The Impact of the Global Pandemic on Veterans with Serious Mental Illness (SMI): Healthcare Utilization and Mortality

Background: Individuals with serious mental illness (SMI) experience barriers to accessing and engaging with healthcare, which may have been exacerbated during the emergence of the global pandemic and the rapid shift to telemedicine platforms, substantially decreasing healthcare utilization for non-COVID-19 disorders. Important repercussions on morbidity and mortality may be seen in the months and years to come, which may disproportionately affect high-risk populations, such as patients with SMI, with reduced access to technology platforms. In this study, we explored the impact of the pandemic on healthcare utilization and all-cause mortality rate in SMI compared to non-SMI individuals for the months of March–September 2020 and the same two quarters in 2019. Methods: Data were obtained from the VA Corporate Data Warehouse (CDW), a data repository from clinical and administrative VA systems. The sample included veterans with ≥1 outpatient clinical encounter nationally between 1 January 2019 and 31 December 2020. Results: The cohort for this study included 1,018,047 veterans receiving care through the Veterans Health Administration between 2019 and 2020. Of those, 339,349 had a diagnosis of SMI. Patients with SMI had a significantly larger pre–post-pandemic decrease in outpatient (49.7%, p p p < 0.001) visits compared to non-SMI patients. Overall, 3752 (1.59%) veterans without SMI and 4562 (1.93%) veterans with SMI died during our observation period. Veterans without SMI who died during the observation period were more likely to have had a positive COVID-19 test compared to veterans with SMI. Unadjusted analyses showed that veterans with SMI were approximately 2.5 times more likely to die than veterans without SMI during the first 6 months of the pandemic, compared to the same two quarters of the previous year. However, after adjustment by pertinent covariates, the predictors associated with an increased risk of death from SMI were older age, being male, a higher CAN score, more inpatient stays in the pre period compared to post, and a positive COVID-19 test. Discussion: Consistent with our initial hypothesis, all the indices of healthcare utilization, namely the number of outpatient, inpatient, and ED visits, significantly decreased between pre- and post-pandemic and did more so for veterans with SMI, despite having more chronic medical illnesses and being prescribed more medications than veterans without SMI. On the other hand, while mortality was greater post-pandemic, factors such as age, morbidity, and having a positive COVID-19 test predicted mortality above and beyond having an SMI diagnosis

Season of Birth Is Associated With Adult Body Mass Index in Patients With Bipolar Disorder

Cardiovascular risk factors, such as abdominal obesity and obesity in general, are very prevalent among patients with bipolar disorder (BD). Although long-term use of psychotropic medications is an important determinant of these risk factors, other evidence suggests that early development may interact with the mood disorder diathesis to exponentially increase the risk of obesity. The goal of our study was to test whether season of birth is associated with adult body mass index (BMI) and abdominal obesity in individuals with bipolar disorder. We compared season of birth effects on BMI in 375 adult patients with bipolar disorder and 196 adult patients with unipolar major depression. We found a significant season of birth effect on BMI in patients with bipolar disorder, but not unipolar. In patients with bipolar disorder, season of birth was also associated with waist circumference, with a stronger effect in males. Season of birth affects adult BMI and waist circumference in patients with bipolar disorder, but not in patients with unipolar depression. Our results suggest that early environmental factors, yet to be identified, interact with specific neurobiological features of bipolar disorder to determine stable traits and disease risk factors in adult life. © Informa Healthcare USA, Inc

Sleep Disorders In Veterans With Serious Mental Illnesses: Prevalence In VA Health Record Data

Study Objectives:: This study aimed to estimate the 12-month prevalence of diagnosed sleep disorders among veterans with and without serious mental illnesses (SMI) in VA health record data in 2019. We also examined diagnosed sleep disorders across a 9-year period and explored associations with demographic and health factors. Methods:: This study used health record data from VISN 4 of the Veterans Health Administration (VHA) from 2011-2019. SMI diagnoses included schizophrenia and bipolar spectrum diagnoses as well as major depression with psychosis. Sleep diagnoses included insomnias, hypersomnias, sleep-related breathing disorders, circadian rhythm sleep-wake disorders, and sleep-related movement disorders. Demographic and health-related factors were also collected from the record. Results:: In 2019, 21.8% of veterans with SMI were diagnosed with a sleep disorder. This is a significantly higher proportion than for veterans without SMI, 15.1% of whom were diagnosed with a sleep disorder. Sleep disorder rates were highest in veterans with a chart diagnosis of major depression with psychosis. From 2011 to 2019, the overall prevalence of sleep disorders in veterans with SMI more than doubled (10.2% to 21.8%), suggesting improvements in the detection and diagnosis of sleep concerns for this group. Conclusions:: Our findings suggest that identification and diagnosis of sleep disorders for veterans with SMI has improved over the past decade, though diagnoses still likely underrepresent actual prevalence of clinically relevant sleep concerns. Sleep concerns may be at particularly high risk of going untreated in veterans with schizophrenia-spectrum disorders

Medical Burden in Late-Life Bipolar and Major Depressive Disorders

11sireservedBackground: Elderly patients with bipolar disorder have been found to have higher mortality than those with major depressive disorder. The authors compare medical burden in elderly patients with bipolar disorder with that in those with major depressive disorder. Methods: Fifty-four patients with bipolar I or II disorder who were 60 years of age and older were equated l-to-2 to 108 patients with nonpsychotic, major depressive disorder according to age, sex, race, and lifetime duration of mood disorder illness. Variables examined included the following: Cumulative Illness Rating Scale for Geriatrics (CIRS-G) total scores, body mass index (BMI), and CIRS-G subscale scores. Results: Compared with patients with major depressive disorder, patients with bipolar disorder had similar levels of general medical comorbidity on the CIRS-G total score and number of systems affected but higher BMI. After controlling for multiple comparisons, the endocrine/metabolic and respiratory subscale scores on the CIRS-G were higher for patients with bipolar disorder. Conclusion: Although overall medical burden appears comparable in elderly patients with bipolar and those with major depressive disorder, patients with bipolar disorder have higher BMI and greater burden of endocrine/metabolic and respiratory disease. © 2008 American Association for Geriatric Psychiatry.mixedGILDENGERS, A.F.; WHYTE, E.M.; DRAYER, R.A.; SORECA, I.; FAGIOLINI, A.; KILBOURNE, A.M.; HOUCK, P.R.; REYNOLDS, C.F.; FRANK, E.; KUPFER, D.J.; MULSANT, B.H.Gildengers, A. F.; Whyte, E. M.; Drayer, R. A.; Soreca, I.; Fagiolini, A.; Kilbourne, A. M.; Houck, P. R.; Reynolds, C. F.; Frank, E.; Kupfer, D. J.; Mulsant, B. H

Season of Birth Is Associated With Adult Body Mass Index in Patients With Bipolar Disorder

Cardiovascular risk factors, such as abdominal obesity and obesity in general, are very prevalent among patients with bipolar disorder (BD). Although long-term use of psychotropic medications is an important determinant of these risk factors, other evidence suggests that early development may interact with the mood disorder diathesis to exponentially increase the risk of obesity. The goal of our study was to test whether season of birth is associated with adult body mass index (BMI) and abdominal obesity in individuals with bipolar disorder. We compared season of birth effects on BMI in 375 adult patients with bipolar disorder and 196 adult patients with unipolar major depression. We found a significant season of birth effect on BMI in patients with bipolar disorder, but not unipolar. In patients with bipolar disorder, season of birth was also associated with waist circumference, with a stronger effect in males. Season of birth affects adult BMI and waist circumference in patients with bipolar disorder, but not in patients with unipolar depression. Our results suggest that early environmental factors, yet to be identified, interact with specific neurobiological features of bipolar disorder to determine stable traits and disease risk factors in adult life. © Informa Healthcare USA, Inc

Il capolavoro sconosciuto

Dai modelli ad una nuova architettura. Le intenzioni contenute in vecchi plastici consunti dal tempo non muoiono con la loro simulazione didattica. E' il prodotto di un architettura collettiva sul tema del "guardare attraverso" ricomponendo, rigenerando, reimpostando, tagliando, incollando e dipingendo l'opera