Clinical risk assessment rating and all-cause mortality in secondary mental healthcare: the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) Case Register

Wu, Chia‐Yi; Chang, Chin‐Kuo; Hayes, Richard D.; Broadbent, Matthew; Hotopf, Matthew; Stewart, Robert

doi:10.1017/s0033291711002698

Cited by 30 publications

(24 citation statements)

References 25 publications

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“…On the other hand, difficulties with ADL independently predicted all-cause mortality. Together with the null findings with respect to self-harm and aggression, this is consistent with research showing that, in some cohorts, self-neglect may be a stronger predictor of mortality than more obvious risk factors such as suicide or violence [38]. It is also consistent with other research showing that ADL impairment is independently predictive of all-cause mortality among individuals with severe mental illness [24].…”

Section: Discussionsupporting

confidence: 89%

Predictors of Natural and Unnatural Mortality among Patients with Personality Disorder: Evidence from a Large UK Case Register

et al. 2014

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BackgroundPeople with personality disorder have reduced life expectancy, yet, within this population, little is known about the clinical predictors of natural and unnatural deaths. We set out to investigate this, using a large cohort of secondary mental health patients with personality disorder.MethodsWe identified patients with an ICD-10 diagnosis of personality disorder, aged ≥15 years in a large secondary mental healthcare case register. The case register was linked to national mortality tracing. Using Cox regression, we modelled the effect of a number of pre-specified clinical variables on all-cause, natural cause and unnatural cause mortality.Findings2,440 patients were identified. Eighty-five deaths (3.5% of cohort) occurred over a 5-year observation period, of which over 50% were from natural causes. All-cause mortality was associated with alcohol or drug use (adjusted Hazard Ratio [aHR] 2.3; 95% CI 1.3–4.1), physical illness (aHR 1.9; 95% CI 1.0–3.6), and functional impairment (aHR 1.9; 95% CI 1.0–3.6). Natural cause mortality was associated with mild problems of alcohol or drug use (aHR 3.4; 95% CI 1.5–7.4), and physical illness (aHR 2.4; 95% CI 1.0–5.6). Unnatural cause mortality was associated only with severe alcohol or drug use (aHR 3.1; 95% CI 1.3–7.3).InterpretationAlcohol and drug use, physical illness, and functional impairment are predictors of mortality in individuals with personality disorder. Clinicians should be aware of the existence of problems in these domains, even at mild levels, when assessing the needs of patients with personality disorder.

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Section: Discussionsupporting

confidence: 89%

Predictors of Natural and Unnatural Mortality among Patients with Personality Disorder: Evidence from a Large UK Case Register

et al. 2014

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“…[12][13][14][15] CRIS was approved as a data-set for secondary analysis by Oxfordshire Research Ethics Committee C (reference 08/H0606/71). Approval for the present study was sought and obtained from the CRIS Oversight Committee.…”

Section: Methodsmentioning

confidence: 99%

Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

et al. 2015

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Obsessive-compulsive disorder (OCD) has similar prevalence rates across the World.1,2 Within Western countries, including the UK, the prevalence of OCD has been shown to be roughly consistent across ethnic groups. For example, the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) study 3,4 examined the prevalence of mental disorders across adult British White, Black Caribbean, Indian, Pakistani, Bangladeshi and Irish ethnic groups. A similar point prevalence of OCD of around 1% was found across all ethnicities. Heyman et al 5 conducted a nationwide (UK) epidemiological survey to establish the prevalence of OCD in young people aged 5-15 (n410 000) and reported a significantly greater proportion of children from ethnic minorities among those with OCD (24%) compared with healthy controls (8.8%) and psychiatric controls (7.4%). Given the similar, if not higher, prevalence of OCD across ethnic groups in Britain [3][4][5] and elsewhere, 6 a proportional representation of different ethnic groups would be expected in mental health services. However, there is substantial evidence to indicate that patients from ethnic minorities, both children 7 and adults, 8 tend to be underrepresented in mental health services in Britain, although data specifically relating to OCD is lacking. Research conducted in North America suggests that patients with OCD from ethnic minorities are underrepresented in clinical trials. Williams et al 9 reviewed 21 randomised controlled trials of OCD conducted in North America and found that ethnic minorities were seriously underrepresented in such studies (91% of participants were White). As OCD has rarely been studied separately, there is little data relating specifically to ethnic inequalities in access to clinical services of this major, yet treatable, psychiatric disorder. The overall aim of the present study was to explore whether individuals with OCD from ethnic minorities are underrepresented in secondary and tertiary clinical services within a large mental health trust in South London, relative to the ethnic composition of the corresponding catchment area. We also aimed to determine whether ethnic inequalities, if found, are restricted to a particular age group (children v. adults) or type of clinical service (community mental health clinics v. specialist clinics) or specific to OCD (compared with depression). Method Study settingThe South London and Maudsley (SLaM) NHS Foundation Trust is Europe's largest specialist mental healthcare trust. It serves a population of approximately 1.2 million residents of four South London boroughs: Lambeth, Southwark, Lewisham and Croydon. A proportion of SLaM services are tertiary care national referral units, 10 including three national specialist clinics for OCD: the Clinic for Young People with OCD and Related Disorders (Maudsley Hospital; child and adolescent out-and in-patients), the Centre for Anxiety Disorders and Trauma (CADAT; Maudsley Hospital, adult out-patients) and the Anxiety Disorders Residential Unit (ADRU; Bethlem Royal H...

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“…Positive responses can be summed to create total scores, i.e. the higher the score the greater the suicide risk [33]. The most recent full risk assessment was considered for these analyses.…”

Section: Methodsmentioning

confidence: 99%

Suicide completion in secondary mental healthcare: a comparison study between schizophrenia spectrum disorders and all other diagnoses

et al. 2014

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BackgroundSuicide completion is a tragic outcome in secondary mental healthcare. However, the extent to which demographic and clinical characteristics, suicide method and service use-related factors vary across psychiatric diagnoses remains poorly understood, particularly regarding differences between ‘schizophrenia spectrum disorders (SSD)’ and ‘all other diagnoses’, which may have implications for suicide prevention in high risk groups.Methods308 patients who died by suicide over 2007–2011 were identified from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register. Demographic, clinical, services use-related factors, ‘full risk assessment’ ratings and the Health of the Nation Outcome Scale (HONOS) scores were compared across psychiatric diagnoses. Specifically, differences between patients with and without SSD were investigated.ResultsPatients with SSD ended their lives at a younger age, were more frequently of Black ethnicity and had higher levels of social deprivation than other diagnoses. Also, these patients were more likely to have HONOS and ‘risk assessment’ completed. However, patients who had no SSD scored significantly higher on ‘self-injury’ and ‘depression’ HONOS items and they were more likely to have the following ‘risk assessment’ items: ‘suicidal ideation’, ‘hopelessness’, ‘feeling no control of life’, ‘impulsivity’ and ‘significant loss’. Of note, ‘disengagement’ was more common in patients with SSD, although they had been seen by the staff closer to the time of suicide than in all-other diagnoses. Whilst ‘hanging’ was the most common suicide method amongst patients with non-SSD, most service users with a SSD diagnosis used ‘jumping’ (from heights or in front of a vehicle).ConclusionsSuicide completion characteristics varied between SSD and other diagnoses in patients receiving secondary mental healthcare. In particular, although clinicians tend to more frequently recognize suicide risk as a focus of concern in patients who have SSD, who are therefore more likely to have a detailed risk assessment documented; ‘known’ suicide risk factors appear to be more relevant in patients with non-SSD. Hence, the classic suicide prevention model might be of little use for SSD.

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Clinical risk assessment rating and all-cause mortality in secondary mental healthcare: the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) Case Register

Abstract: Level of clinician-appraised risk of self-neglect, but not of suicide or violence, predicted all-cause mortality among people receiving specific assessment of risk in a secondary mental health service.

Cited by 30 publications

References 25 publications

Predictors of Natural and Unnatural Mortality among Patients with Personality Disorder: Evidence from a Large UK Case Register

Predictors of Natural and Unnatural Mortality among Patients with Personality Disorder: Evidence from a Large UK Case Register

Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

Suicide completion in secondary mental healthcare: a comparison study between schizophrenia spectrum disorders and all other diagnoses

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