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Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults
JAMA Psychiatry ( IF 25.8 ) Pub Date : 2018-03-01 , DOI: 10.1001/jamapsychiatry.2017.4437
Gregory E. Simon 1 , Christine Stewart 1 , Bobbi Jo Yarborough 2 , Frances Lynch 2 , Karen J. Coleman 3 , Arne Beck 4 , Belinda H. Operskalski 1 , Robert B. Penfold 1 , Enid M. Hunkeler 5
Affiliation  

Importance Individuals with psychotic disorders have increased mortality, and recent research suggests a marked increase shortly after diagnosis.

Objective To use population-based data to examine overall and cause-specific mortality after first diagnosis of a psychotic disorder.

Design, Setting, and Participants This cohort study used records from 5 integrated health systems that serve more than 8 million members in 5 states. Members aged 16 through 30 years who received a first lifetime diagnosis of a psychotic disorder from September 30, 2009, through September 30, 2015, and 2 comparison groups matched for age, sex, health system, and year of diagnosis were selected from all members making an outpatient visit (general outpatient group) and from all receiving a first diagnosis of unipolar depression (unipolar depression group).

Exposures First recorded diagnosis of schizophrenia, schizoaffective disorder, mood disorder with psychotic symptoms, or other psychotic disorder in any outpatient, emergency department, or inpatient setting.

Main Outcomes and Measures Death within 3 years after the index diagnosis or visit date, ascertained from health system electronic health records, insurance claims, and state mortality records.

Results A total of 11 713 members with first diagnosis of a psychotic disorder (6976 [59.6%] men and 4737 [40.4%] women; 2368 [20.2%] aged 16-17 and 9345 [79.8%] aged 18-30 years) were matched to 35 576 outpatient service users and 23 415 members with a first diagnosis of unipolar depression. During the year after the first diagnosis, all-cause mortality was 54.6 (95% CI, 41.3-68.0) per 10 000 in the psychotic disorder group compared with 20.5 (95% CI, 14.7-26.3) per 10 000 in the unipolar depression group and 6.7 (95% CI, 4.0-9.4) per 10 000 in the general outpatient group. After adjustment for race, ethnicity, and preexisting chronic medical conditions, the relative hazard of death in the psychotic disorder group compared with the general outpatient group was 34.93 (95% CI, 8.19-149.10) for self-inflicted injury or poisoning and 4.67 (95% CI, 2.01-10.86) for other type of injury or poisoning. Risk of death due to heart disease or diabetes did not differ significantly between the psychotic disorder and the general outpatient groups (hazard ratio, 0.78; 95% CI, 0.15-3.96). Between the first and third years after diagnosis, all-cause mortality in the psychotic disorder group decreased from 54.6 to 27.1 per 10 000 persons and injury and poisoning mortality decreased from 30.6 to 15.1 per 10 000 persons. Both rates, however, remained 3 times as high as in the general outpatient group (9.0 per 10 000 for all causes; 4.8 per 10 000 for injury or poisoning).

Conclusions and Relevance Increases in early mortality underscore the importance of systematic intervention for young persons experiencing the first onset of psychosis. Clinicians should attend to the elevated suicide risk after the first diagnosis a psychotic disorder.



中文翻译:

首次对青少年和年轻人进行精神病性疾病诊断后的死亡率

重要性 精神病患者的死亡率增加,最近的研究表明,诊断后不久会明显增加。

目的 使用基于人群的数据检查首次诊断为精神病的患者的总体死亡率和特定原因死亡率。

设计,设置和参与者 这项队列研究使用了来自5个综合卫生系统的记录,这些系统为5个州的800万会员提供服务。从2009年9月30日至2015年9月30日首次诊断为精神病的16至30岁的成员,并从所有成员中选择了两个年龄,性别,健康系统和诊断年份相匹配的比较组进行门诊就诊(普通门诊组),并从所有患者中首次诊断出单相抑郁症(单相抑郁症组)。

暴露 首次在任何门诊,急诊科或住院场所诊断为精神分裂症,精神分裂症,具有精神病症状的情绪障碍或其他精神病。

主要结果和衡量 指标从诊断系统的电子病历,保险索赔和州死亡率记录确定的指数诊断或访问日期后的三年内死亡。

结果 共有11 713名首次被诊断出患有精神病的成员(男性6976 [59.6%]和女性4737 [40.4%]; 16-17岁的2368 [20.2%]和18-30岁的9345 [79.8%])是与35 576名门诊服务使用者和23 415名成员首次诊断为单相抑郁症的患者匹配。在首次诊断后的一年中,精神病组的全因死亡率为54.6(95%CI,41.3-68.0)/每万,而单极抑郁症则为20.5(95%CI,14.7-26.3)/每万。普通门诊组每10000例中有6.7例(95%CI,4.0-9.4)。调整种族,种族和先前存在的慢性疾病后,精神疾病组与普通门诊组相比,自伤或中毒的相对死亡风险为34.93(95%CI,8.19-149.10)和4.67( 95%CI,2.01-10。86)用于其他类型的伤害或中毒。精神病患者和普通门诊患者之间因心脏病或糖尿病导致的死亡风险没有显着差异(危险比,0.78; 95%CI,0.15-3.96)。在诊断后的第一年和第三年之间,精神病组的全因死亡率从每万万人54.6降至27.1,伤害和中毒死亡率从每万人30.6降至15.1。但是,这两种比率仍是普通门诊组的3倍(所有原因中每10000人中有9.0人;受伤或中毒时每10000中中有4.8人)。在诊断后的第一年和第三年之间,精神病组的全因死亡率从每万万人54.6降至27.1,伤害和中毒死亡率从每万人30.6降至15.1。但是,这两种比率仍是普通门诊组的3倍(所有原因中每10000人中有9.0人;受伤或中毒时每10000中中有4.8人)。在诊断后的第一年和第三年之间,精神病组的全因死亡率从每万万人54.6降至27.1,伤害和中毒死亡率从每万人30.6降至15.1。但是,这两种比率仍是普通门诊组的3倍(所有原因中每10000人中有9.0人;受伤或中毒时每10000中中有4.8人)。

结论和相关性 早期死亡率的增加突显了系统干预对于首次出现精神病的年轻人的重要性。在首次诊断出精神病后,临床医生应考虑增加自杀风险。

更新日期:2018-03-08
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