Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas
Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas
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DOI：
10.1002/wps.20384
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发表时间：
2017-02-01
期刊：
影响因子：
73.3
通讯作者：
Saxena, Shekhar
中科院分区：
文献类型：
--
作者：
Liu, Nancy H.;Daumit, Gail L.;Saxena, Shekhar
严重精神障碍（SMD）患者死亡率过高是一项重大的公共卫生挑战，需要采取行动。在这一领域，真正经过检验的干预措施的数量和范围仍然有限，缺乏有坚实证据基础的方案执行和扩大战略。此外，大多数现有的干预措施侧重于单一或数量有限的风险因素。在这里，我们提出了一个多层次的模型，突出的风险因素与SMD的人在个人，卫生系统和社会环境水平的过度死亡率。通过该模型，我们描述了一个全面的框架，这可能是有用的设计，实施和评估干预措施和方案，以减少过多的死亡率与SMD的人。这一框架包括以个人为重点、以卫生系统为重点以及以社区和政策为重点的干预措施。总结从风险的多层次模型和综合干预框架中吸取的经验教训，我们确定了临床实践，政策和研究议程的优先事项。
Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio-environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.