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Severe mental illness and infectious disease mortality: a systematic review and meta-analysis
Amy Ronaldson1, Isabelle Nascimento Santana2, Sophie Carlisle1
1Health Service & Population Research Department, Institute of Psychiatry, Psychology, & Neuroscience (IoPPN), King's College London, UK.
Background:
Evidence from meta-analyses suggest that people with severe mental illness (SMI) are at increased risk of death from infectious diseases compared to those without SMI. However, few reviews have focused on mortality risk from specific infection types, apart from COVID-19. The aim of this systematic review and meta-analysis was to comprehensively describe and quantify the risk of death from infections (excluding COVID-19) in people with SMI, exploring specific infection types where possible.
Methods:
PubMed, Web of Science, PsycINFO, and EMBASE were searched for relevant studies up to 18th June 2024. Studies were included if they assessed the impact of SMI (bipolar disorder, schizophrenia and schizoaffective disorders, other psychoses) on risk of mortality from any infectious disease excluding COVID-19. Random-effects meta-analyses of the risk of death from 'infectious diseases', respiratory infections, sepsis, and 'other' infections in SMI were performed. The review protocol was registered in PROSPERO (CRD42023422151).
Findings:
Twenty-nine articles were included in the review. All were observational cohort studies carried out in high income countries and 59% were judged to be of good quality. Narrative analysis indicated that having SMI was associated with increased risk of death from infectious disease (23/29 studies), with mixed results for sepsis. People with SMI were more than twice as likely to die from 'infectious diseases' than the general population (pooled relative risk (RR) = 2.71, 95% confidence interval (CI) = 2.33-3.16, N = 739,852) and more than three times more likely to die from respiratory infections (pooled RR = 3.27, 95% CI = 2.57-4.17, N = 1,353,905). Sources of heterogeneity across studies included SMI diagnosis, gender, type of control group, and infection type.
Interpretation:
People with SMI are at an increased risk of death from infection, particularly from respiratory infections like influenza and pneumonia and should be prioritised for preventative strategies including influenza and pneumococcal vaccines. More work is needed to fully understand why infection mortality risk is increased in SMI.
Funding:
MQ Mental Health Research Fellowship MQF22∖12.
Insights
People with severe mental illness (SMI) face a significantly higher risk of death from infections, especially respiratory ones. Prioritizing preventative strategies like vaccinations is crucial for this vulnerable population.
Area of Science:
- Public Health
- Epidemiology
- Psychiatry
Background:
- Severe mental illness (SMI) is linked to increased mortality from infectious diseases.
- Existing reviews often exclude specific infection types, necessitating a focused analysis.
- This study addresses the gap by examining non-COVID-19 infection mortality in SMI populations.
Purpose of the Study:
- To systematically review and quantify the mortality risk from infections in individuals with SMI.
- To explore specific types of infections contributing to increased mortality.
- To provide evidence for targeted public health interventions.
Main Methods:
- Comprehensive search of PubMed, Web of Science, PsycINFO, and EMBASE databases.
- Inclusion of observational cohort studies assessing SMI impact on infectious disease mortality (excluding COVID-19).
- Random-effects meta-analyses conducted for overall infectious diseases, respiratory infections, and sepsis.
Main Results:
- Twenty-nine high-quality observational studies were included.
- SMI is associated with a 2.71-fold increased risk of death from infectious diseases.
- Mortality risk from respiratory infections is over three times higher in people with SMI (RR=3.27).
Conclusions:
- Individuals with SMI have a substantially elevated risk of death from infections, particularly respiratory infections.
- Prioritization of preventative measures, including vaccinations (influenza, pneumococcal), is recommended for people with SMI.
- Further research is needed to elucidate the underlying mechanisms of increased infection mortality in SMI.
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