Mortality in people with mental disorders in the Czech Republic: a nationwide, register-based cohort study

Krupchanka, Dzmitry; Mladá, Karolína; Winkler, Petr; Khazaal, Yasser; Albanese, Emiliano

doi:10.1016/s2468-2667(18)30077-x

Cited by 32 publications

(27 citation statements)

References 24 publications

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“…It is estimated that approximately every fifth person living in the Czech Republic is currently affected by an affective, anxiety, alcohol or substance use disorder [3]. These mental disorders have a profound effect on the individuals’ quality of life, psycho-social functioning, occurrence and management of somatic comorbidities as well as life expectancy [3, 4]. A large gap between the number of affected persons and those who receive evidence-based treatment may strongly contribute to unfavourable outcomes [5].…”

Section: Introductionmentioning

confidence: 99%

The treatment gap for mental disorders and associated factors in the Czech Republic

et al. 2019

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Objectives:To assess the extent of the treatment gap for mental disorders in the Czech Republic, determine factors associated with the utilization of mental health services and explore what influences willingness to seek mental health care.Methods:Data from the CZEch Mental health Study, a nationally representative study of community-dwelling adults in the Czech Republic were used. The Mini International Neuropsychiatric Interview assessed the presence of mental disorders. 659 participants with current affective, anxiety, alcohol use and substance use disorders were studied.Results:The treatment gap for mental disorders ranged from 61% for affective to 93% for alcohol use disorders. Mental health service use was associated with greater disability (OR 1.04; 95% CI 1.02–1.05; p < 0.001), female gender (OR 3.31; 95% CI 1.97–5.57; p < 0.001), urban residence (OR 1.84; 95% CI 1.12–3.04; p < 0.05) and a higher number of somatic diseases (OR 1.32; 95% CI 1.03–1.67; p < 0.05). Self-identification as having a mental illness was associated with greater willingness to seek a psychiatrist and a psychologist.Conclusions:The treatment gap for mental disorders is alarmingly high in the Czech Republic. Interventions to decrease it should target in particular rural areas, men and people with low self-identification as having a mental illness.

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Section: Introductionmentioning

confidence: 99%

The treatment gap for mental disorders and associated factors in the Czech Republic

et al. 2019

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“…We performed all statistical analyses in Stata 15 34 . In line with expected mortality in this population, one of the study participants died during the study follow-up, however, we considered our sample size too small to warrant the attempt to statistically model survival differences between groups using non-standard methods that adequately account for such rare events 35,36 . Instead, for simplicity, we treated the data following the death of this patient as missing.…”

Section: Statistical Analysesmentioning

confidence: 99%

Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis

Winkler

Koeser

Kondrátová

et al. 2018

The Lancet Psychiatry

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Background The absence of economic evidence hinders current reforms of hospital based mental health systems in Central and Eastern Europe. We aimed to assess the costeffectiveness of care for people with chronic psychoses in psychiatric hospitals compared to discharging patients to the community in the Czech Republic. Methods We conducted a prospective study of people with chronic psychotic disorders and evaluated the impact associated with discharge into community services as compared to not discharging people from psychiatric hospitals at baseline in the Czech Republic. We measured utilization of services, health related quality of life, met and unmet needs, and global functioning using an adapted Client Services Receipt Inventory (CSRI), EQ-5D-5L, Camberwell Assessment of Need (CAN) and General Assessment of Functioning (GAF). Adjusting for baseline differences between the two groups, we assessed differences in societal costs in Euros (€) and QALYs over a year-long follow-up which we then used to estimate the incremental cost-effectiveness ratio (ICER). We conducted multiple sensitivity analyses to assess the robustness of our results. Outcomes In our base case scenario, we included 115 patients who were either inpatient or community services users at the baseline. The two groups were very similar in terms of their observed characteristics. The annual QALY was 0.77 and 0.80 in the group discharged to the community at the baseline compared to not being discharged (difference 0.03 95% confidence interval-0.04 to 0.1), but costs were €8,503 compared to €16,425 (difference €7,922, 95% confidence interval 4,371 to 11,472) such that the ICER reached over 250,000 € per QALY. This is considerably above levels that are conventionally considered to be costeffective and the estimated probability that discharge to the community was cost-effective was very high. None of the sensitivity analyses changed these results qualitatively. Interpretation This study provides economic evidence for deinstitutionalization by showing that discharge to community care is cost-effective when compared to care in psychiatric hospitals in the Czech Republic. Thus, it adds to the human rights-and clinical-based arguments for mental health care reforms in Central and Eastern Europe.

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“…Patients with severe mental illness (SMI) tend on average to die younger than the general population 1–5 . Though most studies have focused on younger people (<65 years of age), increased mortality in patients with psychiatric disorders has recently been found to extend to older people 6 ,.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with severe mental illness (SMI) tend on average to die younger than the general population. [1][2][3][4][5] Though most studies have focused on younger people (<65 years of age), increased mortality in patients with psychiatric disorders has recently been found to extend to older people. 6,7 In addition, an increased risk of dementia has been noted in patients with depression, 8 bipolar disorder 9 and psychotic disorders.…”

Section: Introductionmentioning

confidence: 99%

Investigation of risk of dementia diagnosis and death in patients in older people's secondary care mental health services

Kershenbaum

Cardinal

Chen

et al. 2020

Int J Geriat Psychiatry

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Objectives Previous studies have shown increased rates of death and dementia in older people in specific serious mental illnesses (SMI) such as bipolar disorder or depression. We examined the rates of death and dementia in older people referred into a secondary care psychiatric service across a range of SMIs. Methods We used an anonymised dataset across 6 consecutive years with 28,340 patients aged 65 years and older from a single secondary care psychiatric trust in the United Kingdom. We identified deaths and incident dementia in patients with bipolar disorder/mania, schizophrenia, recurrent depression and anxiety disorders. We compared mortality and dementia rates between these diagnostic groups and in different treatment settings. We also examined mortality rates and dementia rates compared with general population rates. Results Patients with schizophrenia showed the highest hazard rate for death compared to other groups with SMIs (hazard ratio, 1.58; 95% confidence interval (CI), 1.18–2.1, with anxiety group the reference). Survival was reduced in patients referred to liaison psychiatry services. There were no significant differences between the SMI groups in terms of rates of dementia. However, risks of death and dementia were significantly increased compared to the general population (standardized mortality rates with 95% CI, 2.6(2.0–3.3), 3.5(2.6–4.5), 2.5(2.0–3.0) and 1.8 (1.4–2.2) and standardized dementia incidence rates with 95% CI, 2.7(1.5–4.1), 2.9(1.5–4.7), 3.8(2.6–5.2) and 4.3 (3.0–5.7) for bipolar disorder/mania, schizophrenia, recurrent depression and anxiety disorders respectively. Conclusions Older adults referred into an old age psychiatry service show higher rates of dementia and death than those reported for the general population.

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Mortality in people with mental disorders in the Czech Republic: a nationwide, register-based cohort study

Abstract: Czech Ministry of Education, Youth and Sports.

Cited by 32 publications

References 24 publications

The treatment gap for mental disorders and associated factors in the Czech Republic

The treatment gap for mental disorders and associated factors in the Czech Republic

Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis

Investigation of risk of dementia diagnosis and death in patients in older people's secondary care mental health services

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