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Functional status and all-cause mortality in serious mental illness
Richard D Hayes1, Chin-Kuo Chang, Andrea C Fernandes
1Department of Health Service and Population Research, King's College London, Institute of Psychiatry, London, United Kingdom. richard.hayes@kcl.ac.uk
Plos One
|September 13, 2012
Summary
Functional impairment in serious mental illness (SMI) patients significantly increases mortality risk. Activities of daily living (ADLs) are key indicators, particularly in younger and older age groups, highlighting a need for targeted interventions.
Area of Science:
- Psychiatry
- Public Health
- Epidemiology
Background:
- Serious mental illness (SMI) significantly impacts daily functioning and is linked to elevated mortality rates.
- Understanding the contributing factors to this mortality risk is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate whether environmental and functional status of individuals with SMI contribute to their increased mortality risk.
- To identify specific factors associated with higher mortality in SMI populations.
Main Methods:
- Utilized a large secondary mental healthcare case register linked to national mortality data.
- Analyzed schizophrenia, schizoaffective, and bipolar disorder cases (aged ≥15) over a 4-year period (2007-2010).
- Employed Cox regression to model the impact of activities of daily living (ADLs), living conditions, and social factors (HoNOS subscales) on all-cause mortality.
Main Results:
- Identified 6,880 SMI cases with 242 deaths during the study period.
- ADL impairment was significantly associated with increased all-cause mortality risk (adjusted HR 1.9; p=0.001), even after controlling for numerous covariates.
- No significant associations were found for living conditions, occupational, or recreational activities.
- ADL impairment showed the strongest association with mortality in the youngest (15-<35 years) and oldest (≥55 years) age groups.
Conclusions:
- Functional impairment, specifically in ADLs, serves as a critical marker for increased mortality risk in individuals with SMI.
- This association appears particularly pronounced in younger and older age demographics.
- Findings suggest that ADL status is a significant predictor of mortality in SMI patients, warranting clinical attention.
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