University Hospital Düsseldorf; Central Institute for Ambulatory Care in Germany, Berlin, Germany; Alice Salomon University Berlin, Germany; Department of Geriatric Psychiatry, Christophsbad Hospital, Göppingen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany; Psychologische Hochschule Berlin, Berlin, Germany.
Dtsch Arztebl Int. 2019 Jun 10;116(23-24):405-411. doi: 10.3238/arztebl.2019.0405.
Mentally ill patients die on average 10 years earlier than the general population, largely due to general medical disorders. This study is the first to explore in a large German sample the prevalence, mortality, and medical comorbidity in pa- tients with severe mental illness (SMI). The patients were affected by borderline personality disorder (BPD), psychotic disorders, bipolar disorder, or severe unipolar depression.
Our database consists of billing data from all adults with statutory health insurance in Germany. Twelve-month administrative SMI prevalence and medical comorbidity were estimated using cross-sectional data from 2016 (age ≥ 18; N = 59 561 310). Two-year mortality was established longitudinally in a randomly selected subset of the billing data (most recent mortality information available for 2012 to 2014; 2012: n = 15 590 107).
Severe unipolar depression had the highest prevalence (2.01%), followed by psychotic disorders (1.25%), BPD (0.34%), and bipolar disorder (0.29%). While the prevalence of malignant neoplasms showed moderate deviations from reference values [severe unipolar depression: OR = 1.30 (95% CI = 1.29; 1.31), BPD: OR = 1.11 (1.09; 1.14), psychotic dis- orders: OR = 0.90 (0.89; 0.90), bipolar disorder: OR = 1.07 (1.06; 1.09)], other disease groups (infectious, endocrine/nutritional/ metabolic, circulatory, respiratory) were substantially elevated in all categories of SMI. Mortality rates for psychotic disorders, BPD, bipolar disorder, and severe unipolar depression were increased (OR = 2.38 [95% CI=2.32; 2.44], 2.30 [2.08; 2.54], 1.52 [1.42; 1.62], and 1.40 [1.37; 1.44], respectively), with a loss of 2.6 to 12.3 years, depending on age, sex, and SMI.
Mortality is substantially elevated in all SMI patients. The results underline the need to remove barriers to adequate general medical care, both on the patient and the provider side, to reduce excess mortality.
精神疾病患者的平均死亡年龄比普通人群早 10 年，主要是由于一般医疗疾病。这项研究首次在德国的大型样本中探讨了严重精神疾病（SMI）患者的患病率、死亡率和合并症。患者患有边缘型人格障碍（BPD）、精神病性障碍、双相情感障碍或严重单相抑郁。
我们的数据库包含德国所有参加法定健康保险的成年人的计费数据。使用 2016 年的横断面数据（年龄≥18 岁；N=59561310）估计了 12 个月的行政 SMI 患病率和合并症。在计费数据的随机子集中纵向确定了两年的死亡率（最近的死亡率信息可获得 2012 年至 2014 年；2012 年：n=15590107）。
严重单相抑郁的患病率最高（2.01%），其次是精神病性障碍（1.25%）、BPD（0.34%）和双相情感障碍（0.29%）。虽然恶性肿瘤的患病率与参考值有中度偏差[严重单相抑郁：OR=1.30（95%CI=1.29；1.31），BPD：OR=1.11（1.09；1.14），精神病性障碍：OR=0.90（0.89；0.90），双相情感障碍：OR=1.07（1.06；1.09）]，但其他疾病组（感染、内分泌/营养/代谢、循环、呼吸）在 SMI 的所有类别中均显著升高。精神病性障碍、BPD、双相情感障碍和严重单相抑郁的死亡率均升高（OR=2.38[95%CI=2.32；2.44]，2.30[2.08；2.54]，1.52[1.42；1.62]和 1.40[1.37；1.44]），死亡率取决于年龄、性别和 SMI，损失 2.6 至 12.3 年。
所有 SMI 患者的死亡率均显著升高。结果强调了需要消除患者和提供者双方获得充分一般医疗服务的障碍，以降低过高的死亡率。
