Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study
Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with s...
Ausführliche Beschreibung
Autor*in: |
Jennie Lister [verfasserIn] Lu Han [verfasserIn] Sue Bellass [verfasserIn] Jo Taylor [verfasserIn] Sarah L Alderson [verfasserIn] Tim Doran [verfasserIn] Simon Gilbody [verfasserIn] Catherine Hewitt [verfasserIn] Richard IG Holt [verfasserIn] Rowena Jacobs [verfasserIn] Charlotte EW Kitchen [verfasserIn] Stephanie L Prady [verfasserIn] John Radford [verfasserIn] Jemimah R Ride [verfasserIn] David Shiers [verfasserIn] Han-I Wang [verfasserIn] Najma Siddiqi [verfasserIn] |
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E-Artikel |
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Sprache: |
Englisch |
Erschienen: |
2021 |
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Übergeordnetes Werk: |
In: Health Services and Delivery Research - National Institute for Health Research, 2017, 9(2021), 10 |
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Übergeordnetes Werk: |
volume:9 ; year:2021 ; number:10 |
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Link aufrufen |
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DOI / URN: |
10.3310/hsdr09100 |
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Katalog-ID: |
DOAJ063095173 |
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520 | |a Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design: Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting: The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants: The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources: The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results: People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations: Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions: People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work: These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration: National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding: This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information. | ||
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10.3310/hsdr09100 doi (DE-627)DOAJ063095173 (DE-599)DOAJfad600c04bee4aee89b2e8105e3c9ba5 DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Jennie Lister verfasserin aut Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design: Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting: The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants: The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources: The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results: People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations: Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions: People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work: These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration: National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding: This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information. severe mental illness diabetes schizophrenia bipolar disorder clinical practice research datalink mixed methods longitudinal analysis qualitative study interview study Public aspects of medicine Medicine (General) Lu Han verfasserin aut Sue Bellass verfasserin aut Jo Taylor verfasserin aut Sarah L Alderson verfasserin aut Tim Doran verfasserin aut Simon Gilbody verfasserin aut Catherine Hewitt verfasserin aut Richard IG Holt verfasserin aut Rowena Jacobs verfasserin aut Charlotte EW Kitchen verfasserin aut Stephanie L Prady verfasserin aut John Radford verfasserin aut Jemimah R Ride verfasserin aut David Shiers verfasserin aut Han-I Wang verfasserin aut Najma Siddiqi verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 9(2021), 10 (DE-627)1760647098 20504357 nnns volume:9 year:2021 number:10 https://doi.org/10.3310/hsdr09100 kostenfrei https://doaj.org/article/fad600c04bee4aee89b2e8105e3c9ba5 kostenfrei https://doi.org/10.3310/hsdr09100 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 9 2021 10 |
spelling |
10.3310/hsdr09100 doi (DE-627)DOAJ063095173 (DE-599)DOAJfad600c04bee4aee89b2e8105e3c9ba5 DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Jennie Lister verfasserin aut Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design: Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting: The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants: The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources: The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results: People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations: Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions: People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work: These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration: National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding: This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information. severe mental illness diabetes schizophrenia bipolar disorder clinical practice research datalink mixed methods longitudinal analysis qualitative study interview study Public aspects of medicine Medicine (General) Lu Han verfasserin aut Sue Bellass verfasserin aut Jo Taylor verfasserin aut Sarah L Alderson verfasserin aut Tim Doran verfasserin aut Simon Gilbody verfasserin aut Catherine Hewitt verfasserin aut Richard IG Holt verfasserin aut Rowena Jacobs verfasserin aut Charlotte EW Kitchen verfasserin aut Stephanie L Prady verfasserin aut John Radford verfasserin aut Jemimah R Ride verfasserin aut David Shiers verfasserin aut Han-I Wang verfasserin aut Najma Siddiqi verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 9(2021), 10 (DE-627)1760647098 20504357 nnns volume:9 year:2021 number:10 https://doi.org/10.3310/hsdr09100 kostenfrei https://doaj.org/article/fad600c04bee4aee89b2e8105e3c9ba5 kostenfrei https://doi.org/10.3310/hsdr09100 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 9 2021 10 |
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10.3310/hsdr09100 doi (DE-627)DOAJ063095173 (DE-599)DOAJfad600c04bee4aee89b2e8105e3c9ba5 DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Jennie Lister verfasserin aut Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design: Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting: The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants: The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources: The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results: People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations: Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions: People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work: These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration: National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding: This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information. severe mental illness diabetes schizophrenia bipolar disorder clinical practice research datalink mixed methods longitudinal analysis qualitative study interview study Public aspects of medicine Medicine (General) Lu Han verfasserin aut Sue Bellass verfasserin aut Jo Taylor verfasserin aut Sarah L Alderson verfasserin aut Tim Doran verfasserin aut Simon Gilbody verfasserin aut Catherine Hewitt verfasserin aut Richard IG Holt verfasserin aut Rowena Jacobs verfasserin aut Charlotte EW Kitchen verfasserin aut Stephanie L Prady verfasserin aut John Radford verfasserin aut Jemimah R Ride verfasserin aut David Shiers verfasserin aut Han-I Wang verfasserin aut Najma Siddiqi verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 9(2021), 10 (DE-627)1760647098 20504357 nnns volume:9 year:2021 number:10 https://doi.org/10.3310/hsdr09100 kostenfrei https://doaj.org/article/fad600c04bee4aee89b2e8105e3c9ba5 kostenfrei https://doi.org/10.3310/hsdr09100 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 9 2021 10 |
allfieldsGer |
10.3310/hsdr09100 doi (DE-627)DOAJ063095173 (DE-599)DOAJfad600c04bee4aee89b2e8105e3c9ba5 DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Jennie Lister verfasserin aut Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design: Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting: The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants: The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources: The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results: People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations: Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions: People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work: These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration: National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding: This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information. severe mental illness diabetes schizophrenia bipolar disorder clinical practice research datalink mixed methods longitudinal analysis qualitative study interview study Public aspects of medicine Medicine (General) Lu Han verfasserin aut Sue Bellass verfasserin aut Jo Taylor verfasserin aut Sarah L Alderson verfasserin aut Tim Doran verfasserin aut Simon Gilbody verfasserin aut Catherine Hewitt verfasserin aut Richard IG Holt verfasserin aut Rowena Jacobs verfasserin aut Charlotte EW Kitchen verfasserin aut Stephanie L Prady verfasserin aut John Radford verfasserin aut Jemimah R Ride verfasserin aut David Shiers verfasserin aut Han-I Wang verfasserin aut Najma Siddiqi verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 9(2021), 10 (DE-627)1760647098 20504357 nnns volume:9 year:2021 number:10 https://doi.org/10.3310/hsdr09100 kostenfrei https://doaj.org/article/fad600c04bee4aee89b2e8105e3c9ba5 kostenfrei https://doi.org/10.3310/hsdr09100 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 9 2021 10 |
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10.3310/hsdr09100 doi (DE-627)DOAJ063095173 (DE-599)DOAJfad600c04bee4aee89b2e8105e3c9ba5 DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Jennie Lister verfasserin aut Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design: Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting: The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants: The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources: The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results: People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations: Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions: People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work: These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration: National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding: This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information. severe mental illness diabetes schizophrenia bipolar disorder clinical practice research datalink mixed methods longitudinal analysis qualitative study interview study Public aspects of medicine Medicine (General) Lu Han verfasserin aut Sue Bellass verfasserin aut Jo Taylor verfasserin aut Sarah L Alderson verfasserin aut Tim Doran verfasserin aut Simon Gilbody verfasserin aut Catherine Hewitt verfasserin aut Richard IG Holt verfasserin aut Rowena Jacobs verfasserin aut Charlotte EW Kitchen verfasserin aut Stephanie L Prady verfasserin aut John Radford verfasserin aut Jemimah R Ride verfasserin aut David Shiers verfasserin aut Han-I Wang verfasserin aut Najma Siddiqi verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 9(2021), 10 (DE-627)1760647098 20504357 nnns volume:9 year:2021 number:10 https://doi.org/10.3310/hsdr09100 kostenfrei https://doaj.org/article/fad600c04bee4aee89b2e8105e3c9ba5 kostenfrei https://doi.org/10.3310/hsdr09100 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 9 2021 10 |
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RA1-1270 R5-920 Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study severe mental illness diabetes schizophrenia bipolar disorder clinical practice research datalink mixed methods longitudinal analysis qualitative study interview study |
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Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study |
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Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study |
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identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study |
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Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study |
abstract |
Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design: Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting: The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants: The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources: The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results: People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations: Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions: People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work: These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration: National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding: This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information. |
abstractGer |
Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design: Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting: The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants: The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources: The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results: People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations: Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions: People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work: These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration: National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding: This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information. |
abstract_unstemmed |
Background: People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap. Objectives: The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness. Design: Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews. Setting: The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber). Participants: The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff. Data sources: The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation. Results: People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’). Limitations: Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices. Conclusions: People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone. Future work: These findings can inform the development of targeted interventions aimed at addressing inequalities in this population. Study registration: National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921. Funding: This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information. |
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|
score |
7.399768 |