Department of Psychiatry, University of Cambridge, Cambridge, UK; and Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic.
Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
Br J Psychiatry. 2024 Oct;225(4):436-445. doi: 10.1192/bjp.2024.110.
It remains unknown whether severe mental disorders contribute to fatally harmful effects of physical illness.
To investigate the risk of all-cause death and loss of life-years following the onset of a wide range of physical health conditions in people with severe mental disorders compared with matched counterparts who had only these physical health conditions, and to assess whether these associations can be fully explained by this patient group having more clinically recorded physical illness.
Using Czech national in-patient register data, we identified individuals with 28 physical health conditions recorded between 1999 and 2017, separately for each condition. In these people, we identified individuals who had severe mental disorders recorded before the physical health condition and exactly matched them with up to five counterparts who had no recorded prior severe mental disorders. We estimated the risk of all-cause death and lost life-years following each of the physical health conditions in people with pre-existing severe mental disorders compared with matched counterparts without severe mental disorders.
People with severe mental disorders had an elevated risk of all-cause death following the onset of 7 out of 9 broadly defined and 14 out of 19 specific physical health conditions. People with severe mental disorders lost additional life-years following the onset of 8 out 9 broadly defined and 13 out of 19 specific physical health conditions. The vast majority of results remained robust after considering the potentially confounding role of somatic multimorbidity and other clinical and sociodemographic factors.
A wide range of physical illnesses are more likely to result in all-cause death in people with pre-existing severe mental disorders. This premature mortality cannot be fully explained by having more clinically recorded physical illness, suggesting that physical disorders are more likely to be fatally harmful in this patient group.
目前尚不清楚严重精神障碍是否会对躯体疾病的致死性产生影响。
旨在调查与仅患有这些躯体疾病的匹配对照者相比，患有严重精神障碍的个体在发生广泛的躯体健康状况后全因死亡和丧失生命年的风险，并评估这些关联是否可以完全由该患者群体中更多的临床记录的躯体疾病来解释。
我们使用捷克国家住院登记数据，针对每种疾病分别识别了 1999 年至 2017 年间记录的 28 种躯体健康状况的个体。在这些人中，我们确定了在躯体健康状况之前有严重精神障碍记录的个体，并与多达 5 名没有记录到严重精神障碍的对照者相匹配。我们在患有严重精神障碍的个体中，评估了在存在预先存在的严重精神障碍的情况下，每种躯体健康状况后全因死亡的风险，与没有严重精神障碍的匹配对照者相比。
患有严重精神障碍的个体在发生 9 种广泛定义的躯体健康状况中的 7 种和 19 种特定躯体健康状况中的 14 种后，全因死亡的风险增加。患有严重精神障碍的个体在发生 9 种广泛定义的躯体健康状况中的 8 种和 19 种特定躯体健康状况中的 13 种后，丧失了额外的生命年。在考虑躯体多病和其他临床及社会人口学因素的潜在混杂作用后，绝大多数结果仍然稳健。
广泛的躯体疾病更有可能导致患有预先存在的严重精神障碍的个体发生全因死亡。这种过早死亡不能完全由更多的临床记录的躯体疾病来解释，这表明在该患者群体中，躯体疾病更有可能产生致命危害。
