Premature mortality associated with severe mental illness or substance use disorder in an integrated health care system

Iturralde, Esti; Slama, Natalie; Kline-Simon, Andrea H.; Young-Wolff, Kelly C.; Mordecai, Don; Sterling, Stacy

doi:10.1016/j.genhosppsych.2020.11.002

Cited by 22 publications

(23 citation statements)

References 41 publications

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“…Ajetunmobi et al (2013) 7 Fekadu et al (2015) 15 20 and Iturralde et al (2021). 21 disorder had a seven-fold elevated risk of unnatural cause mortality, as measured by SMR, relative to the general population. 4 Although the data from the included studies did not permit us to further quantify the contribution of specific unnatural causes to YPLL, substantial evidence has indicated that suicide is the predominant cause of unnatural deaths in patients with bipolar disorder whose suicide risk is 20-to 30-fold greater than that of the general population.…”

Section: Studies Not Reported By Gendermentioning

confidence: 95%

“…Ajetunmobi et al (2013) 7 Fekadu et al (2015) 15 18 is presented. e. All of the included studies, except Weye et al (2020) 20 and Iturralde et al (2021), 21 did not report variance of YPLL estimates. The 95% CIs for YPLL estimates in Weye et al (2020) 20 were 7.26-10.34 (men) and 6.76-9.44 (women), and in Iturralde et al (2021) 21 was 21.52-21.88 for both men and women combined.…”

Section: Studies Not Reported By Gendermentioning

confidence: 99%

“…Of the 11 studies included in the meta-analysis, eight studies were rated as of good quality 3,11,13,14,[17][18][19][20] and three studies were judged to be of fair quality. 7,15,21 Failure to adjust for gender as a covariate was the most common methodological omission. Details of the quality assessment for individual studies are presented in Supplementary Table 3.…”

Section: Assessment Of Study Qualitymentioning

confidence: 99%

“…b. Variance around the pooled estimates was extrapolated from studies with reported s.e.s including Weye et al (2020) 20 and Iturralde et al (2021). 21 birth or 15 years). This approach, however, does not reflect the underlying age-at-onset distribution of the disorder.…”

Section: Womenmentioning

confidence: 99%

“…Recently, an increasing number of studies have been conducted to examine life expectancy and YPLL for people with bipolar disorder, and mostly suggested 10-15 years shorter lifespan in patients relative to the general population. 3,7,[11][12][13][14][15][16][17][18][19][20][21] Notably, thus far, there has been no study to systematically review the literature specifically for life expectancy or YPLL in people with bipolar disorder. However, a comprehensive evaluation of premature mortality quantified in terms of the magnitude of reduced lifespan associated with bipolar disorder is crucial for developing effective strategies as well as optimising resource allocation and healthcare service delivery to reduce avoidable deaths in this vulnerable population.…”

Section: Introductionmentioning

confidence: 99%

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Life expectancy and years of potential life lost in bipolar disorder: systematic review and meta-analysis

et al. 2022

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Background There is increasing research examining excess mortality in people with bipolar disorder using life expectancy and related measures, which quantify the disease impact on survival. However, there has been no meta-analysis to date summarising existing data on life expectancy in those with bipolar disorder. Aims To systematically review and quantitatively synthesise estimates of life expectancy and years of potential life lost (YPLL) in people with bipolar disorder. Method We searched Embase, Medline, PsycINFO and Web of Science databases up to 31 March 2021. We generated pooled life expectancy using random-effects models, and derived YPLL summary estimate by calculating averaged values weighted by sample size of individual studies. Subgroup analyses were conducted for gender, geographical region, study period, a given age (set-age) for lifespan estimation and causes of death. The study was registered with PROSPERO (CRD42021241705). Results Eleven and 13 studies were included in the review for life expectancy (n = 96 601) and YPLL (n = 128 989), respectively. Pooled life expectancy was 66.88 years (95% CI 64.47–69.28; I2 = 99.9%, P < 0.001), was higher in women than men (70.51 (95% CI 68.61–72.41) v. 64.59 (95% CI 61.16–68.03); z = 2.00, P = 0.003) and was lowest in Africa. Weighted average YPLL was 12.89 years (95% CI 12.72–13.07), and was greatest in Africa. More YPLL was observed when lifespan was estimated at birth than at other set-age. YPLLs attributable to natural and unnatural deaths were 5.94 years (95% CI 5.81–6.07) and 5.69 years (95% CI 5.59–5.79), respectively. Conclusions Bipolar disorder is associated with substantially shortened life expectancy. Implementation of multilevel, targeted interventions is urgently needed to reduce this mortality gap.

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Section: Studies Not Reported By Gendermentioning

confidence: 95%

Section: Studies Not Reported By Gendermentioning

confidence: 99%

Section: Assessment Of Study Qualitymentioning

confidence: 99%

Section: Womenmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Life expectancy and years of potential life lost in bipolar disorder: systematic review and meta-analysis

et al. 2022

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Patterns of Health Care Use 5 Years After an Intervention Linking Patients in Addiction Treatment With a Primary Care Practitioner

et al. 2022

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ImportanceSubstance use disorders are associated with high rates of emergency department (ED) use and challenges engaging with primary care services.ObjectiveTo examine 5-year health care engagement and utilization outcomes for participants in the LINKAGE trial, given previously reported associations of LINKAGE with improved care engagement in the short term.Design, Setting, and ParticipantsIn this post hoc analysis of a nonrandomized controlled trial, participants were assigned to the LINKAGE or usual care (UC) groups using a nonrandomized 3-month alternating off and on strategy over 30 months. Baseline through 5-year follow-up data were collected from April 2011 to October 2018. The trial was conducted at an urban outpatient addiction treatment clinic within a large health system among patients newly enrolled in addiction treatment. Data analysis was conducted from April 2021 to February 2022.InterventionThe LINKAGE intervention included 6 group-based sessions emphasizing patient agency, skill, and motivation in navigating health care services as well as a facilitated telephone or email connection with a primary care practitioner. The UC group received medical education.Main Outcomes and MeasuresSubstance use problem discussions with primary care practitioners (by patient self-report at 1-, 2-, and 5-year follow-up interview) and annual use of the electronic patient portal, primary care, and ED based on electronic health records.ResultsA total of 503 participants, with a mean (SD) age of 42 (12) years, 346 (69%) male participants and 37 (7%) African American, 34 (7%) Asian, and 101 (20%) Hispanic participants, were assigned to LINKAGE (252 participants) or UC (251 participants). Compared with UC participants, LINKAGE participants were significantly more likely to discuss substance use problems with a primary care practitioner at 1-year follow-up (risk ratio [RR], 1.30; 95% CI, 1.03-1.65; P = .03) and use the electronic patient portal at 1- and 2-year follow-up (eg, messaging clinicians at 2 years: RR, 1.24; 95% CI, 1.04-1.47; P = .02). The LINKAGE group had small, statistically significant 5-year annual increases in primary care use (RR, 1.03; 95% CI, 1.003-1.07; P = .03) and significant annual decreases in substance-related ED use (RR, 0.79; 95% CI, 0.64-0.97; P = .03), relative to UC. The LINKAGE group did not significantly differ from the UC group on other types of ED utilization.Conclusions and RelevanceIn this study, a patient activation intervention embedded in outpatient addiction treatment was associated with sustained improvements in health care engagement beyond previously reported 6-month outcomes and with long-term improvements in health care use patterns.Trial RegistrationClinicalTrials.gov Identifier: NCT01621711

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Association of Oxidative Stress–Induced Nucleic Acid Damage With Psychiatric Disorders in Adults

et al. 2022

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IMPORTANCE Nucleic acid damage from oxidative stress (NA-OXS) may be a molecular mechanism driving the severely increased morbidity and mortality from somatic causes in adults with psychiatric disorders.OBJECTIVE To systematically retrieve and analyze data on NA-OXS across the psychiatric disorder diagnostic spectrum.DATA SOURCES The PubMed, Embase, and PsycINFO databases were searched from inception to November 16, 2021. A hand search of reference lists of relevant articles was also performed.STUDY SELECTION Key study inclusion criteria in this meta-analysis were as follows: adult human study population, measurement of any marker of DNA or RNA damage from oxidative stress, and either a (1) cross-sectional design comparing patients with psychiatric disorders (any diagnosis) with a control group or (2) prospective intervention. Two authors screened the studies, and 2 senior authors read the relevant articles in full and assessed them for eligibility. DATA EXTRACTION AND SYNTHESISThe Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Two authors performed data extraction independently, and a senior coauthor was consulted in cases of disagreement. Data were synthesized with random-effects and multilevel meta-analyses. MAIN OUTCOMES AND MEASURESThe predefined hypothesis was that individuals with psychiatric disorders have increased NA-OXS levels. The main outcome was the standardized mean differences (SMDs) among patients and controls in nucleic acid oxidation markers compared across diagnostic groups. Analyses were divided into combinations of biological matrices and nucleic acids.RESULTS Eighty-two studies fulfilled the inclusion criteria, comprising 205 patient vs control group comparisons and a total of 10 151 patient and 10 532 control observations. Overall, the data showed that patients with psychiatric disorders had higher NA-OXS levels vs controls across matrices and molecules. Pooled effect sizes ranged from moderate for urinary DNA markers (SMD = 0.44 [95% CI, 0.20-0.68]; P < .001) to very large for blood cell DNA markers (SMD = 1.12 [95% CI, 0.69-1.55; P < .001). Higher NA-OXS levels were observed among patients with dementias followed by psychotic and bipolar disorders. Sensitivity analyses excluding low-quality studies did not materially alter the results. Intervention studies were few and too heterogenous for meaningful meta-analysis. CONCLUSIONS AND RELEVANCEThe results of this meta-analysis suggest that there is an association with increased NA-OXS levels in individuals across the psychiatric disorder diagnostic spectrum. NA-OXS may play a role in the somatic morbidity and mortality observed among individuals with psychiatric disorders.

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Premature mortality associated with severe mental illness or substance use disorder in an integrated health care system

Cited by 22 publications

References 41 publications

Life expectancy and years of potential life lost in bipolar disorder: systematic review and meta-analysis

Life expectancy and years of potential life lost in bipolar disorder: systematic review and meta-analysis

Patterns of Health Care Use 5 Years After an Intervention Linking Patients in Addiction Treatment With a Primary Care Practitioner

Association of Oxidative Stress–Induced Nucleic Acid Damage With Psychiatric Disorders in Adults

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