Journal Article

Functional Status and All-Cause Mortality in Serious Mental Illness

Begum, Aysha, Chang, Chin-Kuo, Hotopf, Matthew, To, David, Fernandes, Andrea C., Hayes, Richard D., Broadbent, Matthew, Stewart, Robert

2012

Overview

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. 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. 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 <35 years) and oldest (≥ 55 years) groups. 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Activities of Daily Living / Adolescent / Adult / Aged / Aged, 80 and over / Analysis / Biology / Biomedical research / Bipolar disorder / Cardiovascular disease / Cause of Death / Demographics / Female / Health aspects / Health care / Health risks / Health services / Hospitals / Housing conditions / Humans / Impairment / Living conditions / Male / Medicine / Mental disorders / Mental Disorders - mortality / Mental Disorders - physiopathology / Mental health / Mental health care / Mental health services / Mentally ill persons / Middle Aged / Mortality / Mortality risk / Population / Psychiatry / R&D / Research & development / Risk / Schizophrenia / Socioeconomics / Suicides & suicide attempts / United Kingdom - epidemiology / Young Adult