Physical Illness in People with Mental Illness - WANADA

Duty to Care Physical illness in people with mental illness

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Contents

4

Summary

7

Introduction

9

The WA Linked Database

11

Mental Health Services in WA

14

Characteristics of Consumers of Mental Health Services

18

Results

18

Death

19

Suicide

22

Infectious Diseases

25

Cancer

27

Nutritional Deficiencies

29

Parkinson’s Disease

30

Circulatory System Diseases

35

Diseases of Other Major Body Systems

38

Injury and Poisoning

40

Summary by Mental Illness

44

Conclusion

48

Glossary

3

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Death Register 270,000 deaths 1980 - 1998

Hospital Morbidity Data System 7.8 million admissions

WA Health Services Research Linked Database 1980 - 1998 8.8 million records

Mental Health Information System 240,000 patients 1966 - 1998

Cancer Registry 95,000 cancers 1982 - 1998

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Mental Health Services in WA / Characteristics of consumers )LJXUH2XWSDWLHQWSV\FKLDWULFFRQWDFWV² Contacts

300,000 250,000 200,000 150,000 100,000 50,000 0 1970

1974

1978

1982

1986

1990

1994

1998

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5,000

10,000

15,000

20,000

25,000

30,000

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15

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1984

1988

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1996

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Mentally ill WA Population

100 80 60 40 20 0 Males

Females

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19

Suicide ZHHNVDIWHUGLVFKDUJHDUHWKHSHULRGRIGUDPDWLFDOO\KLJKHVWULVNZKHQSHRSOHZLWKPHQWDOLOOQHVV PXVW PDNH WKH WUDQVLWLRQ IURP WKH KRVSLWDO VHWWLQJ WR LQGHSHQGHQW OLYLQJ  )RU PHQ WKH ULVN GHFUHDVHVJUDGXDOO\RYHUWLPHDIWHUWKHILUVWWZRZHHNV)RUZRPHQWKHUHZHUHYHU\IHZVXLFLGHV LQ WKH WKLUG DQG IRXUWK ZHHNV DIWHU GLVFKDUJH ZLWK VXLFLGH ULVN LQFUHDVLQJ DJDLQ DIWHU WKH ILUVW PRQWK7KHGHFOLQHLQVXLFLGHULVNZLWKWLPHVLQFHGLVFKDUJHZRXOGUHIOHFWUHPLVVLRQRILOOQHVVLQ VRPHSHRSOH  )LJXUH6XLFLGHUDWHVE\WLPHVLQFHGLVFKDUJH Suicide 400 rate 300

Males Females

200

100

0 0

5

10

15

20

Weeks since discharge

  )LJXUH6XLFLGHUDWHVE\SULQFLSDOSV\FKLDWULFGLDJQRVLV Alcohol/Drug Schizophrenia Affective psychosis Other psychoses Neurotic disorder

Males

Personality disorder

Females

Adjustment reaction Depressive disorder 0

50

100

150

200

250

300

350

Suicide rate

 )LJXUH  VKRZV VXLFLGH UDWHV E\ SV\FKLDWULF GLDJQRVLV  +LJKHVW UDWHV ZHUH VHHQ IRU VFKL]RSKUHQLDDIIHFWLYHSV\FKRVLVDQGGHSUHVVLYHGLVRUGHU0DOHVZHUHIRXUWLPHVPRUHOLNHO\WR FRPPLW VXLFLGH WKDQ IHPDOHV LQ OLQH ZLWK WKH JHQHUDO SRSXODWLRQ  6XLFLGH ULVN LQFUHDVHG ZLWK

20

Suicide longer inpatient stays probably because those with more severe mental illnesses are at higher risk and likely to stay longer.  )RUDOORWKHUPHQWDOFRQGLWLRQVWKHVXLFLGHULVNZDVKLJKHVWLQWKHSHULRGLPPHGLDWHO\DIWHUILUVW FRQWDFWZLWKPHQWDOKHDOWKVHUYLFHVZKLOHIRUWKRVHZLWKVFKL]RSKUHQLDWKHKLJKHUVXLFLGHULVN UHPDLQHGURXJKO\FRQVWDQWWKURXJKRXWWKHIROORZXSSHULRG  ,QWHUPVRIWKHSK\VLFDOZHOOEHLQJRISHRSOHZLWKPHQWDOLOOQHVVUHGXFWLRQLQVXLFLGHUDWHVLVD NH\JRDORIWKHQDWLRQDOPHQWDOKHDOWKSODQ6XLFLGHULVNLVUDLVHGIRUDOOPHQWDOGLVRUGHUV  7KHUHDUHPDQ\IDFWRUVZKLFKFRQWULEXWHWRWKHULVNRIVXLFLGHPDNLQJLWGLIILFXOWWRLGHQWLI\ULVN IDFWRUVDQGGHYHORSDSSURSULDWHWUHDWPHQWV3UHGLFWLQJSRVVLEOHVXLFLGHULVNLVWKHUHIRUHGLIILFXOW DVWKHYDVWPDMRULW\RISHRSOHZLWKPHQWDOLOOQHVVGRQRWFRPPLWVXLFLGH  7KHDSSURDFKQRZLVWRWUHDWSHRSOHZLWKPHQWDOLOOQHVVDWKRPHGXULQJWKHLQLWLDODFXWHSKDVHRI DQLOOQHVVDVPXFKDVSRVVLEOH(YHQWKRVHDGPLWWHGWRKRVSLWDODUHRQO\NHSWLQIRUVKRUWSHULRGV EHIRUH GLVFKDUJH WR KRPH FDUH  5HVHDUFK LQGLFDWHV WKDW FRPPXQLW\ FDUH RXWVLGH KRVSLWDOVDQG RWKHUPHQWDOKHDOWKFDUHIDFLOLWLHVPD\FRQWULEXWHWRLQFUHDVHGVXLFLGHULVN  6HYHUDOLVVXHVWRDULVHIURPWKHLQFUHDVHLQFRPPXQLW\FDUHDUH  ♦ DGHTXDWHUHVRXUFLQJRIWKHLQSDWLHQWDQGFRPPXQLW\EDVHGFRPSRQHQWVRIVHUYLFHV ♦ HIIHFWLYHFRQWLQXLW\RIFDUHEHWZHHQWKHWZR ♦ WKHGLIILFXOW\RIPRQLWRULQJWKHPRYHIURPKRVSLWDOWRFRPPXQLW\EDVHGFDUHDQG ♦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

21

Suicide / Infectious Diseases )LJXUH5HODWLYHULVNRIVXLFLGHE\\HDURIILUVWFRQWDFWZLWKPHQWDOKHDOWKVHUYLFHV 1.8 Relative risk 1.6 of suicide 1.4 1.2 1 0.8 0.6 0.4 0.2 0 1980

1984

1988

1992

1996

Year of first contact

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22

Infectious Diseases )LJXUH+,9UDWHUDWLRVSHRSOHZLWKPHQWDOLOOQHVVFRPSDUHGWRWKH:$SRSXODWLRQ Alcohol/drugs Schizophrenia Affective psychosis Other psychosis Neurotic disorder Personality disorder Adjustment reaction Total All disorders 0

2

4

6

8

10

HIV rate ratio

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9LUDO+HSDWLWLV

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23

Infectious Diseases )LJXUH9LUDOKHSDWLWLVUDWHUDWLRV Alcohol/Drug Schizophrenia Affective psychosis Other psychoses

Hepatitis A

Neurotic disorder

Hepatitis B

Personality disorder

Hepatitis C

Adjustment reaction Depressive disorder 0

2

4

6

8

10

Hepatitis rate ratio

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6H[XDOO\WUDQVPLVVLEOHGLVHDVHV 

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1

2

3

4

5

6

STDs rate ratio

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24

Infectious Diseases / Cancer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

&DQFHU

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Mentally ill

300

WA population

250 200 150 100 50 0 Incidence rate

Death rate

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

25

Cancer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lcohol/drug Schizophrenia Affective psychoses

Males Females

Other Psychoses Neurotic disorder Personality disorder Adjustment reaction Depressive disorder 0

0.5

1

1.5

2

2.5

Cancer case fatality rate ratios

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26

Nutritional Deficiencies and Deficiency Anaemias 1XWULWLRQDO'HILFLHQFLHVDQG'HILFLHQF\$QDHPLD 

)LJXUH5DWHUDWLRVE\GHILFLHQF\RUDQDHPLD Total Nutritional deficiencies Protein-calorie Thiamine & niacin B-complex components Males Females Total Deficiency anaemias Iron deficieny Pernicious anaemia 0

1

2

3

4

5

6

7

rate ratio

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Males

Day patient

Females

Hostel resident Outpatient 0

1

2

3

4

5

6

7

8

Rate ratio

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Parkinson’s Disease 3DUNLQVRQ·V'LVHDVH

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Males

Neurotic disorders

Females

Adjustment reaction Depressive disorder 0

1

2

3

4

5

6

7

8

rate ratio

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29

Circulatory System Diseases &LUFXODWRU\6\VWHP'LVHDVHV

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Mentally ill WA population

200 150 100 50 0 Heart attack

Other heart disease

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30

Circulatory System Diseases )LJXUH+HDUWGLVHDVHGHDWKUDWHE\\HDU 350 Death rate 300 250 200 150 100 50 0 1980

1982

1984

1986

1988

Males mentally ill Females

1990

1992

1994

1996

1998

Males WA population Females

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Mentally ill WA population

200 150 100 50 0 Acute MI

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Angina

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Circulatory System Diseases )LJXUH+HDUWGLVHDVHKRVSLWDOLVDWLRQDQGGHDWKUDWHVE\SULQFLSDOGLDJQRVLV Dementia Alcohol/Drugs

Hospitalisation

Schizophrenia

Death

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0.5

1

1.5

2

2.5

3

rate ratio

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32

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Schizophrenia

Females

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0.2

0.4

0.6

0.8

1

1.2

1.4

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46

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