Cancer-related mortality in people with mental illness

Context: There is a 30% higher case fatality rate from cancer in psychiatric patients even though their incidence of cancer is no greater than in the general population. The reasons are unclear, but if increased cancer mortality were due to lifestyle only, cancer incidence should be similarly increased. Other hypotheses include delays in presentation, leading to more advanced staging at diagnosis, and difficulties in treatment access following diagnosis

Excess Cancer Mortality in Psychiatric Patients

Objectives: There are conflicting data oil cancer incidence and mortality in psychiatric patients, although most Studies suggest that while cancer mortality is higher, incidence is no different from that in the general population. Different methodologies and outcomes may account for some of the conflicting results. We investigated the association between mental illness and cancer incidence, first admission rates, and mortality in Nova Scotia using a standard methodology

Use of administrative data for the surveillance of mental disorders in 5 provinces

To evaluate the usefulness of administrative data for the surveillance of mental illness in Canada using databases in the following 5 provinces: British Columbia, Ontario, Quebec, Nova Scotia, and Alberta. We used a population-based record-linkage analysis with data from physician billings, hospital discharge abstracts, and community-based clinics. The following diagnostic codes from the International Classification of Diseases, Ninth Edition, were used to define cases: 290 to 319, inclusive. The prevalence of treated psychiatric disorder was similar in Nova Scotia, British Columbia, Alberta, and Ontario at about 15%. The prevalence for Quebec was slightly lower at 12%. Findings from the provinces showed remarkable consistency across age and sex, despite variations in data coding. Women tended to show a higher prevalence overall of treated mental disorders than men. Prevalence increased steadily to middle age, declining in the 50s and 60s, and then increasing again after age 70 years. Provincial and territorial administrative data can provide a useful, reliable, and economical source of information for the surveillance of treated mental disorders. Such a surveillance system can provide longitudinal data at little cost to support health service provision and planning

Smoking and mental illness: results from population surveys in Australia and the United States

<p>Abstract</p> <p>Background</p> <p>Smoking has been associated with a range of mental disorders including schizophrenia, anxiety disorders and depression. People with mental illness have high rates of morbidity and mortality from smoking related illnesses such as cardiovascular disease, respiratory diseases and cancer. As many people who meet diagnostic criteria for mental disorders do not seek treatment for these conditions, we sought to investigate the relationship between mental illness and smoking in recent population-wide surveys.</p> <p>Methods</p> <p>Survey data from the US National Comorbidity Survey-Replication conducted in 2001–2003, the 2007 Australian Survey of Mental Health and Wellbeing, and the 2007 US National Health Interview Survey were used to investigate the relationship between current smoking, ICD-10 mental disorders and non-specific psychological distress. Population weighted estimates of smoking rates by disorder, and mental disorder rates by smoking status were calculated.</p> <p>Results</p> <p>In both the US and Australia, adults who met ICD-10 criteria for mental disorders in the 12 months prior to the survey smoked at almost twice the rate of adults without mental disorders. While approximately 20% of the adult population had 12-month mental disorders, among adult smokers approximately one-third had a 12-month mental disorder – 31.7% in the US (95% CI: 29.5%–33.8%) and 32.4% in Australia (95% CI: 29.5%–35.3%). Female smokers had higher rates of mental disorders than male smokers, and younger smokers had considerably higher rates than older smokers. The majority of mentally ill smokers were not in contact with mental health services, but their rate of smoking was not different from that of mentally ill smokers who had accessed services for their mental health problem. Smokers with high levels of psychological distress smoked a higher average number of cigarettes per day.</p> <p>Conclusion</p> <p>Mental illness is associated with both higher rates of smoking and higher levels of smoking among smokers. Further, a significant proportion of smokers have mental illness. Strategies that address smoking in mental illness, and mental illness among smokers would seem to be important directions for tobacco control. As the majority of smokers with mental illness are not in contact with mental health services for their condition, strategies to address mental illness should be included as part of population health-based mental health and tobacco control efforts.</p

Mental health: the Achilles heel of evidence-based policy

Although there is a growing interest in evidence-based medicine in clinical practice, translation of the same principles to health policy is more sporadic. This article examines the gap between reality and aspiration in the area of mental health. It specifically examines two initiatives in the wake of public concern about the link between violence and psychiatric disorder: specialist services for severe or dangerous severe personality disorders, and compulsory community treatment. Neither of these interventions has been shown to be clearly evidence based. In terms of numbers needed to treat, it would take 100 community treatment orders to prevent one readmission and 500 to prevent one arrest. This paper asks for more honesty about how, when, and if we use research evidence