Severe mental illness increases mortality risk after MI
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Patients with a severe mental illness had increased risk for mortality after MI compared with those without a diagnosis of mental illness, according to results published in BMC Medicine.
“The link between severe mental illness and increased risk of occurrence of many physical diseases, including CVDs, is well established. However, less attention has been given to how severe mental illness aects outcomes from these physical diseases, including heart attacks,” Caroline Jackson, PhD, chancellor’s fellow at the University of Edinburgh, Scotland, U.K., told Healio. “We also wanted to investigate whether any dierences in outcome between those with vs. without severe mental illness had changed over time, given that it has been about 20 years since the rst study was published suggesting that such disparities existed and there has been increasing awareness of mental health disparities in physical disease.”
In a national retrospective cohort study, researchers analyzed 235,310 patients with MI, of whom 0.3% had bipolar disorder, 0.4% had schizophrenia and 2.7% had major depression, to investigate the associations between severe mental illness and MI prognosis. Utilizing logistic regression, researchers compared patients with severe mental illness and patients with no history of mental illness for 30-day, 1-year and 5-year mortality rates. The researchers also evaluated coronary revascularization and risk for further MI and vascular events.
According to the researchers, severe mental illness was overall associated with higher mortality rates as well as subsequent MI and stroke.
Jackson and colleagues found 30-day mortality was elevated in patients with schizophrenia (OR = 1.95; 95% CI, 1.64-2.3), bipolar disorder (OR = 1.53; 95% CI, 1.26-1.86) and major depression (OR = 1.31; 95% CI, 1.23-1.4). Mortality remained elevated in patients with those conditions at 1 year and 5 years.
Risk for further MI was also elevated in patients with schizophrenia (HR = 1.42; 95% CI, 1.24-1.63), bipolar disorder (HR = 1.34; 95% CI, 1.13-1.58) and major depression (HR = 1.38; 95% CI, 1.31-1.45), as was risk for further vascular events, including stroke (HR in schizophrenia = 1.46; 95% CI, 1.29-1.65; HR in bipolar disorder = 1.4; 95% CI, 1.2-1.62; HR in major depression = 1.4; 95% CI, 1.33-1.46), according to the researchers.
Conversely, revascularization rates were lower in patients with schizophrenia (HR = 0.57; 95% CI, 0.48-0.67), bipolar disorder (HR = 0.69; 95% CI, 0.56-0.85) and major depression (HR = 0.78; 95% CI, 0.73-0.83).
Researchers noted women with major depression had a greater reduction in revascularization compared with men with major depression.
“We do not fully understand the underlying reason for the observed disparities, but it is likely to be complex and multifactorial. ... It is important to rstly ensure that cardiologists are aware of the poorer prognosis experienced by patients with a severe mental illness following a heart attack and that clinical decision-making isn’t aected by the presence of a mental illness,” Jackson said in an interview. “Better integrated care across clinical specialties could help support/facilitate this, particularly between psychiatry and physical health specialties and between secondary and primary/community care.”
For more information:
Caroline Jackson, PhD, can be reached at caroline.jackson.ed.ac.uk.
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