Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Hepatol Commun. 2023 Mar 30;7(4). doi: 10.1097/HC9.0000000000000129. eCollection 2023 Apr 1.
Mental health diagnoses are common and known to impact key outcomes in patients with chronic illnesses including cirrhosis. However, the independent impact of psychiatric comorbidities on mortality in these patients and potential mitigating effects of outpatient mental health-related care has not been well characterized.
This was a retrospective cohort study of patients with cirrhosis in the Veterans Health Administration between 2008 and 2021. Adjusted Cox regression was performed to evaluate the association between mental health-related diagnoses [groups: alcohol use disorder (AUD)/substance use disorder (SUD) alone, non-AUD/SUD alone, and any mental health diagnosis (AUD/SUD or non-AUD/SUD)] and all-cause mortality. In subgroup analyses, the impact of regular outpatient mental health visits was also assessed.
We identified 115,409 patients, 81.7% of whom had any mental health diagnosis at baseline. During the study window there was a significant increase in the number of mental health clinic visits per person-year (β=0.078, 95% CI: 0.065-0.092, p < 0.001), but a decrease in AUD/SUD clinic utilization (p < 0.001). In regression models, there was a 54% increased hazard in all-cause mortality for any mental health diagnosis, 11% for non-AUD/SUD, and 44% for AUD/SUD (each p < 0.001). Regular mental health visits resulted in a 21% decreased risk in all-cause mortality for AUD/SUD diagnosis, compared with 3% and 9% for any mental health diagnosis and non-AUD/SUD diagnosis, respectively (each p < 0.001).
Mental illness is associated with an increased risk of all-cause mortality in veterans with cirrhosis. Regular outpatient mental health care may be protective against all-cause mortality, particularly among patients with AUD/SUD. Future studies should focus on relevant clinical practice changes, including implementing integrated care programs.
精神健康诊断在患有慢性疾病（包括肝硬化）的患者中很常见，已知会影响关键结局。然而，精神共病对这些患者死亡率的独立影响，以及门诊心理健康相关护理的潜在缓解作用尚未得到充分描述。
这是一项对退伍军人事务部 2008 年至 2021 年期间肝硬化患者的回顾性队列研究。采用调整后的 Cox 回归评估心理健康相关诊断（各组：酒精使用障碍/物质使用障碍单独、非酒精/物质使用障碍单独和任何精神健康诊断（酒精/物质使用障碍或非酒精/物质使用障碍）与全因死亡率之间的关联。在亚组分析中，还评估了定期门诊心理健康就诊的影响。
我们确定了 115409 名患者，其中 81.7%的患者在基线时有任何精神健康诊断。在研究期间，每人每年的心理健康诊所就诊次数显著增加（β=0.078，95%CI：0.065-0.092，p<0.001），但酒精/物质使用障碍诊所就诊次数减少（p<0.001）。在回归模型中，任何精神健康诊断的全因死亡率危险比增加 54%，非酒精/物质使用障碍的增加 11%，酒精/物质使用障碍的增加 44%（均 p<0.001）。与任何精神健康诊断和非酒精/物质使用障碍诊断相比，定期心理健康就诊使酒精/物质使用障碍诊断的全因死亡率降低 21%（均 p<0.001）。
精神疾病与肝硬化退伍军人的全因死亡率增加相关。定期门诊心理健康护理可能对全因死亡率有保护作用，特别是在患有酒精/物质使用障碍的患者中。未来的研究应侧重于相关的临床实践变化，包括实施综合护理计划。
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