Functional Status and All-Cause Mortality in Serious Mental Illness
Functional Status and All-Cause Mortality in Serious Mental Illness
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DOI：
10.1371/journal.pone.0044613
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发表时间：
2012-09-06
期刊：
影响因子：
3.7
通讯作者：
Stewart, Robert
中科院分区：
文献类型：
--
作者：
Hayes, Richard D.;Chang, Chin-Kuo;Stewart, Robert
背景：严重的精神疾病会影响个人日常生活能力的许多方面。本研究的目的是确定严重精神疾病患者的环境和功能状况是否与该患者组观察到的高死亡率风险有关。方法：我们在与全国死亡率追踪相关的大型二级精神保健病例登记册中确定年龄为>= 15岁的精神分裂症、分裂情感性和双相情感障碍病例。我们使用Cox回归模拟了4年观察期（2007- 2010）的日常生活活动（ADLs）、生活条件、职业和娱乐活动以及相关因素（国家健康结局量表[HoNOS]子量表）对全因死亡率的影响。结果：观察期内共发现6880例重度精神障碍患者（242例死亡）。在控制了广泛的协变量（包括人口因素、身体健康、心理健康症状和行为、社会经济地位和心理健康服务接触）后，ADL功能障碍与全因死亡风险增加相关（调整后的风险比为1.9；95% CI为1.3-2.8;p = 0.001， ADL类别间的趋势p = 0.001）。其他三次接触没有发现关联。年龄分层表明，最年轻（15 ~ 55岁）组的adl与死亡率的相关性最强。结论：严重精神疾病诊断患者的功能障碍是死亡风险增加的标志，可能在较年轻的年龄组中作为阴性症状的标志。
Background: Serious mental illness can affect many aspects of an individual's ability to function in daily life. The aim of this investigation was to determine if the environmental and functional status of people with serious mental illness contribute to the high mortality risk observed in this patient group.Methods: We identified cases of schizophrenia, schizoaffective and bipolar disorder aged >= 15 years in a large secondary mental healthcare case register linked to national mortality tracing. We modelled the effect of activities of daily living (ADLs), living conditions, occupational and recreational activities and relationship factors (Health of the Nation Outcome Scale [HoNOS] subscales) on all-cause mortality over a 4-year observation period (2007-10) using Cox regression.Results: We identified 6,880 SMI cases (242 deaths) in the observation period. ADL impairment was associated with an increased risk of all-cause mortality (adjusted HR 1.9; 95% CI 1.3-2.8; p = 0.001, p for trend across ADL categories = 0.001) after controlling for a broad range of covariates (including demographic factors, physical health, mental health symptoms and behaviours, socio-economic status and mental health service contact). No associations were found for the other three exposures. Stratification by age indicated that ADLs were most strongly associated with mortality in the youngest (15 to = 55 years) groups.Conclusions: Functional impairment in people with serious mental illness diagnoses is a marker of increased mortality risk, possibly in younger age groups as a marker of negative symptomatology.