This study was funded by the National Health and Medical Research Council. ... of the WA Linked Database was funded by the Lotteries Commission of Western.
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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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Midwives Notification and Birth Register 430,000 births 1980 - 1998
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
De-identified database for research
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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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Characteristics of Consumers of Mental Health Services $QDO\VLVRISHRSOHZLWKPHQWDOLOOQHVVRQWKH0+,6UHYHDOHGWKHIROORZLQJ ♦ ZHUHIHPDOH ♦ PDOHVWHQGHGWREH\RXQJHUWKDQIHPDOHVUHIOHFWLQJWKHGLIIHUHQWPHQWDOLOOQHVVHVLQPDOHV DQGIHPDOHV ♦ SHRSOH RI $ERULJLQDO RU 7RUUHV 6WUDLW ,VODQGHU GHVFHQW PDGH XS RI SHRSOH ZLWK PHQWDO LOOQHVV RQ WKH 0+,6 DOWKRXJK WKH\ PDNH XS RQO\ RI WKH JHQHUDO :$ SRSXODWLRQ ♦ D KLJKHU SURSRUWLRQ RI PDOHV ZHUH VLQJOH FRPSDUHG ZLWK IHPDOHV UHIOHFWLQJ WKH \RXQJHU DJHGLVWULEXWLRQRIPDOHVZLWKPHQWDOLOOQHVVRQWKH0+,6 ♦ PRUH IHPDOHV ZHUH ZLGRZHG GLYRUFHG RU VHSDUDWHG LQ SDUW GXH WR WKH ORQJHU OLIH H[SHFWDQF\RIIHPDOHVLQ:$ ♦ RYHUDOORIPDOHVDQGRIIHPDOHVZHUHQRWLQWKHODERXUIRUFH ♦ OLYHGRXWVLGHRIWKH3HUWKPHWURSROLWDQDUHDURXJKO\LQOLQHZLWKWKH:$JHQHUDO SRSXODWLRQ DQG ♦ WKHLQFLGHQFHRIPHQWDOLOOQHVVLVKLJKHUDPRQJWKHVRFLRHFRQRPLFDOO\GLVDGYDQWDJHG
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Affective psychoses
Females
Other psychoses Neurotic disorders Personality disorders Adjustment reaction Depressive disorder 0
5,000
10,000
15,000
20,000
25,000
30,000
Number of consumers
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1984
1988
1992
1996
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17
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50
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150
200
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Death rate
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Mentally ill WA Population
100 80 60 40 20 0 Males
Females
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²\HDUVDIWHUGLVFKDUJH7KHVXLFLGHUDWHZDVORZHVW GXULQJLQSDWLHQWFDUHDQGFRPSDUDEOHWRWKHVXLFLGHUDWHLQWKHJHQHUDOSRSXODWLRQ7KHILUVWWZR
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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♦ 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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,QIHFWLRXV'LVHDVHV
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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
7KHVHULRXVO\PHQWDOO\LOODUHDWJUHDWO\LQFUHDVHGULVNRI+,9LQIHFWLRQGXHWRLQWUDYHQRXVGUXJ XVH DQG KLJKULVN VH[XDO EHKDYLRXUV ,Q WKLV VWXG\ D SULPDU\ SV\FKLDWULF GLDJQRVLV KDV EHHQ DVVLJQHGWRHDFKSHUVRQ,QVRPHFDVHVWKLVLVDQDOFRKRORUGUXJXVHSUREOHPLIWKDWLVZKDW WKH\ KDYH EHHQ VSHFLILFDOO\ WUHDWHG IRU +RZHYHU GUXJ XVH LV D VLJQLILFDQW SUREOHP LQ SHRSOH ZLWKPRVWPHQWDOLOOQHVVHV
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
+LJKHUUDWHVRIKRVSLWDOLVDWLRQZHUHREVHUYHGLQSHRSOHZLWKPHQWDOLOOQHVVIRUHDFKRIWKHWKUHH PDLQW\SHVRIKHSDWLWLVZLWKWKRVHGLDJQRVHGZLWKDOFRKRORUGUXJXVHGLVRUGHUVDWKLJKHVWULVN +HSDWLWLV & LQIHFWLRQ LV SUREDEO\ WKH VLQJOH PRVW VLJQLILFDQW LVVXH WR DGGUHVV LQ WHUPV RI LQIHFWLRXVGLVHDVHFRQWUROPHDVXUHVDPRQJSHRSOHZLWKPHQWDOLOOQHVV
6H[XDOO\WUDQVPLVVLEOHGLVHDVHV
)LJXUH67'UDWHUDWLRVSHRSOHZLWKPHQWDOLOOQHVVFRPSDUHGWRWKH:$SRSXODWLRQ Alcohol/drugs Schizophrenia Affective psychosis Other psychosis Neurotic disorder Personality disorder Adjustment reaction Depressive disorder Total All disorders 0
1
2
3
4
5
6
STDs rate ratio
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24
Infectious Diseases / Cancer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
&DQFHU
)RUWKHSXUSRVHVRIWKLVVWXG\SHRSOHZLWKPHQWDOLOOQHVVZLWKDFDQFHUGLDJQRVHGSULRUWRWKHLU ILUVWFRQWDFWZLWKPHQWDOKHDOWKVHUYLFHVZHUHH[FOXGHG2QO\GDWDIURPZDVLQFOXGHGLQ WKLVDQDO\VLVDVWKLVLVZKHQWKH:$FDQFHUUHJLVWU\VWDUWHG DQGGXULQJWKLVSHULRGSHRSOH ZLWK D PHQWDO LOOQHVV KDG D FDQFHU GLDJQRVHG 7KH PRVW FRPPRQ FDQFHUV LQ :$ DUH IHPDOH EUHDVWFDQFHUSURVWDWHFDQFHUDQGOXQJFDQFHU )LJXUH&DQFHULQFLGHQFHDQGGHDWKUDWHV 400 rate per 100,000 350
Mentally ill
300
WA population
250 200 150 100 50 0 Incidence rate
Death rate
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25
Cancer 7KHODFNRIHOHYDWHGQXPEHUVRIFDQFHUVLVXQH[SHFWHGJLYHQWKHKLJKOHYHORIVPRNLQJLQSHRSOH ZLWK PHQWDO LOOQHVV 3DUWLFXODUO\ KLJK DUH WKH UDWHV RI VPRNLQJ DPRQJ SHRSOH ZLWK SV\FKRWLF GLVRUGHUV RI ZKRP RI PDOHV DQG RI IHPDOHV DUH FXUUHQW VPRNHUV 7KH 1DWLRQDO 6XUYH\ RI 0HQWDO +HDOWK DQG :HOOEHLQJ VKRZHG WKDW RI :HVWHUQ $XVWUDOLDQV ZLWK D GLDJQRVDEOH PHQWDO KHDOWK FRQGLWLRQ ZHUH FXUUHQW VPRNHUV FRPSDUHG WR DPRQJ SHRSOH ZLWKRXWDPHQWDOGLVRUGHU 2YHUDOOWKHUHZHUHQRPRUHFDQFHUVLQSHRSOHZLWKPHQWDOLOOQHVVWKDQLQWKHJHQHUDOSRSXODWLRQ ZKHUHDVGHDWKVIURPFDQFHUZHUHKLJKHULQPDOHVDQGKLJKHULQIHPDOHV7DNLQJLQWR DFFRXQWWKHIDFWWKDWVRPHFDQFHUVDUHPRUHGHDGO\WKDQRWKHUVWKHFDVHIDWDOLW\UDWHFDQEHXVHG WRFRPSDUHWKHVXUYLYDORISHRSOHZLWKPHQWDOLOOQHVVZLWKFDQFHUFRPSDUHGWRSHRSOHZLWKWKH VDPHFDQFHUDWWKHVDPHDJHDQGVH[ZKRZHUHQRWXVHUVRIPHQWDOKHDOWKVHUYLFHV)LJXUH VKRZV FDQFHU FDVH IDWDOLW\ UDWLRV E\ SULQFLSDO SV\FKLDWULF GLDJQRVLV 7KHVH ILJXUHV VKRZHG WKDW PDOHVZHUHPRUHOLNHO\WRGLHIROORZLQJFDQFHUGLDJQRVLVWKDQWKHJHQHUDOSRSXODWLRQDQG IHPDOHVZHUHPRUHOLNHO\WRGLHIURPWKHLUFDQFHUGLDJQRVLV3HRSOHZLWKDOFRKRODQGGUXJ GLVRUGHUVKDGWKHKLJKHVWUDWHRIGHDWKRIDOOWKHPDLQSV\FKLDWULFGLDJQRVHVH[DPLQHG )LJXUH&DQFHUFDVHIDWDOLW\UDWHUDWLRVE\SULQFLSDOGLDJQRVLV Alcohol/drug Schizophrenia Affective psychoses
Males Females
Other Psychoses Neurotic disorder Personality disorder Adjustment reaction Depressive disorder 0
0.5
1
1.5
2
2.5
Cancer case fatality rate ratios
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·WJHWFDQFHUDQ\PRUHWKDQDQ\RQHHOVHEXW WKH\DUHPRUHOLNHO\WRGLHRILWDQGVRRQHU
26
Nutritional Deficiencies and Deficiency Anaemias 1XWULWLRQDO'HILFLHQFLHVDQG'HILFLHQF\$QDHPLD
)LJXUH5DWHUDWLRVE\GHILFLHQF\RUDQDHPLD Total Nutritional deficiencies Protein-calorie Thiamine & niacin B-complex components Males Females Total Deficiency anaemias Iron deficieny Pernicious anaemia 0
1
2
3
4
5
6
7
rate ratio
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Nutritional Deficiencies and Deficiency Anaemias GUXJGLVRUGHUVDQGPDOHVZLWKRWKHUSV\FKRVHV$VZDVWKHFDVHZLWKQXWULWLRQDOGHILFLHQFLHVWKH ZRUVW DIIHFWHG ZHUH UHVLGHQWV RI SV\FKLDWULF KRVWHOV )LJXUH 5DWHV RI GHILFLHQF\ DQDHPLDV KDYH EHHQ LQFUHDVLQJ ERWK LQ WKH JHQHUDO SRSXODWLRQ DQG LQ SHRSOH ZLWK PHQWDO LOOQHVV 7KH GLIIHUHQFHLQUDWHVEHWZHHQWKHWZRJURXSVKDVUHPDLQHGURXJKO\FRQVWDQWRYHUWLPH )LJXUH'HILFLHQF\UDWHUDWLRVE\W\SHRIFDUH Nutritional deficiencies Involuntary Voluntary Day patient Hostel resident Outpatient Deficiency anaemias Involuntary Voluntary
Males
Day patient
Females
Hostel resident Outpatient 0
1
2
3
4
5
6
7
8
Rate ratio
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28
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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eath rate
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Mentally ill WA population
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Circulatory System Diseases )LJXUH+HDUWGLVHDVHGHDWKUDWHE\\HDU 350 Death rate 300 250 200 150 100 50 0 1980
1982
1984
1986
1988
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1990
1992
1994
1996
1998
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Total IHD
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Circulatory System Diseases )LJXUH+HDUWGLVHDVHKRVSLWDOLVDWLRQDQGGHDWKUDWHVE\SULQFLSDOGLDJQRVLV Dementia Alcohol/Drugs
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Schizophrenia
Death
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0.5
1
1.5
2
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3
rate ratio
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Circulatory System Diseases )LJXUH+HDUWSURFHGXUHUDWHUDWLRVE\SULQFLSDOGLDJQRVLV Dementia Alcohol/Drug Males
Schizophrenia
Females
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0.2
0.4
0.6
0.8
1
1.2
1.4
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0.5
1
1.5
2
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3.5
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41
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42
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43
Conclusions &RQFOXVLRQV
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Conclusions ♦ ♦ ♦
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45
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46
Conclusions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
47
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