The Case for Severe Mental Illness as a Disparities Category

Goldman, Matthew L.; Spaeth-Rublee, Brigitta; Pincus, Harold Alan

doi:10.1176/appi.ps.201700138

Cited by 26 publications

(17 citation statements)

References 9 publications

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“…Impaired psychosocial functioning in patients with SMI is multifactorial: adverse medication reactions (parkinsonism, obesity), and treatment setting (in-or outpatient) may influence functional recovery (9)(10)(11)(12)(13). For example, the medication side effect parkinsonism is associated with poor vocational performance (11), while some studies show positive results for community-based rehabilitation versus in-hospital treatment in patients with SMI (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Proxy WHO Disability Assessment Schedule 2.0 Is Clinically Useful for Assessing Psychosocial Functioning in Severe Mental Illness

et al. 2020

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Aims: This study explores how well the World Health Organization Disability Assessment Schedule (WHODAS 2.0) assesses problems with psychosocial functioning in patients with severe mental illness (SMI). Further, we assessed the relationships between psychosocial functioning and psychopathology, medication side effects, treatment setting, and quality of life. Methods:We performed an observational, cross-sectional study on the island of Curaçao to assess psychosocial functioning in 77 patients with SMI; they mainly had psychotic disorders. We interviewed their healthcare providers using the proxy version of the WHODAS 2.0. In addition, patients were examined for psychiatric symptoms, medication side effects (including drug-induced movement disorders), and quality of life. Associations were examined with Spearman's rank correlation (r).Results: Difficulties in psychosocial functioning were reported by patients with SMI in the WHODAS 2.0 domains of understanding and communicating [mean (M)=34.5, standard deviation (SD)=18.6), participation in society (M=25.5, SD=15.6), and getting along with people (M=24.1, SD=16.1)]. Notably, outpatients had more problems participating in society than inpatients (M=33.6, SD=18.5 versus M=23.2, SD=14.1, p=0.03). A positive correlation was observed between drug-induced parkinsonism and the WHODAS 2.0 total score (r =0.30; p=0.02), as well as with various subscales, getting around, and household activities. Conclusion:The proxy version of the WHODAS 2.0 is clinically useful for patients with severe mental illness. The highest scores on the WHODAS 2.0 were found in domains related to interactions with other people and to participation in society. Inpatient status appeared to aid participation in society; this might be due to living in the sheltered clinic Frontiers in Psychiatry | www.frontiersin.org environment and its associated daily activities. We further found that drug-induced parkinsonism was associated with a broad spectrum of psychosocial disabilities.

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Section: Introductionmentioning

confidence: 99%

Proxy WHO Disability Assessment Schedule 2.0 Is Clinically Useful for Assessing Psychosocial Functioning in Severe Mental Illness

et al. 2020

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“…Our findings are particularly noteworthy because people with SMI are increasingly identified as a health disparities population because of their high mortality rates and frequently low-quality care. 22 For example, in Medicaid populations served in the fragmented public health care system, studies consistently show that only 30% of people with SMI are screened for diabetes, [23][24][25] though our recent work in KPNC found higher screening rates (55%). 15 That increased diabetes screening is critical because of the burden of disease, with 28% of those screened having diabetes and 47% having prediabetes.…”

Section: Discussionmentioning

confidence: 72%

“…1). Specifically, young adults [18][19][20][21][22][23][24][25][26][27][28][29] had over twice the risk of having poor control compared to older adults (aRR 2.15, 95% CI 1.65-2.79, p < 0.001), Hispanics were 18% more likely to have poor control compared to whites (aRR 1.18, 95% CI 1.01-1.39, p value 0.041), and people without any primary care visits were over twice as likely to have poor control when compared to those who frequently utilized primary care services (aRR 2.72, 95% CI 2.23-3.33, p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

Comorbid Diabetes and Severe Mental Illness: Outcomes in an Integrated Health Care Delivery System

Mangurian

Schillinger

Newcomer³

et al. 2019

J GEN INTERN MED

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BACKGROUND: Diabetes prevalence is twice as high among people with severe mental illness (SMI) when compared to the general population. Despite high prevalence, care outcomes are not well understood. OBJECTIVE: To compare diabetes health outcomes received by people with and without comorbid SMI, and to understand demographic factors associated with poor diabetes control among those with SMI. DESIGN: Retrospective cohort study PARTICIPANTS: 269,243 adults with diabetes MAIN MEASURES: Primary outcomes included optimal glycemic control (A1c < 7) or poor diabetes control (A1c > 9) in 2014. Secondary outcomes included control of other cardiometabolic risk factors (hypertension, dyslipidemia, smoking) and recommended diabetes monitoring. KEY RESULTS: Among this cohort, people with SMI (N = 4,399), compared to those without SMI (N = 264,844), were more likely to have optimal glycemic control, adjusting for various covariates (adjusted relative risk (aRR) 1.25, 95% CI 1.21-1.28, p < .001) and less likely to have poor control (aRR 0.92, 95% CI 0.87-0.98, p = 0.012). Better blood pressure and lipid control was more prevalent among people with SMI when compared to those without SMI (aRR 1.03; 95% CI 1.02-1.05, p < .001; aRR 1.02; 95% CI 1.00-1.05, p = 0.044, respectively). No differences were observed in recommended A1c or LDL testing, but people with SMI were more likely to have blood pressure checked (aRR 1.02, 95% CI 1.02-1.03, p < .001) and less likely to receive retinopathy screening (aRR 0.80, 95% CI 0.71-0.91, p < .001) than those without SMI. Among people with diabetes and comorbid SMI, younger adults and Hispanics were more likely to have poor diabetes control. CONCLUSIONS: Adults with diabetes and comorbid SMI had better cardiometabolic control than people with diabetes who did not have SMI, despite lower rates of retinopathy screening. Among those with comorbid SMI, younger adults and Hispanics were more vulnerable to poor A1c control.

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“…The consistency of disparities across multiple domains also adds support to recent calls to monitor health equity not just along traditional dimensions of identity, such as race/ethnicity and gender, but also for groups who may face stigma and discrimination related to mental health conditions. 18,19 These investigations may provide a path to improving patients' health care experiences, which may in turn improve patient engagement among vulnerable patients.…”

Section: Discussionmentioning

confidence: 99%

Substance Use Disorder-Related Disparities in Patient Experiences of Primary Care

et al. 2019

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Purpose: To assess disparities in primary care experiences for patients with a substance use disorder (SUD) diagnosis. Methods: We assessed differences in Veterans Health Administration (VA) primary care patients' experiences using data from the 2014 outpatient VA Patient-Centered Medical Home Survey of Healthcare Experiences of Patients (SHEP; N =286,026). We obtained patient demographics and diagnoses from VA electronic medical record data. Results: Patients with an SUD diagnosis reported worse experiences for 8 of 12 SHEP measures, including access, provider communication, and information received ( p <0.05). Conclusion: Targeted strategies may be needed to ensure patients with SUD have favorable primary care experiences.

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The Case for Severe Mental Illness as a Disparities Category

Cited by 26 publications

References 9 publications

Proxy WHO Disability Assessment Schedule 2.0 Is Clinically Useful for Assessing Psychosocial Functioning in Severe Mental Illness

Proxy WHO Disability Assessment Schedule 2.0 Is Clinically Useful for Assessing Psychosocial Functioning in Severe Mental Illness

Comorbid Diabetes and Severe Mental Illness: Outcomes in an Integrated Health Care Delivery System

Substance Use Disorder-Related Disparities in Patient Experiences of Primary Care

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