People with severe mental illness at 50 per cent higher risk of death following COVID-19 infection
Peer-Reviewed PublicationNew research from King’s College London has found that in the UK people with severe mental illness were at increased risk of death from all causes following COVID-19 infection compared to those without severe mental illness.
Published in the British Journal of Psychiatry, the study investigated the extent to which having severe mental illness, which includes schizophrenia and psychosis, increased the risk of death during the first two waves of the COVID-19 pandemic.
Researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) and ESRC Centre for Society and Mental Health analysed data from over 660,000 UK patients between February 2020 and April 2021.
Among the 7146 people with severe mental illness, there was a 50 per cent greater risk of death from all causes following COVID-19 infection compared with those without severe mental illness.
Black Caribbean/Black African people were at a 22 per cent higher risk of death following COVID-19 infection than White people, and this was similar for people with and without severe mental illness. However, in around 30 per cent of patient data, ethnicity was not recorded.
The study revealed regional differences: on average, risk of death following COVID-19 infection was higher among Northern UK regions compared to Southern regions. Those in Northern Ireland, the East Midlands and the North-East were at between 24 – 28 per cent increased risk of death compared to those in London.
Dr Alex Dregan, senior author and Senior Lecturer in psychiatric epidemiology at King’s IoPPN said: “We are the first group to use the Clinical Practice Research Datalink to understand the impact of COVID-19 on premature morbidity among people with severe mental illness, making this one of the largest studies of its kind Previous research has shown that these health inequalities exist but our study really demonstrates how the pandemic has exacerbated them. We now need to try to understand why this is happening and see if there is a pattern in how these people do or do not seek and access services.”
The research also found that those with more than one long-term health condition (multimorbidity) were at greater risk of death: for each additional long-term health condition, the risk of death increased by six per cent for people with severe mental illness and 16 per cent for people without severe mental illness following COVID-19 infection.
The study is part of a Health Foundation funded project called COVID-19 Ethnic Inequalities in Mental health and Multimorbidities (COVE-IMM) that is using both quantitative and qualitative methods.
Principal investigator on the COVE-IMM project and co-lead of the platform for cohorts and quantitative methods at the ESRC Centre for Society and Mental Health, and lead author Dr Jayati Das-Munshi said:
“These are stark findings and highlight the health inequalities that exist for people living with severe mental illness, people from racialised groups and people from different regions of the country. We still need to learn more about the experiences of these groups which we are doing through in-depth interview research and we also need to understand the gap in how our services provide for these vulnerable people. The pandemic shone a light on these inequalities, and we must learn from this to develop new policies and improve service provision.”
The data was from the Clinical Practice Research Database – one of the world’s largest clinical research databases containing over 60 million anonymised electronic primary care records. Researchers were part of the ESRC Centre for Society and Mental Health, the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South London and the NIHR Maudsley Biomedical Research Centre.
JOURNAL
The British Journal of Psychiatry
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Severe mental illness, race/ethnicity, multimorbidity and mortality following COVID-19 infection: nationally representative cohort study’
ARTICLE PUBLICATION DATE
25-Oct-2023
Undiagnosed: More than 7 million Americans unaware they have mild cognitive impairment
Two new USC Dornsife studies suggest that of the 8 million Americans who have MCI, more than 90% don’t know it — an especially worrisome finding since early diagnosis is key to delaying onset of dementia and Alzheimer’s disease.
By Katharine Gammon
For many people, forgetting your keys or struggling to plan tasks can seem like a normal part of the aging process. But those lapses can actually be symptoms of something more serious: mild cognitive impairment, or MCI, which could be an early sign of Alzheimer’s disease.
Unfortunately, most people who have MCI don’t know it, so they’re unable to take advantage of preventive measures or new treatments, such as a recently approved drug for Alzheimer’s disease, that could slow its progression. Those are the findings of two new studies published in parallel by researchers at the USC Dornsife College of Letters, Arts and Sciences.
In one study, published in Alzheimer’s Research & Therapy, the researchers analyzed data from 40 million Medicare beneficiaries age 65 and older and compared the proportion diagnosed with the rate expected in this age group. They found that fewer than 8% of expected cases were actually diagnosed. In other words, of the 8 million individuals predicted to have MCI based on their demographic profile, which includes age and gender, about 7.4 million were undiagnosed.
“This study is meant to raise awareness of the problem,” says Soeren Mattke, director of the Brain Health Observatory at USC Dornsife’s Center for Economic and Social Research, who led the investigations. “We want to say, ‘Pay attention to early changes in cognition, and tell your doctor about them. Ask for an evaluation.’ We want to reach physicians to say, ‘There’s a measurable difference between aging and pathologic cognitive decline, and detecting the latter early might identify those patients who would benefit from recently approved Alzheimer’s treatments.
The prevalence of MCI is influenced by socioeconomic and clinical factors. People with cardiovascular disease, diabetes, hypertension and other health issues are at higher risk of cognitive decline including dementia. These health issues are more prevalent among members of historically disadvantaged groups, including those with less education and Black and Hispanic Americans.
The researchers found that detection of MCI was even poorer in those groups. Mattke says that’s concerning because the overall disease burden in those populations is higher. “So, they’re hit twice: They have higher risk and yet lower detection rates.”
The second study, published in Journal of Prevention of Alzheimer's Disease looked at 200,000 individual primary care clinicians and found that 99% of them underdiagnosed MCI. “There’s really just a tiny fraction of physicians in a position to diagnose MCI who would find these cases early enough for maximum therapeutic potential,” Mattke explains.
MCI by definition doesn’t cause disability, whereas dementia is itself a disabling condition reflecting more serious cognitive impairment. In MCI, challenges to everyday functioning tend to be more sporadic, says Soo Borson, clinical professor of family medicine at Keck School of Medicine of USC and co-lead of the BOLD Center on Early Detection of Dementia, who was not involved in the studies.
MCI can come in various forms: forgetfulness is the most familiar form, Borson says. Another is an executive form, which mainly affects efficiency in getting things done and difficulty with tasks that used to be easier, such as balancing a checkbook or paying bills online. There is even a behavioral form — in which mild changes in personality may predominate. These various forms often coexist.
It is important to understand that MCI refers to a level of cognitive functioning and not a specific disease state. Recent advances in the treatment of the most common cause of MCI — Alzheimer’s disease — lend new urgency to improving detection of MCI.
There are several reasons MCI might be so widely underdiagnosed in the United States. An individual may not be aware of or bring up their concern; a physician might not notice subtle signs of difficulty; or a clinician might notice but not correctly enter the diagnostic code in a patient’s medical record.
Another important reason: Time during a clinical visit may not be set aside to discuss or assess brain health unless the visit was planned expressly to include it. Detection of cognitive impairment is not difficult, but it does not occur without planning.
Mattke notes that risk-based MCI detection — focusing attention on people at greatest risk — would help identify more cases because time and resources could be focused on those high-risk individuals. Digital tests that could be administered before a medical visit could also help more people learn about their cognitive risk and current functioning.
Early treatment is vital, says Mattke, because the brain is limited in its ability to recover — brain cells, once lost, do not grow back, and any damage can no longer be repaired.
“For MCI caused by Alzheimer’s disease, the earlier you treat the better your outcomes,” he says. “This means even though the disease may be slowly progressing, every day counts.”
JOURNAL
The Journal of Prevention of Alzheimer s Disease
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Detection Rates of Mild Cognitive Impairment in Primary Care for the United States Medicare Population
ARTICLE PUBLICATION DATE
25-Oct-2023
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