Association of severe mental illness with stroke outcomes and process-of-care quality indicators: nationwide cohort study. (July 2022)

• Record Type: Journal Article
• Authors: Fleetwood, Kelly; Wild, Sarah H.; Smith, Daniel J.; Mercer, Stewart W.; Licence, Kirsty; Sudlow, Cathie L. M.; Jackson, Caroline A.
• Is Part Of: British journal of psychiatry. Volume 221:Number 1(2022)
• Page Start: 394
• Page End: 401
• Publication Date: 2022-07
• Subjects: Schizophrenia -- bipolar affective disorders -- depressive disorders -- stroke -- epidemiology; Psychiatry -- Periodicals; Psychology, Pathological -- Periodicals; 616.89005
• DOI: 10.1192/bjp.2021.120
• Languages: English
• ISSNs: 0007-1250

Abstract

Abstract : Background: Severe mental illness (SMI) is associated with increased stroke risk, but little is known about how SMI relates to stroke prognosis and receipt of acute care. Aims: To determine the association between SMI and stroke outcomes and receipt of process-of-care quality indicators (such as timely admission to stroke unit). Method: We conducted a cohort study using routinely collected linked data-sets, including adults with a first hospital admission for stroke in Scotland during 1991–2014, with process-of-care quality indicator data available from 2010. We identified pre-existing schizophrenia, bipolar disorder and major depression from hospital records. We used logistic regression to evaluate 30-day, 1-year and 5-year mortality and receipt of process-of-care quality indicators by pre-existing SMI, adjusting for sociodemographic and clinical factors. We used Cox regression to evaluate further stroke and vascular events (stroke and myocardial infarction). Results: Among 228 699 patients who had had a stroke, 1186 (0.5%), 859 (0.4%), 7308 (3.2%) had schizophrenia, bipolar disorder and major depression, respectively. Overall, median follow-up was 2.6 years. Compared with adults without a record of mental illness, 30-day mortality was higher for schizophrenia (adjusted odds ratio (aOR) = 1.33, 95% CI 1.16–1.52), bipolar disorder (aOR = 1.37, 95% CI 1.18–1.60) and major depression (aOR = 1.11, 95% CI 1.05–1.18). Each disorder was also associated with marked increased risk of 1-year and 5-year mortality and further stroke and vascular events. There were no clear differences in receipt of process-of-care quality indicators. Conclusions: Pre-existing SMI was associated with higher risks of mortality and further vascular events. Urgent action is needed to better understand and address the reasons for these disparities.