Liu Nancy H, Daumit Gail L, Dua Tarun, Aquila Ralph, Charlson Fiona, Cuijpers Pim, Druss Benjamin, Dudek Kenn, Freeman Melvyn, Fujii Chiyo, Gaebel Wolfgang, Hegerl Ulrich, Levav Itzhak, Munk Laursen Thomas, Ma Hong, Maj Mario, Elena Medina-Mora Maria, Nordentoft Merete, Prabhakaran Dorairaj, Pratt Karen, Prince Martin, Rangaswamy Thara, Shiers David, Susser Ezra, Thornicroft Graham, Wahlbeck Kristian, Fekadu Wassie Abe, Whiteford Harvey, Saxena Shekhar
World Health Organization, Geneva, Switzerland.
University of California, Berkeley, CA, USA.
World Psychiatry. 2017 Feb;16(1):30-40. doi: 10.1002/wps.20384.
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.
严重精神障碍（SMD）患者的超额死亡率是一项需要采取行动应对的重大公共卫生挑战。该领域经过实际检验的干预措施的数量和范围仍然有限，且缺乏实施和扩大具有充分证据基础的项目的策略。此外，大多数现有的干预措施都只关注单一或其他有限数量的风险因素。在此，我们提出一个多层次模型，突出个体、卫生系统和社会环境层面上SMD患者超额死亡率的风险因素。基于该模型，我们描述了一个综合框架，该框架可能有助于设计、实施和评估旨在降低SMD患者超额死亡率的干预措施和项目。这个框架包括以个体为重点、以卫生系统为重点、社区层面和以政策为重点的干预措施。结合从风险多层次模型和综合干预框架中学到的经验教训，我们确定了临床实践、政策和研究议程的优先事项。
