Severe Mental Illness and Type 2 Diabetes Outcomes and Complications: A Nationwide Cohort Study.

OBJECTIVE: To compare cardiovascular and mortality outcomes in people with severe mental illness (SMI) versus no mental illness in a national cohort study of people with type 2 diabetes. RESEARCH DESIGN AND METHODS: We included adults diagnosed with type 2 diabetes between 2004 and 2018 from the national Scottish diabetes register, ascertaining history of mental illness from linked psychiatric and general hospital admission records. We identified major cardiovascular disease (CVD) events, all-cause mortality, and CVD-specific mortality through record linkage. Using Cox regression, we estimated hazard ratios (HRs) for associations between SMI and outcomes, adjusting for baseline sociodemographic and clinical characteristics, including history of CVD, comorbidity, hypertension, high cholesterol, HbA1c, BMI, alcohol use disorder, and smoking. RESULTS: Among 259,875 people with type 2 diabetes, 1.0%, 0.5%, and 3.0% had schizophrenia, bipolar disorder, and major depression, respectively. After adjusting for sociodemographic characteristics, the risk of major CVD events was higher in people with schizophrenia (HR 1.22, 95% CI 1.06-1.41), bipolar disorder (HR 1.58, 95% CI 1.33-1.87), and major depression (HR 1.59, 95% CI 1.49-1.70) compared with people without a history of mental illness. SMI was also associated with an approximately twofold increased risk of CVD-specific and all-cause mortality. All associations attenuated following further adjustment for clinical characteristics. CONCLUSIONS: Among people with diabetes, people with a history of SMI have poorer cardiovascular and mortality outcomes compared with those without mental illness. While the underlying mechanisms are further investigated, effective prevention and management of cardiovascular risk factors is needed in this high-risk group.

Severe mental illness and quality of care for type 2 diabetes: A retrospective population-based cohort study.

AIMS: To compare quality of care for type 2 diabetes in people with severe mental illness (SMI) versus no mental illness. METHODS: We used routinely collected linked data to create a retrospective cohort study. We included 158,901 people diagnosed with type 2 diabetes in Scotland during 2009-2018 of whom 1701 (1%), 768 (0.5%) and 5211 (3%) had a prior hospital admission record for schizophrenia, bipolar disorder, and major depression, respectively. We compared recording of HbA1c, cholesterol, creatinine, blood pressure, urinary albumin, foot examination, retinopathy screening, body mass index and smoking during the first year after diabetes diagnosis using logistic regression and recording of HbA1c and retinopathy screening over longer follow-up using generalised linear mixed effects model, adjusting for confounding factors. RESULTS: Receipt of care during the first year was generally similar, or better, for people with each SMI than for people without any mental illness. During mean follow up of 4.8 (SD 2.5) years, depression and bipolar disorder were associated with lower odds of receiving retinopathy screening. CONCLUSIONS: Receipt of diabetes care was similar or better among people with SMI versus without SMI. However, mechanisms to support improved retinopathy screening for people with SMI are needed.

Association of severe mental illness with stroke outcomes and process-of-care quality indicators: nationwide cohort study.

BACKGROUND: Severe mental illness (SMI) is associated with increased stroke risk, but little is known about how SMI relates to stroke prognosis and receipt of acute care. AIMS: To determine the association between SMI and stroke outcomes and receipt of process-of-care quality indicators (such as timely admission to stroke unit). METHOD: We conducted a cohort study using routinely collected linked data-sets, including adults with a first hospital admission for stroke in Scotland during 1991-2014, with process-of-care quality indicator data available from 2010. We identified pre-existing schizophrenia, bipolar disorder and major depression from hospital records. We used logistic regression to evaluate 30-day, 1-year and 5-year mortality and receipt of process-of-care quality indicators by pre-existing SMI, adjusting for sociodemographic and clinical factors. We used Cox regression to evaluate further stroke and vascular events (stroke and myocardial infarction). RESULTS: Among 228 699 patients who had had a stroke, 1186 (0.5%), 859 (0.4%), 7308 (3.2%) had schizophrenia, bipolar disorder and major depression, respectively. Overall, median follow-up was 2.6 years. Compared with adults without a record of mental illness, 30-day mortality was higher for schizophrenia (adjusted odds ratio (aOR) = 1.33, 95% CI 1.16-1.52), bipolar disorder (aOR = 1.37, 95% CI 1.18-1.60) and major depression (aOR = 1.11, 95% CI 1.05-1.18). Each disorder was also associated with marked increased risk of 1-year and 5-year mortality and further stroke and vascular events. There were no clear differences in receipt of process-of-care quality indicators. CONCLUSIONS: Pre-existing SMI was associated with higher risks of mortality and further vascular events. Urgent action is needed to better understand and address the reasons for these disparities.

Epidemiological investigations identified an outbreak of Shiga toxin-producing Escherichia coli serotype O26:H11 associated with pre-packed sandwiches.

In October 2019, public health surveillance systems in Scotland identified an increase in the number of reported infections of Shiga toxin-producing Escherichia coli (STEC) O26:H11 involving bloody diarrhoea. Ultimately, across the United Kingdom (UK) 32 cases of STEC O26:H11 stx1a were identified, with the median age of 27 years and 64% were male; six cases were hospitalised. Among food exposures there was an association with consuming pre-packed sandwiches purchased at outlets belonging to a national food chain franchise (food outlet A) [odds ratio (OR) = 183.89, P < 0.001]. The common ingredient identified as a component of the majority of the sandwiches sold at food outlet A was a mixed salad of Apollo and Iceberg lettuce and spinach leaves. Microbiological testing of food and environmental samples were negative for STEC O26:H11, although STEC O36:H19 was isolated from a mixed salad sample taken from premises owned by food outlet A. Contamination of fresh produce is often due to a transient event and detection of the aetiological agent in food that has a short-shelf life is challenging. Robust, statistically significant epidemiological analysis should be sufficient evidence to direct timely and targeted on-farm investigations. A shift in focus from testing the microbiological quality of the produce to investigating the processes and practices through the supply chain and sampling the farm environment is recommended.

Severe mental illness and mortality and coronary revascularisation following a myocardial infarction: a retrospective cohort study.

BACKGROUND: Severe mental illness (SMI), comprising schizophrenia, bipolar disorder and major depression, is associated with higher myocardial infarction (MI) mortality but lower coronary revascularisation rates. Previous studies have largely focused on schizophrenia, with limited information on bipolar disorder and major depression, long-term mortality or the effects of either sociodemographic factors or year of MI. We investigated the associations between SMI and MI prognosis and how these differed by age at MI, sex and year of MI. METHODS: We conducted a national retrospective cohort study, including adults with a hospitalised MI in Scotland between 1991 and 2014. We ascertained previous history of schizophrenia, bipolar disorder and major depression from psychiatric and general hospital admission records. We used logistic regression to obtain odds ratios adjusted for sociodemographic factors for 30-day, 1-year and 5-year mortality, comparing people with each SMI to a comparison group without a prior hospital record for any mental health condition. We used Cox regression to analyse coronary revascularisation within 30 days, risk of further MI and further vascular events (MI or stroke). We investigated associations for interaction with age at MI, sex and year of MI. RESULTS: Among 235,310 people with MI, 923 (0.4%) had schizophrenia, 642 (0.3%) had bipolar disorder and 6239 (2.7%) had major depression. SMI was associated with higher 30-day, 1-year and 5-year mortality and risk of further MI and stroke. Thirty-day mortality was higher for schizophrenia (OR 1.95, 95% CI 1.64-2.30), bipolar disorder (OR 1.53, 95% CI 1.26-1.86) and major depression (OR 1.31, 95% CI 1.23-1.40). Odds ratios for 1-year and 5-year mortality were larger for all three conditions. Revascularisation rates were lower in schizophrenia (HR 0.57, 95% CI 0.48-0.67), bipolar disorder (HR 0.69, 95% CI 0.56-0.85) and major depression (HR 0.78, 95% CI 0.73-0.83). Mortality and revascularisation disparities persisted from 1991 to 2014, with absolute mortality disparities more apparent for MIs that occurred around 70 years of age, the overall mean age of MI. Women with major depression had a greater reduction in revascularisation than men with major depression. CONCLUSIONS: There are sustained SMI disparities in MI intervention and prognosis. There is an urgent need to understand and tackle the reasons for these disparities.

Use of sequence analysis for classifying individual antidepressant trajectories to monitor population mental health.

BACKGROUND: Over the past decade, antidepressant prescriptions have increased in European countries and the United States, partly due to an increase in the number of new cases of mental illness. This paper demonstrates an innovative approach to the classification of population level change in mental health status, using administrative data for a large sample of the Scottish population. We aimed to identify groups of individuals with similar patterns of change in pattern of prescribing, validate these groups by comparison with other indicators of mental illness, and characterise the population most at risk of increasing mental ill health. METHODS: National Health Service (NHS) prescription data were linked to the Scottish Longitudinal Study (SLS), a 5.3% sample of the Scottish population (N = 151,418). Antidepressant prescription status over the previous 6 months was recorded for every month for which data were available (January 2009-December 2014), and sequence dissimilarity was computed by optimal matching. Hierarchical clustering was used to create groups of participants who had similar patterns of change, with multi-level logistic regression used to understand group membership. RESULTS: Five distinct prescription pattern groups were observed, indicating: no prescriptions (76%), occasional prescriptions (10%), continuation of prior use of prescriptions (8%), a new course of prescriptions started (4%) or ceased taking prescriptions (3%). Young, white, female participants, of low social grade, residing in socially deprived neighbourhoods, living alone, being separated/divorced or out of the labour force, were more likely to be in the group that started a new course of antidepressant prescriptions. CONCLUSIONS: The use of sequence analysis for classifying individual antidepressant trajectories offers a novel approach for capturing population-level changes in mental health risk. By classifying individuals into groups based on their anti-depressant medication use we can better identify how over time, mental health is associated with individual risk factors and contextual factors at the local level and the macro political and economic scale.