Researchers have found higher-than-expected death rates from physical health problems for people with mental illness. Dr. Alex Mitchell of Leicester University, U.K., and colleagues in Australia examined findings from 22 studies including 825,754 patients, on outcomes after “acute coronary events” such as heart attack. All the studies were based in the U.S.
There was increased mortality in patients who had been diagnosed with severe mental illness. This group was also 14 percent less likely to receive essential coronary care procedures following their heart attack, says Dr. Mitchell. He explains that such procedures, which include revascularization, coronary artery bypass graft and angioplasty, are effective at improving outcomes.
Ten of the studies looked at care for people with schizophrenia. These found that schizophrenic patients received just half the usual rate of intervention.
Overall, there was an 11 percent higher mortality rate in the year after acute heart disease for those with psychiatric diagnoses. Full results are published in the British Journal of Psychiatry.
“People with known mental health conditions have higher background rates of cardiovascular risk factors such as smoking, inactivity, and obesity,” said Dr. Mitchell. “We already know that this is reflected in a higher rate of heart disease but what we demonstrate here is that mortality is greater even after patients come under healthcare.
“We don’t yet know the reason for these poorer outcomes but it is worrying that we also find such patients may receive less frequent life-saving interventions. Patients with significant mental health problems can be considered a vulnerable group who should be receiving at least equal and possibly enhanced care.”
He said we urgently need to know whether patients are declining treatment, or it is not being offered equally to all patients.
The authors write, “Further work is required to explore whether these factors are causally linked and whether improvements in medical care might improve survival in those with mental ill health.”
In a 2010 journal article, Dr. Mitchell writes that, among people with a severe mental illness there is a higher than average overall mortality rate and a lower life expectancy. “The presence of this medical co-morbidity adversely affects quality of life and recovery from the underlying psychiatric disorder,” he states.
Many chronic conditions go unrecognized, and many deaths are avoidable, he believes. Studies suggest that mental health professionals often miss physical conditions among their patients, and rarely undertake physical examinations.
“What has only recently become clear is that the quality of medical care provided to those with known mental health diagnoses is less than ideal,” Dr. Mitchell writes.
His team looked at eight studies on heart care for schizophrenic patients. This showed lower than expected provision of medical care in most studies. Prescribing rates were different to those for non-mentally ill patients; some drugs were underprescribed and some overprescribed.
“These deficits in medical treatment appear to exist alongside worrying elevations in mortality,” the researchers say.
Their analysis suggests that raised death rates are related to the poorer quality of care. Many of the “excess” deaths are considered preventable, and are highest in young males with coexisting alcohol or drug problems, and in patients living in poverty, those who are unemployed, and those who lack health insurance.
Possible reasons include the under-recognition of illness, inadequate treatment, poor monitoring and lack of healthcare utilization.
Surveys indicate that people with mental ill health (including schizophrenia, bipolar disorder and major depressive disorder) perceive barriers to accessing physical healthcare, and this is reflected in their behavior. For example, people with psychotic disorders are less likely to have a primary care physician.
Dr. Mitchell asks, “Assuming these disparities are robust, what can be done to improve preventive care and ultimately reduce avoidable deaths in people with mental ill health?”
Several attempts have been made to improve access to preventive healthcare such as screening. Better communication between primary care providers and specialist mental health services seems to help improve screening rates. But there is a lack of agreement on which healthcare professionals should be responsible.
What’s more, “the abilities of psychiatrists to look after physical health of patients is at best underdeveloped,” says Dr. Mitchell.
He concludes, “It is worrying that deficits in preventive care may prejudice the long-term health of those with mental ill health. Every effort should be made to deliver high-quality medical care to people with severe mental illness.”
Mitchell, A. J. and Lawrence, D. Revascularisation and mortality rates following acute coronary syndromes in people with severe mental illness: comparative meta-analysis. The British Journal of Psychiatry, Vol. 198, Jun 1, 2011.
Mitchell, A. J. and Lord, O. Do deficits in cardiac care influence high mortality rates in schizophrenia? A systematic review and pooled analysis. Journal of Psychopharmacology, Vol. 24, November 2010, pp. 69-80.