in the majority of patients. Within the Type A population, a MHD was present in 50.6% (N = 162) of patients, of which the most common indication for MHD was the presence of antidepressant or antipsychotic medication (28.6%). In patients with Type A dissections, the presence of a MHD did not significantly affect the rate of index hospitalization intervention (68%) or long-term mortality (12.5% in patients with a MHD). Within the Type B population, a MHD was present in 49.4% (n = 158) of patients, of which the most common indication for MHD was the presence of antidepressant or antipsychotic medication (30.5%). In patients with Type B dissections, the presence of a MHD did not significantly affect the rate of index hospitalization intervention (50.3% in patients with a MHD) or long-term mortality (10.1% in patients with a MHD). The overall participation in follow-up care was not significantly decreased based on the presence of a MHD compared to those without a MHD (1.66 ± 2.16 years vs. 1.68 ± 2.20 years, P = 0.93). CONCLUSION: MHD is more prevalent in AD patients than in the general population, but demonstrating a causal relationship between MHD and development/progression of AD is challenging. Despite a high prevalence of MHD in AD patients, in-hospital mortality and follow-up compliance was similar to non-MHD patients.

Mortality from mental disorders and suicide in male professional American football and soccer players: A meta-analysis.

OBJECTIVE: To determine the risk of mortality from mental disorders and suicide in professional sports associated with repeated head impacts. METHODS: A systematic search was performed in PubMed, Web of Science, Scopus, and SPORTDiscus (since inception to June 8, 2021) to find studies comparing the incidence of mortality from mental disorders or suicide in former or active professional athletes of sports characterized by repeated head impacts vs athletes with no such exposure or the general non-athletic population. RESULTS: Seven retrospective studies of moderate-to-high quality that included data from boxers and from basketball, ice hockey, soccer, and National Football League (NFL) players, respectively (total = 27 477 athletes, 100% male) met all inclusion criteria. Former male NFL players (n = 13 217) had a lower risk of mortality from mental disorders (standard mortality rate [SMR] = 0.30; 0.12-0.77; p = 0.012) and suicide (SMR = 0.54; 0.37-0.78; p < 0.001) than the general population. This finding was also corroborated in male soccer players (n = 13,065; SMR = 0.55; 0.46-0.67; p < 0.001). Male athletes participating in sports associated with repeated head impacts (n = 18,606) had also a lower risk of all-cause, cardiovascular disease (CVD), and cancer mortality (all p < 0.01) than the general population. CONCLUSIONS: Participation of male athletes in American football or soccer at the professional level might confer a certain protective effect against mortality from mental disorders or suicide, besides its association with a lower risk of all-cause, CVD, or cancer-related mortality.

Long-term observation of mortality among inpatients evacuated from psychiatric hospitals in Fukushima prefecture following the Fukushima nuclear disaster.

The debate regarding the need for hospital evacuation and the evacuation distance remains rather chaotic. Furthermore, the relationship between hospital evacuation and the prognoses of psychiatric inpatients has not yet been investigated. We aimed to reveal the association between the long-term prognosis of psychiatric inpatients evacuated immediately following the Fukushima Daiichi Nuclear Power Plant accident and their backgrounds. In this retrospective cohort study, 777 psychiatric inpatients who were immediately evacuated from their hospitals following the accident were included for analysis. Survival time was the primary outcome. We conducted univariable and multivariable analyses to examine the associations between mortality and linear distance of evacuation and different backgrounds, including psychiatric/physical traits. Univariable analysis showed that the estimated survival time among patients was significantly associated with their evacuation distance. A multivariable analysis showed that a longer evacuation distance had a significantly lower hazard ratio (HR) and resulted in lower mortality. In contrast, older patients with physical complications of respiratory disease (International Statistical Classification of Diseases and Related Health Problems 10th revision, J00-99) and genitourinary disease (N00-99) showed a significantly higher HR and had a higher mortality than patients without these complications. To prevent death among elderly psychiatric inpatients with physical comorbidities during disasters, the evacuation destination should be determined taking into consideration the evacuees' tolerance for long-distance transportation and the availability of post-evacuation care in the destination hospitals.

COVID-19 vaccine willingness amongst patients with mental illness compared with the general population.

Patients with mental illness are at an increased risk of COVID-19 infection, morbidity, and mortality, and prioritisation of this group for COVID-19 vaccination programmes has therefore been suggested. Vaccine uptake may, however, be compromised by vaccine hesitancy amongst patients with mental illness, posing a critical public health issue. We conducted two surveys to provide weighted estimates of vaccine willingness amongst patients with mental illness and the general population of Denmark. Vaccine willingness was high in both groups, but slightly lower amongst patients with mental illness (84.8%), compared with the general population (89.5%) (p < .001). Based on these findings, vaccine hesitancy does not appear to be a major barrier for vaccine uptake amongst patients with mental illness in Denmark, but may be so in other countries with lower general vaccine willingness. Replication of the present study in other countries is strongly warranted.

Identifying the Most Important Consultation-Liaison Psychiatry Publications in 2020 Using a Novel Literature Assessment Instrument.

BACKGROUND: As the science of consultation-liaison psychiatry advances, the Academy of Consultation-Liaison Psychiatry's Guidelines and Evidence-Based Medicine Subcommittee reviews articles of interest to help academy members remain familiar with the latest in evidence-based practice. OBJECTIVE: We identify the 10 most important articles for clinical practice in consultation-liaison psychiatry from 2020 using the new Importance and Quality instrument for assessing scientific literature. METHODS: The subcommittee published annotated abstracts for 97 articles on the academy website in 2020. Reviewers then rated all articles on clinical importance to practice and quality of scholarship using the Importance and Quality instrument. We describe the 10 articles with the highest aggregate scores and analyze the reliability of Importance and Quality instrument. RESULTS: Twenty-four raters identified the top 10 scoring articles of 2020. These articles provide practical guidance on key areas of consultation-liaison psychiatry including management of COVID-19, lithium treatment for complex patients, medical risks among patients with severe mental illness, and substance use disorders in medical settings. The assessment instrument demonstrated good to excellent interrater reliability. CONCLUSION: These articles offer valuable guidance for consultation-liaison psychiatrists regardless of their practice area. Collaborative literature reviews with standardized assessments help clinicians deliver evidence-based care and foster a high standard of practice across the specialty.

California's Mental Health Services Act and Mortality Due to Suicide, Homicide, and Acute Effects of Alcohol: A Synthetic Control Application.

California's Mental Health Services Act (MHSA) substantially expanded funding of county mental health services through a state tax, and led to broad prevention efforts and intensive services for individuals experiencing serious mental disorders. We estimated the associations between MHSA and mortality due to suicide, homicide, and acute effects of alcohol. Using annual cause-specific mortality data for each US state and the District of Columbia from 1976-2015, we used a generalization of the quasi-experimental synthetic control method to predict California's mortality rate for each outcome in the absence of MHSA using a weighted combination of comparison states. We calculated the association between MHSA and each outcome as the absolute difference and percentage difference between California's observed and predicted average annual rates over the postintervention years (2007-2015). MHSA was associated with modest decreases in average annual rates of homicide (-0.81/100,000 persons, corresponding to a 13% reduction) and mortality from acute alcohol effects (-0.35/100,000 persons, corresponding to a 12% reduction). Placebo test inference suggested that the associations were unlikely to be due to chance. MHSA was not associated with suicide. Protective associations with mortality due to homicide and acute alcohol effects provide evidence for modest health benefits of MHSA at the population level.

Acute care utilisation towards the end of life and the place of death for patients with serious mental disorders: a register-based cohort study in South London.

OBJECTIVES: The aim of the study was to explore acute care utilisation towards end of life by and the place of death for patients with serious mental disorders and to demonstrate any inequalities in end-of-life care faced by this patient group. STUDY DESIGN: This is a retrospective cohort study using linked, routinely collected data. METHODS: This study used linked data extracted from mental health records, Hospital Episode Statistics and mortality data. Adult cases (≥18 years old) were included if they had a serious mental disorder and died between 2007 and 2015. Multiple imputation was used to manage missing data, and generalised linear models were used to assess multiple adjusted associations between sociodemographic and clinical explanatory variables and acute service use at the end of life and in-hospital deaths. RESULTS: A cohort of 1350 adults was analysed. More than half visited the accident and emergency (A&E) department in the last 90 days of life, and a third had a burdensome transition (multiple hospital admissions in the last 90 days of life or at least one in the last three days); the median number of days spent in the hospital was 4 (range: 0-86). Having more comorbidities was a strong correlate of more A&E visits (adjusted odds ratio [OR] = 1.03 [95% confidence interval = 1.02-1.04]), burdensome transitions (adjusted OR = 1.06 [1.04-1.08]) and days spent in the hospital (adjusted OR = 1.04 [1.03-1.05]). Having a diagnosis of schizophrenia spectrum disorder, compared with other serious mental disorder diagnoses, was associated with fewer A&E visits (adjusted OR = 0.78 [0.71-0.88]) and fewer days in the hospital (adjusted OR = 0.77 [0.66-0.89]). Younger age was associated with more A&E visits (adjusted OR = 1.28 [1.07-1.53]) and fewer days spent in the hospital (adjusted OR = 0.70 [0.52-0.95]). Hospital deaths were high (51%), and in a fully adjusted model, they were associated with having more comorbidities (adjusted OR = 1.02 [1.01-1.03]) and accessing acute care at the end of life (including more A&E visits; adjusted OR = 1.07 [1.05-1.10]), burdensome transitions (adjusted OR = 1.53 [1.37-1.71]) and days spent in the hospital (adjusted OR = 2.05 [1.70-247]). CONCLUSION: People with comorbidities are more likely to use more burdensome acute health care at the end of life and are more likely to die in the hospital. Hospital deaths could be reduced, and end-of-life care could be improved by targeting patients with comorbidities and who are accessing more acute healthcare services.