Dying Too Soon: Excess Mortality in Severe Mental Illness
Dying Too Soon: Excess Mortality in Severe Mental Illness
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DOI：
10.3389/fpsyt.2019.00855
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发表时间：
2019-12-06
影响因子：
4.7
通讯作者：
Dekker, Jack J. M.
中科院分区：
文献类型：
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作者：
de Mooij, Liselotte D.;Kikkert, Martijn;Dekker, Jack J. M.
目的：我们的目的是确定6年内严重精神疾病（SMI）患者死亡率的基线预测因素，并将死亡率描述为标准化死亡率比（SMR）。我们假设心血管疾病、年龄、吸烟、更严重的精神症状和更严重的精神副作用以及酒精或药物使用是死亡率的独立危险因素。方法：在基线时对322名SMI患者进行医学检查。6年后估计SMR，并评价各种变量对生存时间的影响。结果：近11%的SMI患者在研究结束时死亡。所有SMI患者的全因SMR为4.51（95% CI 3.07-5.95）（男性为4.89，95% CI 2.97-6.80，女性为3.94，95% CI 1.78-6.10）。自然原因占超额死亡率的86%，非自然原因占14%。心血管疾病是导致死亡率过高的主要原因。多变量考克斯回归分析显示，过早死亡与较长的烟草使用史（HR：1.03，95% CI 1.02-1.03）和更严重的紊乱症状（HR：2.36，95% CI 2.21-2.52）相关。结论：在我们的研究中，SMI患者的高SMR和心血管疾病相关死亡的发生率值得关注。这项研究强调了迫切需要干预措施，以降低SMI患者的过度死亡率。
Aims: We aimed to identify baseline predictors of mortality in patients with a severe mental illness (SMI) over a 6-year period and to describe mortality rates as standardised mortality ratios (SMRs). We hypothesised that cardiovascular diseases, older age, cigarette smoking, more severe psychiatric symptoms and more severe psychotropic side effects, and alcohol or drug use were independent risk factors for mortality. Method: Medical examinations were conducted at baseline in a cohort of 322 SMI patients. SMRs were estimated after 6 years and an evaluation was made of the impact of a wide range of variables on survival time. Results: Almost 11% of the SMI patients had died at the end of the study period. All-cause SMRs were 4.51 (95% CI 3.07-5.95) for all SMI patients (4.89, 95% CI 2.97-6.80 for men, and 3.94, 95% CI 1.78-6.10 for women). Natural causes accounted for 86% of excess mortality and unnatural causes for 14%. Cardiovascular disease was a major contributor to this excess mortality. Multivariate Cox regression analyses showed that premature death was associated with a longer history of tobacco use (HR: 1.03, 95% CI 1.02-1.03) and more severe symptoms of disorganisation (HR: 2.36, 95% CI 2.21-2.52). Conclusions: The high SMR and the incidence of cardiovascular disease-related death in SMI patients in our study justify concern. This study underscores the urgent need for interventions to reduce excess mortality in patients with SMI.