No abstract

T he excess mortality of people with mental illness has been known for many years. In 1841, William Farr 1 reported to the Royal Statistical Society on mortality within the major asylums and licensed houses of the period in England. He estimated, using life-table methods, the mortality rate in the best facility to be about 3 times that of the general population, and mortality in other facilities to be several times higher again. The report inspired the British parliament to require regular compilation of statistics within all asylums, and established mortality rate as a measure of the quality of care provided. The high mortality was attributed to infectious diseases and the poor conditions within the asylums, such as lack of exercise and warmth, poor diet, and lack of medical care. During subsequent years, mortality in people with mental illness has been the subject of hundreds of studies. In the most comprehensive meta-analyses to date, Harris and Barraclough 2,3 identified 152 reports on all-cause mortality and 249 on suicide. They found that all mental disorders were associated with an increased risk of premature death. Overall

Psychiatric patients have not shared in the improving oral health of the general population. Management should include oral health assessment using standard checklists that can be completed by non-dental personnel. Interventions include oral hygiene and management of xerostomia.

We examined heterogeneity in BMI trajectory classes among youth and variables that may be associated with trajectory class membership. We used data from seven rounds (1997–2003) of the 1997 National Longitudinal Survey of Youth (NLSY97), a nationally representative, longitudinal survey of people born between 1980 and 1984 who were living in the United States in 1997. The analyses were based on an accelerated longitudinal design. General growth mixture modeling implemented in Mplus (version 4.1) was used to identify subtypes of youth BMI growth trajectories over time. Four distinct youth BMI trajectories were identified. Class 1 includes youth at high risk for becoming obese by young adulthood (at age 12 and 23, ∼67 and 90%, respectively, are classified as obese, and almost 72% will have had a BMI ≥ 40 at some time during this developmental period). Class 2 includes youth at moderate‐to‐high risk (at age 12 and 23, ∼55 and 68%, respectively, are classified as obese). Class 3 includes youth at low‐to‐moderate risk (i.e., at age 12 and 23, ∼8 and 27%, respectively, are classified as obese). Class 4 includes youth at low risk (few of these youth are obese at any age during this developmental period). These results highlight the importance of considering heterogeneity in BMI growth among youth and early interventions among those most at risk of the adverse health consequences of excess weight.