Use and outcomes of mechanical ventilation for people with severe mental disorders admitted due to natural causes: A

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Gonzalo Martínez-Alés1, Teresa López-Cuadrado2, Mark Olfson3

  • 1Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.

General Hospital Psychiatry
|May 4, 2020
PubMed
Abstract

Insights

Mechanical ventilation use increased significantly more in severe mental disorder (SMD) patients than others. Despite similar mortality trends, SMD patients with circulatory diseases faced higher risks, warranting further study.

Area of Science:

  • Critical Care Medicine
  • Psychiatry
  • Public Health

Background:

  • Severe mental disorders (SMD) are associated with complex health needs.
  • Invasive mechanical ventilation (MV) is a critical intervention for respiratory failure.
  • Understanding temporal trends and outcomes of MV in SMD patients is crucial for optimizing care.

Purpose of the Study:

  • To analyze temporal trends in the incidence of invasive mechanical ventilation (MV) among patients with severe mental disorders (SMD) admitted for natural causes.
  • To compare the in-hospital mortality and clinical characteristics of SMD patients undergoing MV with those without SMD.
  • To investigate specific mortality risks, particularly for circulatory diseases, in SMD patients requiring MV.

Main Methods:

  • Retrospective analysis of 224,507 hospitalizations in Spain (2000-2015) for patients aged 15-69 requiring MV.
  • Exclusion of poisonings and injuries to focus on natural causes.
  • Comparison of demographic and clinical data, MV incidence, and in-hospital mortality between SMD and non-SMD groups.

Main Results:

  • SMD patients undergoing MV were younger and had fewer comorbidities but showed a higher mortality risk (OR=1.39) for circulatory diseases.
  • The incidence of MV use quadrupled in the SMD group compared to the non-SMD group (AAPC 6.9% vs. 1.5%).
  • Overall in-hospital mortality declined similarly in both groups, yet circulatory-specific mortality remained elevated in SMD patients by 2015 (44% vs. 38%).

Conclusions:

  • Invasive mechanical ventilation use increased disproportionately among severe mental disorder patients for natural causes.
  • While overall mortality trends were comparable, elevated circulatory-specific mortality risk in SMD patients requires further investigation.
  • These findings highlight disparities in critical care outcomes for individuals with severe mental disorders.
Keywords:
Artificial respirationBipolar disorderCritical careDepressive disorderMechanical ventilatorsSchizophreniaSevere mental disorders

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