Doessel Darrel P, Williams Ruth Fg, Whiteford Harvey
Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt, Australia.
Queensland Centre for Mental Health Research, School of Population Health, The University of Queensland, Australia.
Aust New Zealand Health Policy. 2010 Jan 7;7:3. doi: 10.1186/1743-8462-7-3.
This study determines the trend in mental health-related mortality (defined here as the aggregation of suicide and deaths coded as "mental/behavioural disorders"), and its relative numerical importance, and to argue that this has importance to policy-makers. Its results will have policy relevance because policy-makers have been predominantly concerned with cost-containment, but a re-appraisal of this issue is occurring, and the trade-off between health expenditures and valuable gains in longevity is being emphasised now. This study examines longevity gains from mental health-related interventions, or their absence, at the population level. The study sums mortality data for suicide and mental/behavioural disorders across the relevant ICD codes through time in Australia for the period 1916-2004. There are two measures applied to the mortality rates: the conventional age-standardised headcount; and the age-standardised Potential Years of Life Lost (PYLL), a measure of premature mortality. Mortality rates formed from these data are analysed via comparisons with mortality rates for All Causes, and with circulatory diseases, cancer and motor vehicle accidents, measured by both methods.
This study finds the temporal trend in mental health-related mortality rates (which reflects the longevity of people with mental illness) has worsened through time. There are no gains. This trend contrasts with the (known) gains in longevity from All Causes, and the gains from decreases achieved in previously rising mortality rates from circulatory diseases and motor vehicle accidents. Also, PYLL calculation shows mental health-related mortality is a proportionately greater cause of death compared with applying headcount metrics.
There are several factors that could reverse this trend. First, improved access to interventions or therapies for mental disorders could decrease the mortality analysed here. Second, it is important also that new efficacious therapies for various mental disorders be developed. Furthermore, it is also important that suicide prevention strategies be implemented, particularly for at-risk groups. To bring the mental health sector into parity with many other parts of the health system will require knowledge of the causative factors that underlie mental disorders, which can, in turn, lead to efficacious therapies. As in any case of a knowledge deficit, what is needed are resources to address that knowledge gap. Conceiving the problem in this way, ie as a knowledge gap, indicates the crucial role of research and development activity. This term implies a concern, not simply with basic research, but also with applied research. It is commonplace in other sectors of the economy to emphasise the trichotomy of invention, innovation and diffusion of new products and processes. This three-fold conception is also relevant to addressing the knowledge gap in the mental health sector.
本研究确定了与心理健康相关的死亡率（此处定义为自杀和编码为“精神/行为障碍”的死亡人数总和）的趋势及其相对数值重要性，并论证其对政策制定者具有重要意义。其结果将具有政策相关性，因为政策制定者主要关注成本控制，但目前正在对这一问题进行重新评估，并且现在正在强调卫生支出与寿命延长方面的宝贵收益之间的权衡。本研究在人群层面考察了与心理健康相关的干预措施（或缺乏此类干预措施）对寿命延长的影响。该研究汇总了澳大利亚1916年至2004年期间相关国际疾病分类代码下自杀和精神/行为障碍的死亡率数据。对死亡率应用了两种衡量方法：传统的年龄标准化人数；以及年龄标准化的潜在寿命损失年数（PYLL），这是一种衡量过早死亡的指标。通过与所有原因的死亡率以及循环系统疾病、癌症和机动车事故的死亡率进行比较（均采用这两种方法衡量），对这些数据形成的死亡率进行分析。
本研究发现，与心理健康相关的死亡率的时间趋势（反映了精神疾病患者的寿命）随时间推移而恶化。没有收益。这一趋势与所有原因导致的寿命延长（已知情况）以及循环系统疾病和机动车事故死亡率此前上升趋势的下降所带来的收益形成对比。此外，PYLL计算表明，与采用人数指标相比，与心理健康相关的死亡在死亡原因中所占比例更大。
有几个因素可能扭转这一趋势。首先，改善精神障碍干预措施或治疗方法的可及性可以降低此处分析的死亡率。其次，开发针对各种精神障碍的新有效疗法也很重要。此外，实施预防自杀策略也很重要，特别是针对高危人群。要使心理健康部门与卫生系统的许多其他部门处于同等地位，需要了解精神障碍的潜在致病因素，这反过来又可以带来有效的治疗方法。如同在任何知识不足的情况下一样，需要资源来填补这一知识空白。以这种方式将问题视为知识空白，表明了研发活动的关键作用。这个术语意味着不仅关注基础研究，也关注应用研究。在经济的其他部门，强调新产品和新工艺的发明、创新和传播三分法是很常见的。这种三重概念也与解决心理健康领域的知识空白相关。
