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.

To determine the association between SMI and stroke outcomes and receipt of process-of-care quality indicators (such as timely admission to stroke unit).

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).

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.

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.

严重精神疾病 (SMI) 与中风风险增加有关，但关于 SMI 如何与中风预后和接受急症护理的关系知之甚少。

确定 SMI 与中风结局和接受护理过程质量指标（如及时入住中风病房）之间的关联。

我们使用常规收集的关联数据集进行了一项队列研究，包括 1991 年至 2014 年期间在苏格兰首次因卒中入院的成年人，以及 2010 年可用的护理过程质量指标数据。我们确定了预先存在的精神分裂症、双相情感障碍来自医院记录的疾病和重度抑郁症。我们使用逻辑回归来评估 30 天、1 年和 5 年死亡率和接受预先存在的 SMI 的护理过程质量指标，并根据社会人口学和临床因素进行调整。我们使用 Cox 回归来评估进一步的中风和血管事件（中风和心肌梗死）。

在 228 699 例卒中患者中，分别有 1186 例（0.5%）、859 例（0.4%）、7308 例（3.2%）患有精神分裂症、双相情感障碍和重度抑郁症。总体而言，中位随访时间为 2.6 年。与没有精神疾病记录的成年人相比，精神分裂症（调整优势比 (aOR) = 1.33, 95% CI 1.16–1.52）、双相情感障碍（aOR = 1.37, 95% CI 1.18–1.60）的 30 天死亡率更高和重度抑郁症（aOR = 1.11, 95% CI 1.05–1.18）。每种疾病还与 1 年和 5 年死亡率以及进一步中风和血管事件的风险显着增加有关。在接受护理过程质量指标方面没有明显差异。

预先存在的 SMI 与更高的死亡风险和进一步的血管事件相关。需要采取紧急行动来更好地理解和解决这些差异的原因。