SOCIAL AND ECONOMIC PREDICTORS FOR THE COURSE AND PROGNOSIS OF THE SEVERE MENTAL DISORDERS- THE SEP-MD DATA LINKAGE STUDY

尽管对包括精神分裂症在内的严重精神疾病（SMI）进行了三十多年的研究，但围绕哪些因素最能预测这些疾病的病程和结局的核心挑战性问题仍然存在。与一般人群相比，重度精神障碍患者的预期寿命缩短11至17年，住院精神病患者入院的可能性增加，就业水平较低。患有重度精神障碍的少数族裔群体可能会经历更大的不平等-与患有重度精神障碍的英国白色服务用户相比，他们的强制入学率和社会排斥率更高。先前的国际研究表明，重度精神障碍的病程可能会随着环境而发生很大变化，但关于社会/环境因素是否可能改变重度精神障碍的病程的研究有限，研究结论受以下因素的影响：人们失去了随访，样本量太小，少数民族背景的人参与太少，以便得出可靠的结论。随着时间的推移跟踪SMI患者的传统研究是时间密集型的，运行成本高，并且在后勤方面具有挑战性，因为随着时间的推移跟踪人们是困难的。该项目将通过将英国人口普查数据与欧洲最大的二级精神卫生保健提供者之一的电子临床记录联系起来来解决这些重要问题。这是一种创新的数据联系，因为联合王国人口普查每十年进行一次，收集有关重要社会指标的详细信息（例如，与家庭贫困、社会孤立、移民状况、就业和长期失业有关的信息），这些信息通常在健康记录中无法获得。临床记录将来自英国主要的心理健康信托基金-南伦敦和莫兹利信托基金，该基金会为伦敦一个种族多元化、地理位置明确的城市地区提供近乎垄断的二级心理保健，覆盖范围约为120万人。通过联系，我们将创建一个19人的队列，800名患有严重精神疾病的人至少随访了8年，我们将能够评估家庭贫困、社会孤立、种族和移民状况等社会因素与诊断、处方和疾病严重程度与我们的主要结果-死亡率，住院（强制和自愿）和长期失业。我们的目标是评估人们生活的特点（例如生活在社会分散的社区或更贫困地区的影响）以及个人层面的特点（例如社会孤立，生活在贫困中，烟草使用，处方，诊断和疾病严重程度）以及这些如何与重度精神病患者的死亡风险相关联。这种联系也将使我们能够评估社会和临床因素与住院精神病患者入院（包括根据英国精神卫生法强制拘留）的关联。最后，这种联系将使我们能够评估预测长期失业的临床和社会因素，定义为失业超过一年和/或从未就业，在SMI患者样本中。我们的分析将评估所有这些关联与种族和移民身份的相互作用。通过我们的研究，我们还将考虑患有严重精神疾病的人是否处于多重弱势地位-即在一系列指标上处于弱势地位，经历极端的健康不平等。我们已经开发了研究问题与我们的非学术合作伙伴，黑繁荣和协同合作中心，并打算为调查结果直接告知公共政策，服务发展和当前的研究和话语有关的人经历的不平等生活与严重的精神疾病。

Despite more than thirty years of studies into the severe mental illnesses (SMI), including schizophrenia; central challenging questions remain around which factors most strongly predict course and outcomes of these conditions. People with SMI experience an 11 to 17 year reduction in life expectancy, an increased possibility of in-patient psychiatric admissions, and lower levels of employment, compared to the general population. Ethnic minority groups with SMI may experience even greater inequalities- with higher rates of compulsory admissions and social exclusion, compared to White British service users with SMI. Previous international work has suggested that the course of SMI may show strong variation with the environment, yet there has only been limited research conducted on whether social/ environmental factors potentially modify the course of SMI, with conclusions from studies affected by people being lost to follow up, sample sizes being too small, and with too few people of an ethnic minority background taking part, in order to enable robust conclusions. Traditional studies which follow people with SMI over time are time-intensive, expensive to run and logistically challenging to conduct, as tracing people over time is difficult. This project will address these important issues by linking UK Census data with the electronic clinical records from one of the largest secondary mental healthcare providers in Europe. This is an innovative data linkage as UK census is conducted every ten years and collects detailed information around important social indicators (for example, relating to household poverty, social isolation, migration status, employment and long-term worklessness) which are not usually available in good detail in health records. The clinical records will come from a major UK Mental Health Trust- South London & Maudsley Trust, which provides near-monopoly secondary mental healthcare to an ethnically-diverse, geographically defined urban area in London, with a catchment of approximately 1.2 million people.Through the linkage we will create a cohort of 19,800 people with severe mental illnesses followed over a minimum of eight years and we will be able to assess the association of social factors such as household poverty, social isolation, ethnicity and migration status, alongside clinical factors such as diagnosis, prescriptions and severity of illness with our main outcomes- mortality, in-patient admissions (compulsory and voluntary) and long-term worklessness. We will aim to assess the characteristics of where people live (for example the effect of living in socially fragmented neighbourhoods or more deprived areas) alongside person-level level characteristics (e.g. being socially isolated, living in poverty, tobacco use, prescriptions, diagnosis and illness severity) and how these are associated with mortality risks in people with SMI. The linkage will also enable us to assess the association of social and clinical factors with in-patient psychiatric admissions (including compulsory detentions under the UK Mental Health Act). Finally the linkage will allow us to assess clinical and social factors predicting long-term worklessness, defined as being unemployed for more than a year and/ or never holding employment, in a sample of people with SMI. Our analyses will assess the interplay of all of these associations with ethnicity and migration status. Through our study we will also consider whether people with severe mental illnesses who are multiply disadvantaged- i.e.disadvantaged across a range of indicators, experience extreme health inequalities. We have developed the research questions with our non-Academic partners, Black Thrive and the Synergi Collaborative Centre, and will intend for the findings to directly inform public policy, service development and current research and discourses regarding the inequalities experienced by people living with severe mental illnesses.