Cybulski L, Dewey M E, Hildersley R, Morgan C, Stewart R, Wuerth M, Das-Munshi J
Department of Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, SE5 8AF, United Kingdom.
Division of Insurance Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden.
Schizophr Bull. 2025 Sep 8;51(5):1367-1379. doi: 10.1093/schbul/sbae195.
The association of social and clinical indicators with employment, disability, and health outcomes among individuals with severe mental illnesses (SMI) remains unclear. Existing evidence primarily comes from smaller cohort studies limited by shorter follow-up and high attrition, or registry-based research, which lacks information on important social determinants.
We utilized a novel data linkage consisting of clinical records of individuals diagnosed with schizophrenia-spectrum or bipolar disorders from the South London and Maudsley Mental Health Trust, linked at the individual-level to the 2011 UK Census, a rich source for sociodemographic information. Using logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals to determine associations between socioeconomic and clinical indicators and economic inactivity, self-rated health, and disability outcomes.
The sample comprised 8249 people with SMI diagnoses. Economic inactivity (77.3%), disability (68.3%) and poor health (61.1%) were highly prevalent. Longer duration of illness and comorbid substance misuse were associated with economic inactivity, poorer self-rated health, and disability, with associations noted between living alone and all outcomes (aORs and 95% CI: Economic inactivity: 1.72, 1.45-2.03; disability: 1.48, 1.31-1.68; poor health: 1.32, 1.18-1.49). Relative to the White British group, Black African, South Asian, and Other Black groups were more likely to be economically inactive. Black Caribbean and other groups were less likely to report poorer self-rated health or disability.
Our findings highlight considerable disability, poorer health, and economic inactivity experienced by people with SMI. Addressing comorbid substance misuse and social isolation could play a role in improving outcomes.
严重精神疾病（SMI）患者的社会和临床指标与就业、残疾及健康结局之间的关联仍不明确。现有证据主要来自规模较小的队列研究，这些研究存在随访时间较短和失访率高的局限性，或者是基于登记处的研究，而后者缺乏重要社会决定因素的信息。
我们利用了一种新颖的数据关联方法，该方法将来自南伦敦和莫兹利精神健康信托基金的被诊断患有精神分裂症谱系或双相情感障碍的个体的临床记录，在个体层面与2011年英国人口普查数据相链接，人口普查数据是社会人口学信息的丰富来源。我们使用逻辑回归来估计调整后的优势比（aORs）和95%置信区间，以确定社会经济和临床指标与经济不活跃、自评健康及残疾结局之间的关联。
样本包括8249名被诊断患有严重精神疾病的人。经济不活跃（77.3%）、残疾（68.3%）和健康状况不佳（61.1%）的发生率很高。疾病持续时间较长和合并物质滥用与经济不活跃、自评健康状况较差及残疾相关，独居与所有结局之间均存在关联（aORs和95% CI：经济不活跃：1.72，1.45 - 2.03；残疾：1.48，1.31 - 1.68；健康状况不佳：1.32，1.18 - 1.49）。相对于英国白人组，非洲黑人、南亚人和其他黑人组经济不活跃的可能性更大。加勒比黑人及其他组报告自评健康状况较差或残疾的可能性较小。
我们的研究结果凸显了严重精神疾病患者存在的严重残疾、健康状况较差及经济不活跃情况。解决合并物质滥用和社会隔离问题可能有助于改善结局。
